不同模式下骨科手术机器人微创经椎间孔入路腰椎椎间融合术的置钉准确性与手术效率比较  

Comparison of nail placement accuracy and surgical efficiency of orthopedic robot-assisted minimally invasive transforaminal lumbar interbody fusion under different modes

作　　者：王辉[1] 孙小刚 田永昊[1] 原所茂[1] 王连雷 刘新宇[1] WANG Hui;SUN Xiaogang;TIAN Yonghao;YUAN Suomao;WANG Lianlei;LIU Xinyu(Department of Spinal Surgery,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Spinal Surgery,Tengzhou Central People’s Hospital,Tengzhou 277599,China)

机构地区：[1]山东大学齐鲁医院脊柱外科,山东济南250012 [2]滕州市中心人民医院脊柱外科,山东滕州277599

出　　处：《机器人外科学杂志(中英文)》2025年第2期210-216,共7页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金(81874022,82172483,82102522);山东省重点研发计划(2022CXGC01050);山东省自然科学基金(ZR202102210113);山东省泰山学者项目(tsqn202211317);中央高水平医院临床研究基金(2022-PUMCH-D-004)。

摘　　要：目的:比较术中行X线配准和CT配准两种模式的骨科手术机器人辅助微创经椎间孔入路腰椎椎间融合术(TLIF)的置钉准确性与手术效率。方法:选取2021年6月-2023年6月于山东大学齐鲁医院接受机器人辅助TLIF的57例患者,其中19例采用匹配术前CT的术中X线配准机器人辅助置入椎弓根螺钉(X线配准组),19例采用术中CT配准机器人辅助置入椎弓根螺钉(CT配准组),19例采用徒手置入椎弓根螺钉(徒手组)。比较三组螺钉的置入准确性、固定上位节段关节突关节侵扰率、术中透视次数、出血量、辐射暴露水平、术后住院时间和临床效果,以及X线配准组和CT配准组的手术时间。结果:三组患者的出血量、术后住院时间和腰椎滑脱节段比较,差异无统计学意义(P>0.05),三组患者术后VAS评分和ODI评分均较术前明显好转(P<0.05)。X线配准组较CT配准组患者的术中辐射暴露少,且均低于徒手组(P<0.05)。X线配准组和CT配准组的临床可接受螺钉数量大于徒手组,固定上位节段关节突关节侵扰率小于徒手组,但差异无统计学意义(P>0.05)。X线配准组配准及规划时间低于CT配准组,机器人装备时间及置钉时间高于CT配准组(P<0.05),两组患者总手术时间差异无统计学意义(P>0.05),但均高于徒手组(P<0.05)。结论:术中行X线配准和CT配准两种模式的机器人辅助TLIF具有较高的置钉准确性和安全性,辐射量低,可作为TLIF的有效辅助方式。Objective:To compare the nail placement accuracy and surgical efficiency of orthopedic robot-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)with intraoperative X-ray and CT alignment.Methods:57 patients who underwent robotic-assisted MIS-TLIF from June 2020 to June 2023 in Qilu Hospital of Shandong University were selected.They were divided into the X-ray alignment group(n=19),the CT alignment group(n=19)and the freehand group(n=19).Patients in the above three groups underwent intraoperative X-ray alignment-assisted pedicle screw placement,intraoperative CT alignment-assisted pedicle screw placement and freehand pedicle screw placement,respectively.Screw placement accuracy,rate of superior level facet joint violations,number of intraoperative fluoroscopies,bleeding,radiation exposure level,postoperative length of hospital stay,and clinical outcomes among the three groups were compared.Meanwhile,operative time were compared between the X-ray-aligned group and CT-aligned group.Results:There was no statistically significant difference in bleeding,postoperative length of hospital stay,and lumbar spondylolisthesis segments among the three groups(P>0.05).Postoperative VAS and ODI scores of the three groups were significantly improved compared with those before surgery(P<0.05).Intraoperative radiation exposure in the X-ray alignment group was lower than that in the CT alignment group,and they were both lower than that in the freehand group(P<0.05).There was no statistically significant difference in the clinically acceptable screw placement and rate of superior level facet joint violations among the three groups of patients(P>0.05).The X-ray alignment group has lower alignment and planning time(P<0.05),and higher robot equipping and nail placement time than the CT alignment group(P<0.05),but the difference in the total operative time between the two groups was not statistically significant(P>0.05).The total operative times of the X-ray-aligned group and CT-aligned group were higher than that

关 键 词：骨科手术机器人 微创经椎间孔入路腰椎椎间融合术 X线配准 CT配准 置钉准确性 手术效率 

分 类 号：R681.5[医药卫生—骨科学]