机器人辅助枢椎椎弓根螺钉置入的准确性研究  

Accuracy of axis pedicle screw placement in robot-assisted upper cervical

作　　者：吴佳源 何达 韦祎 段芳芳 刘波 袁强 胡临 蒋协远 Wu Jiayuan;He Da;Wei Yi;Duan Fangfang;Liu Bo;Yuan Qiang;Hu Lin;Jiang Xieyuan(Department of Spine Surgery,Bejing Jishuitan Hospital,Capital Medical University(National Center for Orthopaedics),Beijing 100035,China;Research Unit of Intelligent Orthopaedics,Chinese Academy of Medical Sciences,Bejing 100035,China;Bejing Jishuitan Orthopaedic Robot Engineering Research Center Co.,Ltd,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院(国家骨科医学中心)脊柱外科,北京100035 [2]中国医学科学院智能骨科创新单元,北京100035 [3]北京积水潭骨科机器人工程研究中心有限公司,北京100035

出　　处：《中华骨科杂志》2024年第17期1125-1132,共8页Chinese Journal of Orthopaedics

基　　金：首都卫生发展科研专项项目(首发2024-2-2076);中国医学科学院医学与健康科技创新工程项目(2021-I2M-5-007);骨科手术机器人北京市工程研究中心骨科手术机器人临床应用研究项目(2023OSR-GCZX202202)

摘　　要：目的探讨机器人辅助枢椎椎弓根螺钉置入的准确性及其影响因素。方法回顾性分析2017年1月至2020年12月在北京积水潭医院因寰枢椎不稳接受上颈椎后路内固定手术,术中使用机器人辅助枢椎椎弓根螺钉置入的连续27例患者的病历资料。男10例、女17例,年龄(41.3±16.6)岁(范围12~75岁),体质指数为(23.0±2.9)kg/m^(2)(范围18.9~30.0kg/m^(2))。创伤性寰枢椎不稳16例、畸形导致寰枢椎不稳11例。机器人辅助枢椎椎弓根螺钉置入准确性通过术后CT采用Gertzbein-Robbins分级进行评价。对影响置钉准确性的患者因素和手术因素行单因素分析,确定可能影响置钉准确性因素(P<0.200)后通过广义估计方程多因素分析确定影响置钉准确性的独立影响因素。结果27例患者共置入49枚枢椎椎弓根螺钉,Gertzbein-Robbins分级A级35枚(71.4%)、B级12枚(24.5%)、C级2枚(4.1%),临床可接受率(Gertz-bein-Robbins分级A级和B级)为95.9%(47/49)。无一例患者发生因螺钉移位导致的血管、神经损伤。未侵犯骨皮质螺钉组与侵犯骨皮质螺钉组患者因素(年龄、性别、体质指数、术前颈椎曲度和寰枢椎不稳原因)的差异无统计学意义(P>0.05);手术因素中示踪器位置、螺钉侧别、螺钉类型及置钉方式的差异无统计学意义(P>0.05),而枢椎椎弓根有效宽度与螺钉直径差值的差异有统计学意义(t=3.484,P<0.001)。广义估计方程结果显示机器人辅助枢椎椎弓根螺钉置入术中示踪器固定于Mayfield头架较枢椎棘突可实现更准确的螺钉置入[0R=83.231,95%CI(3.898,1776.952),P=0.005];枢椎椎弓根有效宽度与螺钉直径差值越大,螺钉置入的准确率越高[0R=5.330,95%CI(1.648,17.243),P=0.005]。结论机器人辅助枢椎椎弓根螺钉置入准确且安全,示踪器固定于Mayfield头架较枢椎棘突可提高螺钉置入准确性,枢椎椎弓根有效宽度与螺钉直径差值大可降低螺钉侵犯骨皮质的概率,通过螺钉型Objective To evaluate the precision of robot-assisted axis pedicle screw placement and to evaluate the fac-tors influencing the accuracy of the placement.Methods The medical records of 27 consecutive patients who underwent posteri-or internal fixation of the upper cervical spine for atlantoaxial instability with intraoperative robot-assisted axis pedicle screw placement from January 2017 to December 2020 at Beijing Jishuitan Hospital were retrospectively analyzed.T The cohort com-prised 10 males and 17 females,aged 41.3±16.6 years(range 12-75 years),with a body mass index(BMI)of 23.0±2.9 kg/m^(2)(range 18.9-30.0 kg/m^(2)).There were 16 cases of traumatic atlantoaxial instability and 11 cases of atlantoaxial instability caused by deformity.The accuracy of robot-assisted axis pedicle screw placement was evaluated by postoperative CT using Gertzbein-Rob-bins scale.Factors potentially affecting placement accuracy were initially identified via univariate analysis,with significant factors(P<0.200)subsequently analyzed through multivariate modeling using generalized estimating equations.Results A total of 49 axis pedicle screws were placed in 27 patients,with 35(71.4%)in Gertzbein-Robbins scale grade A,12(24.5%)in grade B,2(4.1%)in e grade C,and O in grades D and E.The clinically acceptable rate(Gertzbein-Robbins grades A and B)was 95.9%.No patient experienced vascular or neurologic injury due to screw displacement.The results of univariate analysis showed no statistical significance for patient factors(age,gender,BMI,preoperative cervical curvature,and causes of atlantoaxial instability);no statistical significance for the surgical factors of tracker position,screw position,screw type,and screw placement approach(P>0.05),and a statistically significant difference for the difference between the effective width of the axis pedicle and the screw diameter(t=3.484,P<0.001).The results of multifactorial analysis showed that tracker fixation to the Mayfield frame in robot-assisted axis pedicle screw placement over the axis

关 键 词：枢椎 颈椎 机器人手术 椎弓根钉 影响因素分析 

分 类 号：R687.3[医药卫生—骨科学]