机器人辅助手术与三维“C”型臂X线机在无神经损伤胸腰椎骨折患者椎弓根螺钉内固定术中的应用比较  

Comparison of application of robot-assisted surgery and three-dimensional C-arm X-ray machine during pedicle screw internal fixation for patients with thoracolumbar fractures without nerve injury

作　　者：董红 周龙 胡艳 胡娜娜 唐霞 DONG Hong;ZHOU Long;HU Yan;HU Nana;TANG Xia(Department of Orthopaedics,Chengdu Shangjin Nanfu Hospital,Chengdu 611743,China;Department of Orthopaedic Injury,Sichuan Province Orthopedic Hospital,Chengdu 610041,China;Department of Nosocomial Infection Management,Chengdu Shangjin Nanfu Hospital,Chengdu 611743,China)

机构地区：[1]成都上锦南府医院骨科,四川成都611743 [2]四川省骨科医院骨伤科,四川成都610041 [3]成都上锦南府医院医院感染管理科,四川成都611743

出　　处：《中国医学物理学杂志》2024年第4期449-454,共6页Chinese Journal of Medical Physics

基　　金：四川省科技计划项目(2022YFS0161)。

摘　　要：目的:对比机器人辅助手术与三维“C”型臂X线机在无神经损伤胸腰椎骨折患者椎弓根螺钉内固定术中的应用效果。方法:回顾性分析85例无神经损伤胸腰椎骨折患者的临床资料,患者均行经皮椎弓根内固定手术治疗。根据手术方式不同,分为观察组(机器人辅助置钉)和对照组(三维“C”型臂X线透视下置钉)。记录两组手术时间、术中失血量、术中透视次数及术后住院时间,比较两组置钉和复位情况;随访1个月,评价患者术后疼痛[疼痛视觉模拟评分(VAS)]及功能恢复情况[Oswestry功能障碍指数(ODI)]。结果:观察组手术时间较对照组缩短(P<0.05),术中透视次数较对照组减少(P<0.05),但两组术中失血量、术后住院时间比较差异无统计学意义(P>0.05)。观察组置钉准确率94.57%,显著高于对照组的83.59%(P<0.05)。术后1周,两组伤椎前缘高度比均较术前升高(P<0.05),伤椎Cobb角及局部后凸角值均较术前降低(P<0.05),但两组同时间点伤椎前缘高度比、Cobb角及局部后凸角比较差异均无统计学意义(P>0.05)。术后1月,两组患者VAS评分、ODI均较术前降低(P<0.05),但两组同时间点VAS评分、ODI比较差异均无统计学意义(P>0.05)。结论:机器人辅助置钉和三维“C”型臂X线下置钉用于无神经损伤胸腰椎骨折患者,均能获得较好的伤椎复位效果,促进患者早期功能恢复,但机器人辅助置钉能缩短手术时间、减少术中透视次数、提高置钉准确率,更具临床应用优势。Objective To compare the application effect of robot-assisted surgery and three-dimensional C-arm X-ray machine on patients with thoracolumbar fractures without nerve injury during pedicle screw internal fixation.Methods A retrospective analysis was conducted on 85 patients with thoracolumbar fractures without nerve injury.All patients were treated with percutaneous pedicle screw internal fixation.According to different surgical procedures,the patients were divided into observation group(robot-assisted screw placement) and control group(screw placement under three-dimensional C-arm X-ray fluoroscopy).The surgical time,intraoperative blood loss,intraoperative fluoroscopy frequency and postoperative hospital stay in two groups were recorded;and the screw placement and reduction were compared between two groups.Postoperative pain[visual analogue scale(VAS)]and functional recovery[Oswestry disability index(ODI)]were evaluated after 1 month of follow-up.Results Compared with control group,observation group shortened surgical time(P<0.05) and reduced intraoperative fluoroscopy frequency(P<0.05),but the differences between two groups in intraoperative blood loss and postoperative hospital stay were trivial(P>0.05).The accuracy rate of screw placement in observation group was94.57%,significantly higher than 83.59% in control group(P<0.05).One week postoperatively,the injured vertebral anterior height ratio was increased in both groups as compared with that before surgery(P<0.05),and the Cobb angle and local kyphosis angle of injured vertebrae were lower than those before surgery(P<0.05),but the injured vertebral anterior height ratio,Cobb angle and local kyphosis angle of injured vertebrae didn't differ significantly between two groups at the same time point(P>0.05).One month postoperatively,the VAS score and ODI in both groups were lower than those before surgery(P<0.05),but there were no statistical differences in VAS score and ODI between two groups at the same time point(P>0.05).Conclusion Both robot-assisted screw p

关 键 词：胸腰椎骨折 微创 椎弓根螺钉内固定 机器人 “C”型臂X线机 

分 类 号：R318[医药卫生—生物医学工程] R687.3[医药卫生—基础医学]