导航和机器人辅助下颈椎椎弓根螺钉固定手术操作指南(2024版)  

Operating guidelines for navigation-and robot-assisted pedicle screw fixation in the lower cervical spine(version 2024)

作　　者：都金鹏 陈伯华[2] 程黎明[3] 初同伟 董健[5] 段永超 樊珊[1] 冯皓宇 范顺武[7] 冯世庆 郭华[1] 高延征[9] 官众[10] 海涌[11] 何达[12] 贺利军 贺园 黄云飞 蒋电明 姜建元[15] 林斌[16] 刘斌[17] 刘宝戈[18] 李淳德[19] 李放 李锋[21] 李水霞 吕国华[22] 李利[23] 廖琦[24] 李危石[25] 刘晓光[25] 刘忠军[25] 刘勇[26] 刘宏建[27] 鲁世保[28] 梅伟[29] 邱勇[30] 戎利民[31] 申勇[32] 沈慧勇[33] 舒钧[34] 宋跃明[35] 孙宏慧 孙天胜 苏佳灿 王岩[23] 王哲 王征[23] 夏虹 闫景龙[39] 闫亮[1] 殷国勇[40] 袁文 赵杰[42] 仉建国[43] 朱悦[44] 郝定均[1] 贺宝荣[1] 中国医师协会骨科医师分会脊柱创伤学组[45] Du Jinpeng;Chen Bohua;Cheng Liming;Chu Tongwei;Dong Jian;Duan Yongchao;Fan Shan;Feng Haoyu;Fan Shunwu;Feng Shiqing;Guo Hua;Gao Yanzheng;Guan Zhong;Hai Yong;He Da;He Lijun;He Yuan;Huang Yunfei;Jiang Dinming;Jiang Jianyuan;Lin Bin;Liu Bin;Liu Baoge;Li Chunde;Li Fang;Li Feng;Li Shuixia;Lyu Guohua;Li Li;Liao Qi;Li Weishe;Lu Xiaoguang;Liu Zhongjun;Liu Yong;Liu Hongjan;Lu Shibao;Mei Wei;Qu Yong;Rong Limin;Shen Yong;Shen Huiyong;Shu Jun;Song Yueming;Sun Honghui;Sun Tiansheng;Su Jiacan;Wang Yan;Wang Zhe;Wang Zheng;Xia Hong;Yan Jinglong;Yan Liang;Yin Guoyong;Yuan Wen;Zhao Jie;Zhang Jianguo;Zhu Yue;Hao Dingjun;He Baorong;Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association(Honghui Hospital,Xi'an Jiaotong University,Xi'an 710054,China;Affiliated Hospital of Qingdao University,Qingdao 266003,China;Tongji Hospital Affiliated to Tongji University,Shanghai 200065,China;Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Zhongshan Hospital of Fudan University,Shanghai 200032,China;Shanxi Bethune Hospital,Taiyuan 030032,China;Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Second Hospital of Shandong University,Jinan 250033,China;Henan Provincial People's Hospital,Zhengzhou 450003,China;Affiliated Hospital of Qinghai University,Xining 810001,China;Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Bejing Jishuitan Hospital,Bejing 100035,China;Xi'an No.5 Hospital,Xi'an 710082,China;Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;th Hospital of Joint Logistic Support Force of PLA,Zhangzhou 363099,China;Inner Mongolia Medical University,Hohhot 101110,China;Beijing Tiantan Hospital,Capital Medical University,Bejing 100070,China;Peking University First Hospital,Beijing 100034,China;Seventh Medical Center,Chinese PLA General Hospital,Beijing 100026,China;Tongji Hospital,Tongji Medical College,Huazhong University o

