骨科机器人辅助下经皮微波消融联合椎体成形术治疗脊柱转移瘤应用探讨

Application and exploration of Robot-assisted percutaneous microwave ablation combined with vertebroplasty on the treatment of spinal metastases

目的探讨骨科机器人辅助下经皮微波消融联合椎体成形术在脊柱转移瘤手术治疗中的安全性及优势。方法回顾性分析2019—2021年间甘肃省人民医院骨软科收治的41例无脊髓压迫症状脊柱单发或多节段脊柱转移瘤患者的临床资料。所有患者被分为机器人辅助组(21例)和传统透视组(20例)。术前均行X线、CT及MRI检查进行全身评估及脊柱转移瘤相关评分。手术均由同一主刀医师完成,记录两组患者手术时间、出血量、透视次数、椎弓根突破率及骨水泥渗漏情况;术后对比分析两组患者VAS评分、椎体中线高度。结果机器人辅助组手术时间[(369.4±68.5)min]、术中出血量[(665.6±282.5)ml]、术中透视次数[(10.5±1.8)次]较对照组[(550.2±100.3)min、(1089.6±368.6)ml、(16.2±3.3)次]少(均P<0.05)。椎弓根突破率[(5.8±0.4)%]、骨水泥渗漏率[(6.9±0.5)%]较对照组[(20.8±1.5)%、(22.3±1.8)%]低(均P<0.05)。术后两组患者VAS评分、椎体中线高度均相近(均P>0.05)。结论骨科机器人辅助下经皮微波消融联合椎体成形术在脊柱转移瘤手术治疗中可缩短手术时间、减少出血量、降低透视次数、降低椎弓根突破率及骨水泥渗漏率,具有较高的安全性。

Objective To investigate the safety and advantages of robot-assisted percutaneous microwave ablation combined with vertebroplasty in the surgical treatment of spinal metastases.Methods The clinical data of 41 patients with single or multi-level spinal metastases without neurological injury were retrospectively analyzed from February 2019 to February 2021.They were divided into robot assisted group(n=21)and traditional fluoroscopy group(n=20).Preoperative X-ray,CT,and MRI examinations were performed to evaluate the whole body and score related to spinal metastases.All operations were performed by the same surgeon.The operative time,blood loss,fluoroscopy times,pedicle breakthrough rate,puncture inclination and bone cement leakage were recorded in 2 groups.VAS score and midline height of vertebral body in 2 groups were compared and analyzed after operation.Results Compared with the control group,the operative time[(369.4±68.5)min],intraoperative blood loss[(665.6±282.5)ml]and intraoperative fluoroscopy times[(10.5±1.8)times]in the robot-assisted group were less in the control group[(550.2±100.3)min,(1089.6±368.6)ml,(16.2±3.3)times](all P<0.05).The pedicle breakthrough rate[(5.8±0.4)%]and the bone cement leakage rate[(6.9±0.5)%]were lower than those in the control group[(20.8±1.5)%,(22.3±1.8)%](all P<0.05).The puncture inclination of robot-assisted group was higher than that of traditional fluoroscopy group(all P<0.05).There was no significant difference in postoperative VAS score and midline height of vertebral body between 2 groups(all P>0.05).Conclusions Robot-assisted percutaneous microwave ablation combined with vertebroplasty in the surgical treatment of spinal metastases can shorten the operation time,reduce the amount of blood loss,and reduce the number of fluoroscopy,reduce the pedicle breakthrough rate and the rate of bone cement leakage,which has a high safety.