机器人辅助与传统徒手技术在成人退变性脊柱侧凸后路手术中椎弓根螺钉置入的准确性分析  

Analysis of the accuracy between orthopedic robot‑assisted and traditional manual pedicle screw placement techniques in adult degenerative scoliosis posterior surgery

作　　者：赵书杰 薛澳 李寅 陈建[1] 黄振飞 周炜[1] 余利鹏[1] 殷国勇 李青青[1] Zhao Shujie;Xue Ao;Li Yin;Chen Jian;Huang Zhenfei;Zhou Wei;Yu Lipeng;Yin Guoyong;Li Qingqing(Department of Orthopedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Jiangsu Institute of Functional Reconstruction and Rehabilitation,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029 [2]江苏省功能重建与康复研究所,南京210029

出　　处：《中华医学杂志》2024年第37期3490-3497,共8页National Medical Journal of China

基　　金：国家自然科学基金(82030069、82102570);国家重点研发计划重点专项(2022YFA1205004)。

摘　　要：目的:比较机器人辅助与传统徒手技术在成人退变性脊柱侧凸(ADS)后路手术中椎弓根螺钉置入的准确性。方法:回顾性分析2019年3月至2023年12月在南京医科大学第一附属医院(江苏省人民医院)接受脊柱后路手术的92例ADS患者的临床资料,其中男19例,女73例,年龄(63.6±9.8)岁。依据置钉技术不同分为机器人辅助椎弓根螺钉置入组(34例)和徒手组(58例)。分析比较两组手术时间、术中出血量、关节突关节侵扰程度、术后并发症、侧凸矫正率,术前、术后1周以及术后1个月的疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。依据Gertzbein-Robbins分类标准评价置钉准确率。结果:机器人组和徒手组的基线数据、手术时间、术中失血量、侧凸矫正率及术前、术后1周和术后1个月的VAS和ODI评分等差异均无统计学意义(均P>0.05)。机器人组置钉准确性显著高于徒手组[90.9%(416/458)比80.1%(697/870),P<0.001]。从手术节段上看,在T_(1~12)节段及L_(1)~S_(1)节段,机器人组置钉准确性高于徒手组[分别为91.5%(130/142)比77.8%(186/239),P=0.001;90.3%(271/300)比80.8%(502/621),P<0.001];而S_(2)骶骨翼髂骨(S_(2)AI)螺钉,机器人组置钉准确性与徒手组差异无统计学意义[90.0%(9/10)比93.8%(15/16),P=0.727],但机器人组穿透皮质螺钉的偏出方向与徒手组差异无统计学意义(P=0.133)。机器人组Nash-Moe 2度和3度椎体置钉准确率均优于徒手组[分别为88.9%(88/99)比71.0%(115/162),P=0.001;89.2%(83/93)比60.2%(68/113),P<0.001]。此外,徒手组关节突关节侵扰的发生率和等级均高于机器人组(均P<0.001)。两组间术后并发症发生率差异无统计学意义(P=0.841)。结论:使用机器人辅助椎弓根螺钉置入在ADS患者后路手术中能显著提高置钉准确性并减少对关节突关节的侵扰。Objective To comparing the accuracy of pedicle screw placement in posterior surgery for adult degenerative scoliosis(ADS)between robotic‑assisted and traditional freehand techniques.Methods This retrospective study included 92 patients with ADS who underwent posterior spinal surgery at the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital)between March 2019 and December 2023.There were 19 males and 73 females with a mean age of(63.6±9.8)years.The patients were divided into two groups based on the technique used for pedicle screw placement:robot‑assisted group(34 cases)and manual group(58 cases).Operative duration,intraoperative blood loss,facet joint violation,postoperative complications,magnitude of curve correction,visual analogue scale(VAS)and Oswestry Disability Index(ODI)scores preoperatively,1 week postoperatively,and 1 month postoperatively were compared and analyzed between the two groups.The Gertzbein‑Robbins classification criteria was used to assess the accuracy of screw placement.Results Differences in baseline data,operative duration,intraoperative blood loss,magnitude of curve correction,and VAS and ODI scores preoperatively,1 week postoperatively,and 1 month postoperatively between the two groups exhibited no statistically significant differences(all P>0.05).The accuracy of pedicle screw placement in the robot‑assisted group was significantly higher than that in the manual group[90.9%(416/458)vs 80.1%(697/870),P<0.001].In terms of surgical segments,in T_(1)‑T_(12) and L_(1)‑S_(1) segments,the accuracy of pedicle screw placement in the robot group were both significantly higher than those in the control group[91.5%(130/142)vs 77.8%(186/239),P=0.001;90.3%(271/300)vs 80.8%(502/621),P<0.001].However,no significant differences was observed in the accuracy of S_(2)‑alar‑iliac(S_(2)AI)screw placement between the two groups[90.0%(9/10)vs 93.8%(15/16),P=0.727].Moreover,no significant differences was found in the deviation direction of the cortical screw penet

关 键 词：脊柱侧凸 成人退变性脊柱侧凸 骨科手术机器人 椎弓根螺钉置入 置钉准确率 

分 类 号：R697.3[医药卫生—泌尿科学]