机构地区：[1]西安交通大学附属红会医院,西安710054 [2]青岛大学附属医院,青岛266003 [3]同济大学附属同济医院,上海200065 [4]陆军军医大学第二附属医院,重庆400037 [5]复旦大学附属中山医院,上海200032 [6]山西白求恩医院,太原030032 [7]浙江大学医学院邵逸夫医院,杭州310016 [8]山东大学第二医院,济南250033 [9]河南省人民医院,郑州450003 [10]青海大学附属医院,西宁810001 [11]首都医科大学附属北京朝阳医院,北京100020 [12]北京积水潭医院,北京100035 [13]西安市第五医院,西安710082 [14]重庆医科大学附属第三医院,重庆401120 [15]复旦大学附属华山医院,上海200040 [16]中国人民解放军联勤保障部队第九○九医院,漳州363099 [17]内蒙古医科大学,呼和浩特101110 [18]首都医科大学附属北京天坛医院,北京100070 [19]北京大学第一医院,北京100034 [20]中国人民解放军总医院第七医学中心,北京100026 [21]华中科技大学同济医学院附属同济医院,武汉又430030 [22]中南大学湘雅二医院,长沙410012 [23]中国人民解放军总医院,北京100853 [24]南昌大学附属第三医院,南昌330008 [25]北京大学第三医院,北京100191 [26]西藏自治区人民医院,拉萨850010 [27]郑州大学第一附属医院,郑州450000 [28]首都医科大学附属北京宣武医院,北京100053 [29]郑州市骨科医院,郑州450053 [30]南京大学医学院附属鼓楼医院,南京210008 [31]中山大学附属第三医院,广州510630 [32]河北医科大学第三医院,石家庄050051 [33]中山大学附属第八医院,深圳518033 [34]昆明医科大学第二附属医院,昆明650106 [35]四川大学华西医院,成都610041 [36]上海交通大学附属新华医院,上海200092 [37]空军军医大学西京医院,西安710032 [38]中国人民解放军南部战区总医院,广州510010 [39]哈尔滨医科大学附属第二医院,哈尔滨宾150001 [40]南京医科大学第一附属医院,南京210029 [41]海军军医大学第二附属医院,

出　　处：《中华创伤杂志》2024年第4期298-309,共12页Chinese Journal of Trauma

基　　金：陕西省科学技术厅重点产业创新链(群)-社会发展领域项目(2023-ZDLSF-03);西安市科技局医学研究-一般研究项目(23YXYJ0083)。

摘　　要：下颈椎椎弓根螺钉具有良好的生物力学稳定性、抗拔出强度,被广泛应用于治疗颈椎创伤、退变等疾患。但颈椎解剖结构复杂,毗邻诸多重要结构,螺钉误置易造成严重并发症。导航、机器人目前已被广泛应用于辅助胸腰椎椎弓根螺钉固定,但辅助下颈椎椎弓根固定尚处于探索阶段,加之辅助置钉存在一定难度,不规范操作易导致辅助手术失败。目前国内外未见导航和机器人辅助下颈椎手术的指南或专家共识。为了规范该项技术的操作,中国医师协会骨科医师分会脊柱创伤学组组织有关专家,基于循证医学证据,制订《导航和机器人辅助下颈椎椎弓根螺钉固定手术操作指南(2024版)》,就导航和机器人辅助下颈椎椎弓根螺钉手术的适应证和禁忌证、术前准备、术中操作和常见问题及防止措施等方面提出10条推荐意见,为各级医院规范地开展该手术提供参考。Lower cervical pedicle screws are widely used in the treatment of cervical disorders such as trauma and degeneration because of their good biomechanical stability and anti-pullout strength.However,the cervical vertebra has complex anatomical structure and is adjacent to many important structures,so screw misplacement may easily result in serious complications.Navigation and robot systems have been wildly applied to assist in thoracic and lumbar pedicle screw fixation but are still in the exploratory stage for lower cervical pedicle fixation.Moreover,there are certain difficulties in navigation-and robot-assisted screw placement,and non-standard application may easily lead to failure of auxiliary surgery.At present,there is no guideline or consensus on navigation-and robot-assisted lower cervical surgery at home and abroad.In order to standardize the procedures of this technique,the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized relevant experts to formulate Operating guidelines for navigation-and robot-assisted pedicle screw fixation in the lower cervical spine(version 2024)based on evidence-based medicine.Ten recommendations were proposed on indications and contraindications,preoperative preparation,intraoperative procedures and common problems and countermeasures of lower cervical pedicle screw surgery assisted by navigation and robot systems,so as to provide a reference for the standardized operation of the surgery in hospitals at all levels.

关 键 词：机器人 颈椎 脊柱骨折 内固定器 手术导航系统 

分 类 号：R687.3[医药卫生—骨科学]