机器人辅助下经皮微创椎弓根螺钉内固定与传统开放内固定治疗胸腰椎骨折的短期疗效比较

Short-term effectiveness comparison between robotic-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in treatment of thoracolumbar fractures

目的比较机器人辅助下经皮微创椎弓根螺钉内固定与传统开放内固定治疗胸腰椎骨折的短期疗效。方法回顾分析2018年1月-5月收治的52例无神经损伤症状胸腰椎骨折患者临床资料,根据手术方式不同分为微创组(24例,采用机器人辅助下经皮微创椎弓根螺钉内固定治疗)和开放组(28例,采用传统开放内固定治疗)。两组患者性别、年龄、致伤原因、骨折节段、胸腰椎损伤分类和损伤程度评分(TLICS)及术前腰痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、固定节段高度及固定节段后凸Cobb角等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、住院时间,以及两组患者术前,术后3 d、1个月、6个月、10个月腰痛VAS评分、ODI评分、固定节段高度及固定节段后凸Cobb角。术后1~3 d复查CT,根据Gertzbein-Robbins分类标准判断并计算植钉准确率。结果微创组手术时间显著长于开放组,但术中出血量和住院时间均显著短于开放组,差异均有统计学意义(P<0.05)。微创组和开放组分别植入椎弓根螺钉132枚和158枚,根据Gertzbein-Robbins分类标准,植钉准确率分别为97.7%(129/132)和96.8%(153/158),比较差异无统计学意义(χ^2=0.505,P=0.777)。两组患者均获随访10个月,术后均未出现排斥反应、内固定物断裂等情况。微创组于术后10个月取出内固定物,开放组不取出。术后各时间点两组腰痛VAS评分、ODI评分、固定节段高度及固定节段后凸Cobb角均较术前有不同程度改善(P<0.05)。除术后3 d微创组腰痛VAS评分和ODI评分显著优于开放组(P<0.05)外,其余各时间点各指标两组间比较差异均无统计学意义(P>0.05)。结论机器人辅助下经皮微创椎弓根螺钉内固定治疗胸腰椎骨折在术中出血量、住院时间、术后早期临床疗效等方面优势显著,骨折复位效果良好。

Objective To compare short-term effectiveness between robot-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in the treatment of thoracolumbar fractures.Methods The clinical data of 52 cases of thoracolumbar fracture without neurological injury symptoms admitted between January 2018 and May 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into minimally invasive group(24 cases, treated with robot-assisted percutaneous minimally invasive pedicle screw internal fixation) and open group(28 cases, treated with traditional open internal fixation). There was no significant difference between the two groups in the general data such as gender, age, cause of injury, fracture segment, thoracolumbar injury classification and severity score(TLICS), preoperative back pain visual analogue scale(VAS) score,Oswestry disability index(ODI) score, fixed segment height, and fixed segment kyphosis Cobb angle(P>0.05). The operation time, intraoperative blood loss, and hospitalization time of the two groups were recorded and compared;as well as the VAS score, ODI score, fixed segment height, and fixed segment kyphosis Cobb angle of the two groups before operation and at 3 days, 1 month, 6 months, and 10 months after operation. CT scan was reexamined at 1-3 days after operation, and the pedicle screw insertion accuracy rate was determined and calculated according to Gertzbein-Robbins classification standard. Results The operation time of the minimally invasive group was significantly longer than that of the open group, but the intraoperative blood loss and hospitalization time were significantly shorter than those of the open group(P<0.05). There were 132 pedicle screws and 158 pedicle screws implanted in the minimally invasive group and the open group respectively. According to the Gertzbein-Robbins classification standard, the accuracy of pedicle screws was97.7%(129/132) and 96.8%(153/158), respectively, showing no significant difference between the two groups(χ2=0.505,P=0.777). The patients in both groups were followed up 10 months, and there was no rejection or internal fixation fracture. In the minimally invasive group, the internal fixator was removed at 10 months after operation, but not in the open group. The VAS score, ODI score, fixed segment heigh, and fixed segment kyphotic Cobb angle of the two groups were improved in different degrees when compared with preoperative ones(P<0.05). Except that the VAS score and ODI score of the minimally invasive group were significantly better than those of the open group at 3 days after operation(P<0.05), there was no significant difference between the two groups at other time points(P>0.05). Conclusion Robotassisted percutaneous minimally invasive pedicle screw internal fixation for thoracolumbar fractures has significant advantages in intraoperative blood loss, hospitalization time, and early postoperative effectiveness and other aspects, and the effect of fracture reduction is good.