脊柱外科三种导航技术辅助椎弓根螺钉植入精确度的比较

Accuracy of Pedicle Screw Insertion among 3 Assisted Technologies in Spine Surgery

目的:分析脊柱机器人与其他导航工具在治疗腰椎退行性疾病时辅助椎弓根螺钉植入的精确度差异。方法:使用脊柱机器人(第1组)对39名患者植入176枚椎弓根螺钉,使用导航模板(第2组)在28例患者中植入134枚螺钉,51例患者通过O-臂导航植入234枚螺钉(第3组)。应用术后CT扫描并根据Rampersaud A^D分级评估螺钉植入的精确度,同时收集其他临床资料。结果:"完美"椎弓根螺钉植入(A级),1~3组精确度分别为90.34%,91.79%,84.19%."临床可接受"螺钉植入(A级+B级),1~3组精确度分别为94.32%,95.52%,90.60%.矢状位偏移角度分别为3.14°±9.28°,2.33°±10.38°,4.40°±7.25°;横断位偏移角度分别为3.26°±8.21°,3.39°±7.00°,4.10°±9.02°.统计分析显示,第1组与第2组、第3组分别相比,其"完美和临床可接受"以及矢状位、横断位偏移精确度差异无统计学意义(P<0.05)。结论:机器人引导技术相比于导航模板或O-臂导航系统,在辅助螺钉植入时并未显示出明显的精确度差异,但其显著减少了不良事件发生率及术中失血量。

Objective:To study the difference of accuracy of pedicle screw insertion between spine robot and other two assisted tools for the treatment of lumbar degenerative disease.Methods:A total of 176 pedicle screws were inserted in 39 patients using spine robot(group 1),134 screws were implanted in 28 patients using navigational template(group 2),234 screws in 51 patients by O-arm-based navigation(group 3).The screw position was evaluated using postoperative CT scans according to Rampersaud A^D classification.Other secondary datas have been collected too.Results:"Perfect"pedicle screw insertion(Grade A)with the accuracy of 90.34%,91.79%and 84.19%were revealed respectively in the group 1~3."Clinically acceptable"screw implantation(Grade A+B)with the accuracy of 94.32%,95.52%and 90.60%were revealed respectively in the group 1~3.Sagittal offset angles were 3.14°±9.28°,2.33°±10.38°,and 4.40°±7.25°.Transversal offset angles were 3.26°±8.21°,3.39°±7.00°and 4.10°±9.02°.No statistically significant difference was found between1 group and other two groups in the accuracy of"Perfect and Clinical acceptable"as well as sagittal or transversal offset(P<0.05).Conclusion:Robotic-assistance technology seem not to shows high-accuracy than navigation template or O-arm system for screw implantation,but it significantly reduced adverse events,postoperative stay and blood loss.