机器人辅助Magerl螺钉内固定术治疗上颈椎疾病  

Robot-assisted Magerl screw fixation for upper cervical diseases

作　　者：郎昭 袁强 范明星 张琦 何达 刘亚军 LANG Zhao;YUAN Qiang;FAN Mingxing;ZHANG Qi;HE Da;LIU Yajun(Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035)

机构地区：[1]首都医科大学附属北京积水潭医院脊柱外科,北京100035

出　　处：《北京生物医学工程》2024年第3期280-284,313,共6页Beijing Biomedical Engineering

基　　金：北京积水潭医院高层次人才“学科骨干”培养计划(XKGG202104)资助。

摘　　要：目的经寰枢关节螺钉(Magerl螺钉)内固定技术是上颈椎疾病的主要手术方式之一。传统方法技术要求高,学习曲线陡峭,由于螺钉错位造成的神经血管并发症发生率高。随着机器人辅助脊柱手术的不断开展,机器人技术的高精确性为Magerl螺钉安全精确置入带来了新的希望。本研究回顾性分析机器人辅助Magerl螺钉内固定手术的安全性及螺钉置入精确性。方法纳入2017年8月至2022年7月于北京积水潭医院行TiRobot机器人辅助Magerl螺钉内固定手术的上颈椎疾病患者18例。记录螺钉安全性及精确性指标。安全性指标包括手术时间、出血量、螺钉相关神经血管并发症情况,以及随访1年时神经功能改善情况、颈部疼痛变化及植骨融合情况。精确性指标包括使用术中C臂锥形束CT图像的叠加技术计算螺钉置入精确性,并根据术后CT对螺钉是否侵犯骨皮质的情况进行分级。结果18例患者共置入Magerl螺钉36枚。平均手术时间为(186.1±61.9)min,平均失血量为(352.8±133.4)mL,无螺钉相关神经血管并发症。术后1年随访时,所有存在脊髓压迫症状的患者神经功能均有改善,患者颈部疼痛症状好转,所有患者均实现植骨融合。螺钉置入的平均平移和角度误差分别为(1.47±0.30)mm和2.30°±0.47°。术后CT判断Ⅰ类螺钉占88.9%(32/36),Ⅱ类螺钉占11.1%(4/36),无Ⅲ类螺钉。结论机器人辅助Magerl螺钉内固定技术治疗上颈椎疾病是安全和精确的。Objective The technique of transarticular screw fixation(Magerl screws)is a major surgical approach for upper cervical diseases.Traditional methods demand technical proficiency with a steep learning curve,resulting in a high incidence of neurovascular complications due to screw misplacement.With the growing application of robot-assisted spinal surgeries,the high precision of robotic technology offers new prospects for safe and accurate placement of Magerl screws.This study retrospectively analyzes the safety and accuracy of robot-assisted Magerl screw fixation procedures.Methods A total of 18 patients with upper cervical diseases who underwent robot-assisted Magerl screw fixation using the TiRobot system at Beijing Jishuitan Hospital from August 2017 to July 2022 were included.Safety parameters,including operative time,blood loss,screw-related neurovascular complications,neurological improvement at 1-year follow-up,changes in neck pain,and graft fusion,were recorded.Accuracy parameters involved screw placement accuracy calculated with intraoperative cone-beam CT images using overlay technology,as well as the cortical violation of screws assessed by postoperative CT scan.Results Thirty-six Magerl screws were inserted in the 18 patients.The mean operative time was(186.1±61.9)min,with a mean blood loss of(352.8±133.4)mL.No screw-related neurovascular complications were observed.At 1-year follow-up,all patients with spinal cord compression symptoms showed neurological improvement,neck pain symptoms improved in all patients,and successful graft fusion was achieved in all cases.The mean translational and angular deviations of screw placement were(1.47±0.30)mm and 2.30°±0.47°,respectively.Postoperative CT assessment indicated Type I screws in 88.9%(32/36)and Type II screws in 11.1%(4/36),with no Type III screws.Conclusions Robot-assisted Magerl screw fixation is a safe and accurate technique for treating upper cervical diseases.

关 键 词：机器人 寰枢椎 Magerl螺钉 安全性 精确性 

分 类 号：R318.04[医药卫生—生物医学工程]