新型可视化骨科机器人辅助与徒手开放腰椎椎弓根螺钉内固定术的回顾性队列研究  

A retrospective cohort study on comparison between a novel visualized orthopedic robot-assisted technique versus a free-hand technique of pedicle screw placement in the lumbar spine

作　　者：曾成 吴佳源 丁红涛 张宁 郎昭 何达 Zeng Cheng;Wu Jiayuan;Ding Hongtao;Zhang Ning;Lang Zhao;He Da(Spine Department,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

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：《首都医科大学学报》2024年第5期808-814,共7页Journal of Capital Medical University

基　　金：北京市医院管理中心“登峰”计划项目(DFL20240401)。

摘　　要：目的研究新型可视化工具集成的骨科机器人系统,对比可视化机器人系统与传统徒手腰椎椎弓根螺钉内固定术的置钉准确率和临床效果。方法回顾性分析43例可视化机器人系统辅助单节段腰椎管扩大减压植骨融合内固定术患者,匹配85例传统徒手置钉法患者为对照组。通过术后腰椎电子计算机断层扫描(computed tomography,CT)影像评估椎弓根螺钉的准确性,对比两组患者的置钉优良率、钉道调整次数、螺钉调整次数、视觉模拟评分(Visual Analogue Scale,VAS)改善指数,日本骨科协会(Japanese Orthopaedic Association Scores,JOA评分)改善指数、手术时间,出血量、术后住院时间、术后并发症。结果机器人组置钉准确率显著高于对照组(P<0.05),钉道调整次数和螺钉调整次数均显著低于对照组(P<0.05),手术时间显著长于对照组(P<0.05),其余围术期参数与对照组差异无统计学意义(P>0.05)。结论新型可视化机器人系统辅助的置钉准确性显著优于徒手置钉,并可以减少重复调整钉道和重复置钉的次数。尽管其手术时间长于传统手术,但其临床疗效不劣于传统手术,且具有一次性置钉成功率高的优势。Objective To study a novel orthopedic robotic system integrated with visualized tool packages and to compare the screw accuracy and clinical outcomes of the visualization robotic system with those of the traditional free-hand lumbar pedicle screw fixation.Methods A total of 43 cases with visualized robot-assisted single-segment lumbar spinal canal decompression with fusion were retrospectively analyzed,matched with 85 cases with traditional free-hand pedicle screw placement as the control group.The accuracy of pedicle screws was evaluated on postoperative lumbar computed tomography(CT)images.The two groups were compared in terms of the number of pedicle track adjustments,the number of pedicle screw turnback,the Visual Analogue Scale(VAS),the Japanese Orthopaedic Association(JOA)scores,the operative time,the amount of blood loss,the postoperative hospitalization time,and the postoperative complications.Results The accuracy of screw placement in the robotic group was significantly higher than that in the control group(P<0.05),the number of pedicle track adjustments and screw turnback were significantly lower than that in the control group(P<0.05),and the operation time was significantly longer than that in the control group(P<0.05),while the other perioperative parameters were not significantly different from those in the control group(P>0.05).Conclusions The accuracy of pedicle screw placement assisted by the novel visualized robotic system was significantly better than that of free-hand screw placement,and it could reduce the number of repeated adjustments of the pedicle track and screw turnback.Although its operation time is longer than that of traditional surgery,its clinical efficacy is not inferior to that of traditional surgery,and it has more advantages and potentials.

关 键 词：手术机器人 腰椎 椎弓根螺钉 内固定 

分 类 号：R738.1[医药卫生—肿瘤]