机器人辅助椎弓根螺钉置钉的准确性观察

Accuracy of robot-assisted pedicle screws placement

目的评估机器人辅助行椎弓根螺钉置钉的准确性并观察置钉并发症。方法回顾性分析2014年12月—2015年5月苏州大学附属第一医院骨科行机器人辅助椎弓根螺钉置入的13例患者临床资料。其中男6例，女7例；年龄41—73岁，平均56．5岁；L1爆裂性骨折2例，L2压缩性骨折1例，L4滑脱症4例，T12爆裂性骨折伴截瘫1例，L1陈旧性压缩性骨折伴后凸畸形1例，退行性侧弯1例，先天性脊柱侧弯术后翻修1例，腰椎间盘突出症伴椎管狭窄症1例，脊髓灰质炎后遗症性脊柱侧弯1例。采用GeRzbein和Robbins标准，CT定量分析椎弓根螺钉位置，并记录置钉所致并发症如神经根、血管、脊髓损伤等。结果由机器人辅助置钉成功12例，其中83枚螺钉由机器人成功辅助置入，1枚螺钉因术中机器人无法注册改为徒手置钉；另1例患者因术中发现机器人置钉的进针点偏差大，改为徒手置钉。根据Gertzbein和Robbins标准，A级80枚，B级2枚，C级1枚，置钉准确率达98．8％（82／83）。无置钉所致并发症如神经根、脊髓损伤及血管损伤等。结论机器人辅助椎弓根螺钉置钉精准性高，可减少或避免置钉所致并发症。

Objective To study the accuracy of robot-assisted pedicle screws placement and to observe the complications relate to the placement of pedicle screws. Methods From December 2014 to May 2015, robotic-assisted screw placement was used in 13 patients （6 males and 7 females） , including 2 cases of from L1 burst fracture, 1 case of L2 compression fracture in 1 case, 4 cases of L4 spondylolisthesis, 1 case of T12 bursting fracture with paraplegia, 1 case of L1 old compression fracture with kyphosis, 1 case of degenerative scoliosis, 1 case of congenital scoliosis revision, 1 case of lumbar intervertebral disc herniation with spinal stenosis and 1 case of sequela of poliomyelitis scoliosis. The mean age of the patients was 56.5 years old （ range, 41 - 73 ）. The accuracy of placement of the pedicle screws was evaluated according to the classification of Gertzbein and Robbins. Results Robotic-guided screw placement was successfully used in 12 out of 13 patients. In those 12 patients, 83 screws （84 planned screws） were successfully implanted. One screw was manually placed due to poor registration. According to classification of Gertzbein and Robbins, 80 screws belonged to grade A, 2 belonged to grade B, 1 belonged to grade C. And the rate of the accuracy of pedicle screws placement was 98.8% （82/83）. There was no complication such as nerve root, spinal cord and vessel injury resulted from pedicle screws placement. Conclusions The accuracy of robot- assisted pedicle screws placement is high. And it can reduce or avoid the complications resulted from pedicle screws placement.