骨科机器人辅助与传统透视下经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的比较

Percutaneous vertebroplasty with robotic orthopedic assistance versus conventional fluoroscopy assistance for treatment of osteoporotic vertebral compression fractures: A clinical comparative study

目的比较骨科机器人辅助与传统透视辅助下经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCF)的临床疗效和安全性。方法将符合要求的180例OVCF患者随机分为两组,观察组应用天玑骨科机器人系统行PVP治疗,对照组采用C型臂透视辅助下行PVP治疗。记录并比较两组患者的手术时间、住院时间、穿刺内倾角度、骨水泥灌注量以及并发症发生情况,并分别于术前、术后1 d、术后1周、术后1月记录两组患者的腰背部疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)及手术椎体Cobb角。结果两组患者的住院时间及骨水泥灌注量差异无统计学意义(P>0.05);观察组手术时间较对照组均明显减少(P<0.05),穿刺内倾角度较对照组明显增大(P<0.05);手术后第1天、术后1周、术后1个月VAS评分以及ODI评分较术前明显降低,差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。术后复查伤椎Cobb角较术前无明显变化(P>0.05)。对照组有15例患者出现骨水泥渗漏入椎管,观察组骨水泥渗漏4例,组间差异有统计学意义(P<0.05)。结论骨科机器人辅助与传统透视辅助PVP治疗OVCF均能获得良好的临床疗效,前者能减少手术时间,降低骨水泥渗漏率,应用前景良好。

Objective To compare the clinical efficacy and safety of percutaneous vertebroplasty(PVP)with robotic orthopedic assistance versus conventional fluoroscopy assistance for treatment of osteoporotic vertebral compression fractures(OVCF).Methods A total of 180 patients with OVCF were randomly divided into experiment group,in which patients were treated with robot-assisted unilateral puncture vertebroplasty;and control group,in which patients were treated with manual unilateral puncture vertebroplasty.The operative time,hospital stay,the injection amount of bone cement,penetration angles,and complications were compared between the 2 groups.The low back pain visual analogue scale(VAS),Oswestry disability index(ODI)and Cobb angle were compared between the 2 groups before the operation and 1 day,1 week and 1 month after the operation.Results There was no significant difference in hospital stay and the injection amount of bone cement between the 2 groups.In the robot-assisted group,the operative time was significantly shorter than that of the conventional fluoroscopy group,but the penetration angle of the robot-assisted group was significantly larger(P<0.05).The VAS score and ODI index 1 day,1 week and 1 month after operation were significantly improved(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no significant difference in the Cobb angle between the two groups before and after operation(P>0.05).Among the 180 vertebrae,bone cement leakage into spinal canal was reported in 15 cases control group,and 4 case in experience group.There was significant difference between the two groups(P<0.05).Conclusion The clinical effect and of PVP with robot-assisted are similar to that of the conventional fluoroscopy,but the former can reduce operation time,and the leakage of bone cement.