机器人与导航技术辅助椎弓根螺钉置入的准确性和疗效比较  

Comparison of accuracy and postoperative efficacy of robot and navigation technology assisted placement of pedicle screws

作　　者：李厚坤 闫亮[1] 单乐群 段永超 孙凯[2] 章雪芳 张雅东 郝定均[1] Li Houkun;Yan Liang;Shan Lequn;Duan Yongchao;Sun Kai;Zhang Xuefang;Zhang Yadong;Hao Dingjun(Department of Spine Surgery,Honghui Hospital,Xi'an Jiaotong University,Xi'an 712046,China;Department of Spine Surgery,Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing 210009,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安712046 [2]南京大学医学院附属南京鼓楼医院脊柱外科,南京210009

出　　处：《中华骨科杂志》2024年第13期851-857,共7页Chinese Journal of Orthopaedics

基　　金：国家"十四五"重点研发计划(2022YFC2407503)。

摘　　要：目的:比较机器人与导航技术辅助椎弓根螺钉内固定的准确性和疗效。方法:回顾性分析2017年6月至2023年4月在西安交通大学附属红会医院脊柱外科行内固定治疗的腰椎疾患患者764例,根据辅助置钉为机器人或导航技术分为文艺复兴组(使用Renaissance■机器人,212例)、天玑组(使用天玑■骨科机器人,301例)和S8导航组(使用StealthStation^(TM) S8外科导航系统,251例)。比较三组患者的手术时间、透视时间、X线辐射剂量、术中失血量、螺钉置入的准确率、螺钉翻修率、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及术后感染率。结果:文艺复兴组置入922枚螺钉、天玑组1260枚螺钉、S8导航组1044枚螺钉。三组临床可接受椎弓根螺钉置入的准确率分别为92.08%(849/922)、99.68%(1256/1260)、99.43%(1038/1044),文艺复兴组小于天玑组和S8组(χ^(2)=90.334,P<0.001;χ^(2)=68.446,P<0.001),天玑组与S8组比较差异无统计学意义(χ^(2)=0.380,P=0.537)。三组手术时间分别为(173.64±62.23)min、(177.11±60.85)min、(176.02±60.93)min,术中失血量分别为(118.16±58.26)ml、(121.84±55.91)ml、(123.62±59.84)ml,组间差异均无统计学意义(P>0.05)。三组透视时间分别为(8.73±2.92)s、(10.67±2.85)s、(11.31±2.89)s,X线辐射剂量分别为(18.83±7.41)μSv、(20.40±7.60)μSv和(22.88±7.47)μSv,组间及两两比较的差异均有统计学意义(P<0.05)。所有患者均获得随访,随访时间3~30个月。术后文艺复兴组3例因螺钉穿透椎弓根皮质刺激神经根而行螺钉翻修术,其他两组均无一例行螺钉翻修术。术后文艺复兴组1例、天玑组1例发生浅表感染,经延长抗生素使用时间后痊愈。术后3个月,文艺复兴组、天玑组、S8导航组腿痛VAS评分分别为(3.52±1.14)分、(3.59±1.12)分、(3.39±1.16)分,背痛VAS评分分别为(3.54±1.14)分、(3.57±1.12)分、(3.51±1.15)分,ODI评分分别为Objective To compare the accuracy and efficacy of robot assisted and navigation assisted pedicle screw fixation.Methods Retrospective analysis of 764 patients with lumbar spine disorders who underwent internal fixation treatment at the Department of Spine Surgery,Honghui Hospital,Xi'an Jiaotong University,from June 2017 to April 2023 were performed.They were divided into the Renaissance group(212 cases),the Tinavi group(301 cases),and the S8 navigation group(251 cases),according to the method of assisted placement of pedicle screws.The operation time,fluoroscopy time,X-ray radiation dose,intra-operative blood loss,accuracy of screw placement,screw revision rate,pain visual analogue scale(VAS),Oswestry disability index(ODI)and postoperative infection rate were compared among the three groups.Results 922 screws were placed in the Renaissance group,1,260 screws in the Tinavi group,and 1,044 screws in the S8 navigation group.The accuracy of clinically acceptable pedicle screw placement was 92.08%(849/922),99.68%(1,256/1,260),and 99.43%(1,038/1,044)in the three groups,respectively,with the Renaissance group being smaller than the Tinavi group and the S8 group(χ^(2)=90.334,P<0.001;χ^(2)=68.446,P<0.001),and the Tinavi group and the S8 group had no statistically significant difference(χ^(2)=0.380,P=0.537).The operation time of the three groups was 173.64±62.23 min,177.11±60.85 min,176.02±60.93 min,and the intraoperative blood loss was 118.16±58.26 ml,121.84±55.91 ml,123.62±59.84 ml,respectively,and the differences between the groups were not statistically significant(P>0.05).The fluoroscopy time of the three groups was 8.73±2.92 s,10.67±2.85 s,and 11.31±2.89 s,and the X-ray radiation doses were 18.83±7.41μSv,20.40±7.60μSv,and 22.88±7.47μSv,respectively,with statistically significant differences between the groups and the two comparisons(P<0.05).All patients were given follow-up for 3-30 months.Three cases in the postoperative Renaissance group underwent screw revision for nerve root irritation due to sc

关 键 词：脊柱 外科手术 计算机辅助 机器人手术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]