导航系统与骨科机器人辅助置钉治疗下颈椎骨折脱位的疗效比较  

Comparative efficacy of navigation system and orthopedic robot‑assisted nail placement in the treatment of lower cervical fracture and dislocation

作　　者：程新楠 李帅 白胶胶 李庆达 雷育宽 朱雷 昌震[2] 赵志刚 黄云飞[2] 冯铭哲 闫亮[2] 惠华[2] 孔令擘 贺宝荣 Cheng Xinnan;Li Shuai;Bai Jiaojiao;Li Qingda;Lei Yukuan;Zhu Lei;Chang Zhen;Zhao Zhigang;Huang Yunfei;Feng Mingzhe;Yan Liang;Hui Hua;Kong Lingbo;He Baorong(Shaanxi University of Chinese Medicine,Xianyang 712046,China;Department of Spine Surgery,Honghui Hospital,Xi′an Jiaotong University School of Medicine,Xi′an 710054,China;Yan′an University School of Medicine,Yan′an 716099,China;Second Hospital of Lanzhou University(Second Clinical Medical College),Lanzhou 730030,China)

机构地区：[1]陕西中医药大学,咸阳712046 [2]西安交通大学医学院附属红会医院脊柱外科,西安710054 [3]延安大学医学院,延安716099 [4]兰州大学第二医院(第二临床医学院),兰州730030

出　　处：《中华创伤杂志》2025年第2期148-156,共9页Chinese Journal of Trauma

基　　金：陕西省重点研发计划(2023‑ZDLSF‑03)。

摘　　要：目的比较导航系统与骨科机器人辅助置钉治疗下颈椎骨折脱位的临床疗效。方法采用回顾性队列研究分析2021年5月至2022年10月西安交通大学医学院附属红会医院收治的49例下颈椎骨折脱位患者的临床资料,其中男38例,女11例;年龄29~61岁[(39.3±7.3)岁]。损伤节段:C312例,C411例,C58例,C69例,C79例。21例采用S8导航系统辅助置入颈椎椎弓根螺钉治疗(导航组,84枚螺钉),28例采用TINAVI骨科机器人辅助置入颈椎椎弓根螺钉治疗(机器人组,112枚螺钉)。比较2组总手术时长、单钉置入时长、总钉置入时长、螺钉距前方皮质距离、切口长度、术中辐射剂量、术中出血量、住院时长;术前及术后3 d椎间隙高度、Cobb角、椎体间滑移距离、美国脊髓损伤协会(ASIA)分级;术前和术后3 d、3个月及末次随访时视觉模拟评分(VAS)、日本骨科学会(JOA)评分、颈部功能障碍指数(NDI);螺钉置入准确率、术中邻近小关节侵犯率及术后并发症(感染、螺钉松动等)情况。结果患者均获随访12~16个月[(13.6±1.9)个月]。导航组总手术时长、螺钉距前方皮质距离、术中辐射剂量分别为(236.2±30.6)min、(2.0±0.2)mm、(374.3±90.3)mGy,明显短于或少于机器人组的(278.4±20.7)min、(10.6±2.9)mm、(448.4±77.9)mGy(P<0.01)。导航组单钉置入时长、总钉置入时长、切口长度、术中出血量分别为(3.5±0.4)min、(23.9±0.5)min、(9.1±2.4)cm、(422.2±30.4)ml,明显长于或多于机器人组的(2.6±0.2)min、(17.9±0.7)min、(6.6±2.6)cm、(360.3±56.3)ml(P<0.01)。2组间住院时长差异无统计学意义(P>0.05)。2组间术前及术后3 d椎间隙高度、Cobb角、椎体间滑移距离、ASIA分级差异均无统计学意义(P>0.05)。2组内术后3 d椎间隙高度、Cobb角、椎体间滑移距离、ASIA分级均较术前明显改善(P<0.05或0.01)。2组间术前和术后3 d、3个月及末次随访时VAS、JOA评分、NDI差异均无统计学意义(P>0.05)。2组Objective To compare the clinical efficacy of navigation system and orthopedic robot‑assisted nail placement in the treatment of lower cervical fracture and dislocation.Methods A retrospective cohort study was conducted to analyze the clinical data of 49 patients with fracture and dislocation of the lower cervical spine who were admitted to Honghui Hospital,Xi′an Jiaotong University School of Medicine from May 2021 to October 2022,including 38 males and 11 females,aged 29‑61 years[(39.3±7.3)years].Injury segments involved C3 in 12 patients,C4 in 11,C5 in 8,C6 in 9 and C7 in 9.Twenty‑one patients were treated with S8 navigation system(navigation group,84 screws),and 28 with TINAVI orthopedic robot(robot group,112 screws).The two groups were compared in terms of the total surgical duration,single screw placement time,total screw placement time,distance between the screw and the anterior cortex,incision length,intraoperative radiation dose,intraoperative blood loss and length of hospital stay.The height of intervertebral space,Cobb angle,sliding distance between vertebral bodies and American Spinal Injury Association(ASIA)grade were assessed before surgery and at 3 days after surgery.Visual analogue scale(VAS),Japanese Orthopedic Association(JOA)score and neck dysfunction index(NDI)before surgery,at 3 days,3 months after surgery and at the last follow‑up were compared.The accuracy of screw placement,intraoperative invasion rate of adjacent facet joints and rate of postoperative complications(infection,screw loosening,etc.)were evaluated.Results All the patients were followed up for 12‑16 months[(13.6±1.9)months].In the navigation group,the total surgical duration,distance from the screw to the anterior cortex and the intraoperative radiation dose were(236.2±30.6)minutes,(2.0±0.2)mm and(374.3±90.3)mGy respectively,which were significantly shorter or less than those in the robot group[(278.4±20.7)minutes,(10.6±2.9)mm and(448.4±77.9)mGy](P<0.01).The single screw placement time,total screw placement

关 键 词：颈椎 脊柱骨折 骨折固定术 TINAVI骨科机器人 

分 类 号：R683.2[医药卫生—骨科学]