机器人与透视辅助经皮椎弓根螺钉置入的比较

Robotic-guided and fluoroscopy-guided percutaneous pedicle screw placement for thoracolumbar fractures

[目的]比较机器人辅助与透视辅助经皮椎弓根螺钉内固定治疗胸腰椎骨折的置钉早期临床与影像结果。[方法]2018年1月~12月,86例无神经损伤症状胸腰椎骨折患者行椎弓钉固定术,其中,42例采用机器人辅助置钉,44例采用常规透视辅助置钉,比较两组早期临床和影像学指标。[结果]两组患者术中失血量、住院时间和VAS评分差异无统计学意义(P>0.05)。机器人组手术时间、透视次数、透视剂量、透视时间均显著优于透视组(P<0.05)。机器人组置钉准确率为95.63%(241/252)高于透视组87.88%(232/264),差异具有统计学意义(P<0.05)。机器人组置钉的内倾角和螺钉与关节面的距离均显著大于透视组(P<0.05)。[结论]机器人辅助治疗胸腰椎骨折可提高置钉准确性,减少透视次数,减少透视时间,降低辐射量,提高手术安全性。

[Objective]To compare the early clinical and radiographic outcomes of robotic-guided and fluoroscopy-guided percutaneous pedicle screw placement for thoracolumbar fractures.[Methods]From January 2018 to December 2018,86 patients underwent pedicle screw fixations for thoracolumbar fractures without neurological injury.Of them,42 patients had the percutaneous pedicle screw placed with the robotic-guidance,while the remaining 44 patients had the screw inserted with conventional fluoroscopy-guidance.The early clinical and radiographic documents were compared between the two groups.[Results]Although no statistically significant differences in intraoperative blood loss,hospital stay and VAS scores were noticed between the two groups(P>0.05),the robotic-guided group proved significantly superior to the fluoroscopy-guided group regarding to operation time,fluoroscopy frequency,dosage and time of X-ray exposure(P<0.05).The accuracy of pedicle screws placed was of 95.6%(241/252)in the robotic-guided group,whereas 87.8%(232/264)in the fluoroscopy-guided group,which proved of statistical significance(P<0.05).In addition,the robotic-guided group had significantly greater convergence angle and distance from the screw to the facet articular surface than the fluoroscopy-guided group(P<0.05).[Conclusion]The robotguided percutaneous pedicle screw placement does take advantages of enhancing the insertional accuracy,saving operation time,reducing X-ray exposure and improving safety of operation over the conventional fluoroscopy guided technique for thoracolumbar fractures.