骨科机器人辅助与徒手椎弓根螺钉置入技术对上颈椎手术安全性及准确性的影响  

Comparison of safety and efficacy of robot assistance versus conventional freehand methods in the upper cervical spine surgery

作　　者：陈建 李青青 赵书杰 武梦圆 周子涵 刘嘉赟 高鹏 凡进 曹晓建 任永信 蔡卫华 余利鹏 殷国勇 周炜 Chen Jian;Li Qingqing;Zhao Shujie;Wu Mengyuan;Zhou Zihan;Liu Jiayun;Gao Peng;Fan Jin;Cao Xiaojian;Ren Yongxin;Cai Weihua;Yu Lipeng;Yin Guoyong;Zhou Wei(Department of Orthopaedics,Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University),Jiangsu Institute of Functional Reconstruction and Rehabilitation,Nanjing 210029,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院)骨科(江苏省功能重建与康复研究所),南京210029

出　　处：《中华骨科杂志》2024年第8期578-586,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82372408);江苏省科技厅重大产学研项目(BA2022003);江苏省自然科学基金(20211379)。

摘　　要：目的评估骨科机器人辅助及徒手椎弓根螺钉植入技术对上颈椎手术安全性及准确性的影响。方法回顾性分析2017年1月至2023年3月63例上颈椎疾病患者的病历资料,依据置钉技术不同分为机器人辅助置钉组(41例)和徒手置钉组(22例)。机器人辅助置钉组行枕颈融合术9例和寰枢椎及以远椎体固定融合术32例,徒手置钉组分别为8例和14例。术后随访至少6个月,采用影像学参数、美国脊柱损伤协会(American Spinal Injury Association,ASIA)脊髓损伤分级、疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association scores,JOA)评分评估术后疗效。比较两组患者的病程、手术时间、术中出血量、透视次数和辐射剂量、住院时间、治疗费用、并发症、椎弓根螺钉置入率、上颈椎椎弓根螺钉置入的准确性及影响因素。结果机器人辅助置钉组中枕颈融合患者和寰枢椎及以远椎体固定融合患者的椎弓根螺钉置入率分别为100%和89.6%(138/154),超过徒手置钉组的43%(18/42)和78%(54/69),差异有统计学意义(χ2=37.403,P<0.001;χ2=5.128,P=0.024)。机器人辅助置钉组两类手术患者的透视辐射剂量和手术时间均超过徒手置钉组(P<0.05)。与徒手置钉组相比,机器人辅助置钉组C1螺钉准确性由42%(11/26)提高至80%(51/64),差异有统计学意义(χ2=13.342,P=0.004);C2螺钉准确性由77%(33/43)提高至88%(63/72),差异无统计学意义(χ2=2.863,P=0.413)。机器人辅助置钉组C1和C2椎弓根螺钉置入的准确性与导针置入顺序相关(r=0.580,P<0.001;r=0.369,P=0.001)。两组患者手术前后延髓角、Chamberlain线、McGregor线、Boogard角、Bull角、斜坡椎管角、枕颈角、后枕颈角、C_(2)~C_(7)角及寰齿前间隙的组间差异均无统计学意义(P>0.05);两组患者术后ASIA脊髓损伤分级均有不同程度提高,术前、术后及末次随访时的组间差异均无统计学意义(P>0.05);两组患者VAObjective To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies,the safety of pedicle screw placement,and clinical efficacy in patients with upper cervical spine diseases.Methods From January 2017 to March 2023,a total of 63 cases with upper cervical spine disease,were divided into two groups based on the screw placement technique:the robot-assisted pedicle screw placement(RA)group(41 cases)and the conventional freehand pedicle screw placement(CF)group(22 cases),were retrospectively included.These patients in the RA and CF groups underwent two types of posterior cervical surgery,including occipitocervical fusion(9 cases and 8 cases)and fixation and fusion of atlantoaxial and distal vertebrae(32 cases and 14 cases).The outcome parameters,including the disease course,surgical time,intraoperative blood loss,fluoroscopy frequency,radiation dose,hospital stay,treatment costs,complications,the rate of the pedicle screw placement,accuracy of upper cervical pedicle screw placement,and the risk factors that possibly affected the accuracy were recorded and analyzed.Postoperative follow-up was conducted for at least 6 months,and the efficacy of patients was assessed using imaging parameters,ASIS classification,VAS,and JOA scores.Results Both groups had no screw-related complications and no spinal cord or vertebral artery injuries.In the RA group,the pedicle screw placement rates for the patients with occipitocervical fusion,and fixation and fusion of atlantoaxial and distal vertebrae were 100%(48/48)and 89.6%(138/154),respectively,far exceeding the placement rate in the CF group 42.9%(18/42)and 78.3%(54/69)(χ2=37.403,P<0.001;χ2=5.128,P=0.024).The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group(P<0.05).Compared with the CF group,the accuracy of C1 screws in the RA group increased from 42%(11/26)to 80%(51/64),with statistical significance(χ2=13.342,P=0.004);while the acc

关 键 词：寰枕关节 颈寰椎 枢椎 颈椎 机器人手术 椎弓根钉 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]