Renaissance机器人辅助下皮质骨螺钉在骨质疏松患者腰椎固定中对照性研究  

Renaissance robot-assisted subcortical bone screw for lumbar fixation in patients with osteoporosis-a preliminary study

作　　者：杨露露 段永超 郝定均[3] 刘团江[3] 宋宗让 尹新华[3] 杨明[3] 陈旭旭 刘世长 YANG Lulu;DUAN Yongchao;HAO Dingjun;LIU Tuanjiang;SONG Zongrang;YIN Xinhua;YANG Ming;CHEN Xuxu;LIU Shichang;无(The Second Clinical Medical College of Shaanxi University of Chinese Medicine,Xianyang 712000;Department of Imaging,Honghui Hospital Affiliated with Xi′an Jiaotong University,Xi′an 710000;Department of Spine Surgery,Honghui Hospital Affiliated with Xi′an Jiaotong University,Xi′an 710000;Department of Joint Surgery,Honghui Hospital Affiliated with Xi′an Jiaotong University,Xi′an 710000)

机构地区：[1]陕西中医药大学第二临床医学院,咸阳712000 [2]西安交通大学附属红会医院影像科,西安710000 [3]西安交通大学附属红会医院脊柱科,西安710000 [4]西安交通大学附属红会医院关节科,西安710000

出　　处：《颈腰痛杂志》2025年第1期143-149,共7页The Journal of Cervicodynia and Lumbodynia

基　　金：国家自然科学基金青年项目(81802690);国家十四五重点研发计划(2022YFC2407503);陕西省自然科学基础研究计划面上项目(2024JC-YBMS-711)。

摘　　要：目的探讨机器人辅助下皮质骨螺钉在骨质疏松患者腰椎固定中的应用效果。方法选取2017年6月至2023年9月手术的24例骨质疏松腰椎后路固定患者(骨密度测量T值均<-2.5)为研究对象,将其分为A、B两组。其中A组11例患者,采用Renaissance机器人植入皮质骨螺钉;B组13例患者采用C臂X线机透视徒手植入。比较两组术后皮质骨螺钉置入效果,以及术后、末次随访临床疗效的差异。结果所有患者均顺利完成手术。术后三维CT提示A组近端小关节侵犯率及螺钉准确性优于B组,差异有统计学意义(P<0.05)。患者随访6~19个月,平均随访时间为12.7个月。术后6个月随访提示所有患者椎间融合良好,未发现螺钉松动或断裂。术后及末次随访两组患者VAS评分和JOA均较术前改善(P<0.05);但组间不同时相点比较,差异无统计学意义(P>0.05)。结论对于骨质疏松患者,Renaissance机器人辅助下进行腰椎皮质骨螺钉置入更为安全。Objective To explore the application of robotic-assisted cortical bone screw in lumbar spine fixation in osteoporotic patients.Methods From June 2017 to September 2018,24 patients with osteoporosis and posterior fixation of the lumbar spine were selected.A cortical bone screw was implanted using the Renaissance robot in 11 patients(group A)and C-arm X-ray machine fluoroscopy in 13 patients(group B).There were 3 males and 21 females,with an average age of 57.2 years.Preoperative routine bone mineral density measurements showed that the T value of all patients was less than-2.5.Robot-assisted screw path design was performed according to three-dimensional computed tomography(CT)before the operation.The Renaissance robot-assisted cortical screw placement was used during the operation.All patients underwent three-dimensional CT examination after the operation.Patients were followed for 6-19 months,the average follow-up time was 12.7 months.Results The operation was successful in all patients.At the 6-month follow-up,all patients had good interbody fusion,and no patients were found with loose or broken screw.The 6-month postoperative follow-up showed that all patients had good intervertebral fusion,and no screw loosening or breakage was found.Although there was no significant difference in clinical results between the two groups after the operation and last follow-up,the proximal facet joint invasion rate and screw accuracy in group A were significantly better than those in group B.Conclusion Renaissance robot-assisted lumbar cortical screw placement is a safe and effective method for lumbar spine fixation in osteoporotic patients.

关 键 词：机器人辅助 骨质疏松 腰椎 皮质骨螺钉 螺钉松动 Renaissance机器人 螺钉固定 

分 类 号：R687.3[医药卫生—骨科学]