机器人辅助椎弓根螺钉置入治疗胸腰椎骨折的临床疗效Meta分析  

Meta-analysis of clinical efficacy of robot-assisted pedicle screw placement for the treatment of thoracolumbar vertebral fractures

作　　者：王丽莉 吕兰婷 刘新颖 陈斌斌 Wang Lili;LYU Lanting;Liu Xinying;Chen Binbin(Health Policy&Technology Assessment Center,Peking University,Beijing 100191,China;School of Public Administration and Policy,Renmin University of China,Beijing 100872,China;School of Business Administration,Shenyang Pharmaceutical University,Shenyang 110016,China;Beijing Medical and Health Economic Research Association,Beijing 100069,China)

机构地区：[1]北京大学医学部卫生政策与技术评估中心,北京100191 [2]中国人民大学公共管理学院,北京100872 [3]沈阳药科大学工商管理学院,沈阳110016 [4]北京医药卫生经济研究会,北京100069

出　　处：《中国医学装备》2024年第2期149-156,共8页China Medical Equipment

摘　　要：目的:分析比较机器人辅助手术与传统导航辅助手术在经皮微创椎弓根螺钉置入治疗胸腰椎骨折的临床效果差异,为临床治疗决策提供参考。方法:检索中国知网(CNKI)、维普、万方数据库及英文数据库的PubMed和Web of science,分别以中文“椎弓根螺钉”“椎弓根钉”“机器人”为关键词进行主题检索,以英文“robot”“pedicle screws”进行系统检索,检索时间均自数据库建库至2022年12月,收集机器人辅助手术和传统导航辅助手术经皮微创椎弓根螺钉置入治疗胸腰锥骨折的相关临床研究,采用Cochrane量表和纽卡斯尔-渥太华量表(NOS)对文献进行质量评价并进行Meta分析,比较机器人辅助手术与传统导航辅助手术的临床效果差异。结果:将符合入选标准的15篇文献纳入研究。与传统导航辅助手术的经皮微创椎弓根螺钉置入相比,机器人辅助手术的手术时间更短[加权均数差(WMD)=-11.45,95%CI(-18.94~-3.95),P<0.05],术中出血量更少[WMD=-19.11,95%CI(-27.51~-10.70),P<0.001],置钉精度更高[A级钉数量:相对危险度(RR)=1.20,95%CI(1.16~1.25),P<0.001;A+B级钉数量:RR=1.09,95%CI(1.07~1.11),P<0.001],并发症更少[RR=0.35,95%CI(0.13~0.93),P<0.05],而住院时间差异无统计学意义(P>0.05)。结论:在经皮微创椎弓根螺钉置入治疗胸腰椎骨折中,机器人辅助手术与传统导航辅助手术相比,在手术时间、术中出血量、置钉精度以及并发症方面均具有优势。Objective:To analyze and compare the clinical efficacy of robot-assisted and conventional navigationassisted percutaneous minimally invasive pedicle screw placement in the treatment of thoracolumbar fractures and to provide reference for clinical treatment decisions.Methods:A literature search was performed in China National Knowledge Infrastructure(CNKI),VIP,Wanfang and English databases PubMed and Web of science by using the keywords"vertebral pedicle screws,"and"robot"in Chinese and"robot"and"pedicle screws"in English.The search time in both Chinese and English was from the establishment of the database to December 2022.The relevant clinical studies on robot-assisted and traditional navigation-assisted percutaneous minimally invasive pedicle screw placement for the treatment of thoracolumbar cone fractures were collected.Cochrane Scale and Newcastle-Ottawa Scale(NOS)were used to evaluate the quality of literatures and meta-analysis was carried out.The clinical effects of robot-assisted and traditional navigation-assisted surgery was compared.Results:A total of 15 articles were included in the study.Compared with traditional navigation-assisted percutaneous minimally invasive pedicle screw placement,robotic-assisted surgery resulted in shorter operative time[WMD=-11.45,95%CI(-18.94~-3.95),P<0.05],less intraoperative bleeding[WMD=-19.11,95%CI(-27.51~-10.70),P<0.001],higher screw placement accuracy[number of grade A nails:RR=1.20,95%CI(1.16~1.25),P<0.001;number of grade A+B nails:RR=1.09,95%CI(1.07~1.11),P<0.001],and fewer complications[RR=0.35,95%CI(0.13~0.93),P<0.05].The difference in hospitalization time was not statistically significant(P>0.05).Conclusion:In percutaneous minimally invasive pedicle screw placement for the treatment of thoracolumbar fractures,robot-assisted surgery has advantages over navigation-assisted surgery in terms of operative time,intraoperative bleeding,placement accuracy and complications.

关 键 词：手术机器人 椎弓根螺钉置入 胸腰椎骨折 META分析 

分 类 号：R683.1[医药卫生—骨科学]