导航与机器人辅助颈椎螺钉内固定术的临床应用

Clinical application of cervical screw internal fixation under navigation and robot assistance

目的随着计算机技术和工业的发展,导航与手术机器人系统以其创伤小、手术操作时间短、精准、稳定和安全等特点,越来越多地运用在脊柱内固定手术中。本研究回顾性分析导航与机器人辅助颈椎螺钉内固定手术的临床应用病例,对其准确性和安全性进行评价。方法纳入2006年1月至2019年8月于北京积水潭医院脊柱外科行导航或机器人辅助颈椎手术的患者369例。手术的主要评价指标包括螺钉置钉精确率、手术时间以及术后5d内并发症发生率。根据Gertzbein-Robbins分类标准,对螺钉是否侵犯骨皮质的情况进行评估。结果369例患者均顺利完成手术,其中导航手术283例、机器人手术86例,手术时间为(195.1±93.6)min。症状在术后明显缓解,术中与术后5d内均未发生并发症。共置入颈椎螺钉1160枚,螺钉分类为A类1030枚、B类115枚、C类15枚。螺钉位置优秀率(A级)为88.8%,螺钉位置可接受率(A级+B级)为98.7%。结论导航与机器人系统辅助颈椎螺钉内固定术的准确性高、安全性好,是未来颈椎手术的发展方向。

Objective With the development of computer technology and industry, navigation and surgical robot systems are increasingly used in spine surgeries, because of their minimal invasiveness, short operation time, accuracy, stability and safety. This study retrospectively analyzed the clinical application of navigation and robot-assisted cervical screw placement, including accuracy and safety. Methods A total of 369 patients underwent navigation or robot-assisted cervical spine surgery at the Beijing Jishuitan Hospital between January 2006 and August 2019. The main measurements included the accuracy of screw placement, operation time, and complications within 5 days after surgery. The accuracy of screw placement was evaluated, according to the Gertzbein-Robbins classification criteria. Results All 369 patients completed their procedures, including 283 navigation guided procedures and 86 robot-assisted procedures. The operation time was 195.1±93.6 minutes. Symptoms were significantly relieved after surgery. No complications occurred during the surgery or within 5 days after surgery. A total of 1 160 cervical screws were placed. 1 030 screws were classified as Grade A, 115 as Grade B, and 15 as Grade C. The excellent screw position rate (Grade A) was 88.8%, and the acceptable rate (Grade A+B) was 98.7%. Conclusions Navigation and robotic system assisted cervical screw internal fixation is accurate and safe, and it is the direction for cervical spine surgery development.