机器人辅助与徒手置钉在腰椎翻修术早期结果比较

Comparison of early outcomes of robotic-assisted technique versus freehand screw placement in lumbar revision surgery

[目的]比较Renaissance机器人系统辅助椎弓根螺钉置入与徒手椎弓根螺钉置入在腰椎翻修手术中的安全性及准确性。[方法]回顾性分析2018年1月~2018年12月在本院行腰椎后路翻修手术的病例69例,其中使用Renaissance机器人系统辅助椎弓根螺钉置入共31例,使用传统徒手椎弓根螺钉置入38例。记录临床资料,并根据术后CT对螺钉精度进行Gertzbein Robbins分级,比较螺钉置入准确性。[结果]两组患者手术时间、术后出血量及手术相关并发症等差异无统计学意义(P>0.05)。机器人组术中出血量、术中透视次数显著少于徒手组(P<0.05)。机器人辅助组共置入螺钉152枚,术后CT评估显示:A级置钉137枚,B级置钉11枚,C级置钉4枚,没有D、E级置钉,置钉准确率97.37%。徒手组共置入螺钉194枚,术后CT评估显示:A级置钉129枚,B级置钉48枚,C级置钉15枚,D级置钉2枚,没有发现E级置钉,置钉准确率91.24%。在螺钉精度分级及螺钉准确性方面,机器人组优于徒手组,差异具有统计学意义(P<0.05)。[结论]与徒手置钉技术相比,Renaissance机器人系统辅助椎弓根螺钉置入在腰椎翻修手术中具有置钉精度高、且术中出血及术中透视次数少的优势。

[Objective] To compare the safety and accuracy of Renaissance robot assisted pedicle screw placement versus freehand technique in lumbar revision surgery. [Methods] A retrospective study was conducted on 69 patients who had lumbar revision surgery from January 2018 to December 2018. Among them, 31 patients had revision surgery performed with Renaissance robotic system assisted pedicle screw placement, whereas the remaining 38 patients were with traditional freehand pedicle screw placement. The documentations were compared between them, including the early clinical outcomes and the accuracy of pedicle screw placement measured on CT scans based on Gertzbein Robbins grading. [Results] Although there were no significant differences in operative time and complications between the two groups(P>0.05), the robot assisted group had significantly less intraoperative bleeding and the frequency of fluoroscopy than the freehand group(P<0.05). In the robotic assisted group,a total of 152 screws were inserted, which were marked as grade A in 137, grade B in 11, grade C in 4 grade and no grade D or E in any screws with accuracy rate of the screws placement of 97.37%(148/152). By comparison, 194 screws were placed in total in the freehanded group, which were rated as grade A in 129, grade B in 48, grade C in 15, grade D in 2 and no grade E in any screw, with accuracy rate of screw placement of 91.24%(177/194). The robot assisted technique was statistically superior to the freehand method in the accuracy of screw placement(P<0.05). [Conclusion] This Renaissance robot assisted pedicle screw placement has advantages of higher accuracy, less intraoperative bleeding and less intraoperative fluoroscopy over the traditional freehand screw placement.