3D打印模型辅助与骨科机器人在脊柱畸形矫形过程中的精准置钉

Precise screw placement of 3D printing model and orthopedic robot in spinal deformity

背景:脊柱畸形导致正常的椎弓根解剖结构发生变化,在脊柱畸形矫形术中置入椎弓根螺钉的难度增加。目的:探讨3D打印模型辅助与骨科机器人在脊柱畸形矫形术中的置钉准确率和单枚螺钉置入时间。方法:40例脊柱畸形患者依据手术方式不同可分为:观察组18例,采用骨科机器人辅助置入椎弓根螺钉,即在开放手术过程中运用机器人进行椎弓根螺钉路径规划,机械臂到达指定位置,置入导针、螺钉;对照组22例,采用3D模型辅助徒手置入椎弓根螺钉。依据GertzbeinRobbins分类标准评价置钉准确率,记录两组患者的单枚螺钉置入时间,比较两组之间的置钉准确率及单枚螺钉置入时间。研究方案的实施符合《赫尔辛基宣言》和甘肃省人民医院对研究的相关伦理要求。结果与结论:(1)两组之间置钉准确率比较差异无显著性意义(P>0.05),A类螺钉准确率,观察组85.9%(256/298)高于对照组79.9%(283/354)(P<0.05),B类、C类、D类螺钉准确率,两组间比较差异无显著性意义(P>0.05);(2)单枚螺钉置入时间两组间比较,差异无显著性意义[(4.01±0.61),(3.74±0.44)min/枚,P>0.05];(3)结果说明,骨科机器人辅助脊柱畸形矫形术中椎弓根螺钉置入,显著提高了A类螺钉置入的准确率,准确度高、有效、可行。

BACKGROUND:Spinal deformities lead to changes in the normal anatomical structure of the pedicle,and it is more difficult to insert pedicle screws during the correction of spinal deformities.OBJECTIVE:To investigate the accuracy of screw placement and single screw placement time in orthopedic surgery with 3 D printing model and orthopedic robot.METHODS:Totally 40 patients with spinal deformity were divided into two groups according to different surgical approaches.In the observation group,18 patients were placed with pedicle screw assisted by orthopedic robot;i.e.,in the process of open surgery,the robot was used to plan the pedicle screw paths;the manipulator reached the designated position;the guide needle and screw were placed.In the control group,22 cases were implanted with pedicle screw assisted by 3 D model.According to Gertzbein-Robbins classification standard,the accuracy of screw placement was evaluated.The time of single screw placement was recorded,and the accuracy and time of single screw placement were compared between the two groups.The protocol was performed in accordance with Declaration of Helsinki and the relevant ethical requirements of the Gansu Provincial Hospital.RESULTS AND CONCLUSION:(1)There was no significant difference in the accuracy of screw placement between the two groups(P>0.05).The accuracy of class A screw was significantly higher in the observation group 85.9%(256/298)than that in the control group 79.9%(283/354)(P<0.05).The accuracies of class B,class C and class D screw were not significantly different between the two groups(P>0.05).(2)The time of single screw placement was not significantly different between the observation group and the control group[(4.01±0.61),(3.74±0.44),P>0.05].(3)It is concluded that orthopedic robot assisted pedicle screw placement can significantly improve the accuracy of class A screw placement,which is highly accurate,effective and feasible.