机器人辅助手术治疗胸腰椎骨折

Robot assisted surgery for thoracolumbar fracture

目的探讨机器人辅助后路复位内固定置钉精准度及治疗胸腰椎骨折的临床疗效。方法纳入2019年3—7月未经椎管减压的胸腰椎骨折患者33例,其中11例接受机器人辅助下复位内固定(机器人组),22例行常规切开复位内固定(常规组)。记录手术时间、术中出血量、住院时间,记录术前、术后3 d及末次随访时Oswestry功能障碍指数(ODI)和疼痛视觉模拟量表(VAS)评分,根据术后CT复查螺钉的位置予以Gertzbein-Robbins分级以评估置钉精准度。结果所有手术顺利完成,患者随访3~7个月,平均5.31个月。机器人组术中出血量及住院时间优于常规组,手术时间较常规组长,差异均有统计学意义(P<0.05)。2组术前及末次随访ODI和VAS评分差异均无统计学意义(P>0.05);机器人组术后3 d ODI和VAS评分优于常规组,差异均有统计学意义(P<0.05)。术后复查CT,按Gertzbein-Robbins分级评估置钉精准度,机器人组可接受螺钉占比89.13%(41/46),明显高于常规组的81.06%(107/132),差异有统计学意义(P<0.05)。结论机器人辅助后路复位内固定治疗胸腰椎骨折虽手术时间长于常规手术,但置钉精准度高、安全有效,且手术微创,术后患者能快速康复,是值得推广和进一步发展的技术。

Objective To investigate the accuracy of robot assisted posterior reduction and internal fixation and its clinical outcome of thoracolumbar fractures.Methods From March to July 2019,33 patients with thoracolumbar fractures without spinal canal decompression were admitted to hospital for surgical treatment,among whom 11 were treated with robot-assisted reduction and internal fixation(robot group),22 were treated with conventional open reduction and internal fixation(convention group).The operation time,intraoperative blood loss and hospital stay were recorded.The Oswestry disability index(ODI)and pain visual analogue scale(VAS)score were recorded at pre-operation,postoperative 3 d and final follow-up.The accuracy of pedicle screws was evaluated by Gertzbein-Robbins grading according to the position of screws on postoperative CT.Results All the operations were successfully completed.The patients were followed up for 3-7 months,mean 5.31 months.The intraoperative blood loss and hospital stay were better in the robot group than in the convention group,and the operation time was longer than convention group,all with a statistical significance(P<0.05).There was no significant difference in ODI and VAS score between the 2 groups before operation and at the final follow-up.ODI and VAS score at postoperative 3 d were lower in the robot group than in the convention group,with a statistical significance(P<0.05).The accuracy of pedicle screw was assessed by Gertzbein-Robbins grading of postoperative CT,and the acceptable screw in the robot group was significantly higher than that in the convention group[89.13%(41/46)vs.81.06%(107/132)],with a statistical significance(P<0.05).Conclusion Although the operation time of robot assisted posterior reduction and internal fixation for thoracolumbar fracture is longer than that of conventional operation,but safe and effective,with high accuracy of pedicle screws and minimally invasive,and the patients can recover quickly after the operation,thus being worthy of promotion and further development.