机器人辅助经皮置钉与徒手Wiltse入路开放置钉治疗脊柱胸腰段骨折的疗效比较

Efficacy comparison of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture

目的比较机器人辅助经皮置钉与徒手Wiltse入路开放置钉治疗脊柱胸腰段骨折的疗效。方法采用回顾性队列研究分析2018年5月至2020年5月苏州大学附属第二医院收治的71例脊柱胸腰段骨折患者的临床资料,其中男52例,女19例;年龄22~54岁[(41.0±7.8)岁]。33例采用机器人辅助经皮置钉(A组),38例采用徒手Wiltse入路开放置钉(B组)。比较两组术中透视次数、手术时间、术中出血量、住院时间和并发症情况,术后3个月和6个月骨折愈合率,术前、术后3 d、3个月、6个月及末次随访时视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),术前、术后3 d及末次随访时伤椎前缘高度比和矢状位Cobb角,术后3 d A级+B级置钉率、关节突关节侵犯率。结果患者均获随访10~24个月[(15.2±4.4)个月]。两组术中透视次数和手术时间差异无统计学意义(P均>0.05)。A组术中出血量为100(100,135)ml,少于B组的160(120,200)ml(P<0.01)。A组住院时间为8(7,11)d,短于B组的12(10,16)d(P<0.01)。两组患者未发生术后感染、脊髓神经根损伤、脑脊液漏等并发症。两组术后3个月、6个月骨折愈合率差异无统计学意义(P均>0.05)。术后3 d A组VAS和ODI分别为3(2,4)分、21(18,23),低于B组的4(3,5)分、27(20,32)。(P<0.05或0.01),余各时相点两组间VAS及ODI差异无统计学意义(P均>0.05)。两组术后3 d和末次随访时伤椎前缘高度比和矢状位Cobb角差异无统计学意义(P均>0.05)。术后3 d A组A级+B级置钉率为96.5%(191/198),高于B组的90.4%(206/228)(P<0.05)。A组关节突关节侵犯率为4.0%(8/198),低于B组的11.8%(27/228)(P<0.01)。结论与徒手Wiltse入路开放置钉相比,机器人辅助经皮置钉治疗脊柱胸腰段骨折可以减少术中出血量,缩短住院时间,减轻术后早期疼痛,提高置钉准确性,降低侵犯关节突关节的风险。

Objective To compare the clinical efficacy of robot-assisted percutaneous screw implantation and free-hand open screw implantation by Wiltse approach in the treatment of thoracolumbar fracture.Methods A retrospective cohort study was performed to analyze the clinical data of 71 patients with thoracolumbar fracture admitted to Second Affiliated Hospital of Soochow University from May 2018 to May 2020.There were 52 males and 19 females,with age range of 22-54 years[(41.0±7.8)years].Of all,33 patients were treated with robot-assisted percutaneous screw implantation(Group A)and 38 patients were treated with free-hand open screw implantation by Wiltse approach(Group B).Following parameters were measured,including frequency of radiation exposure,operation time,intraoperative blood loss,length of hospital stay,incidence of complications,rate of fracture healing at 3 months and 6 months postoperatively,visual analogue scale(VAS)and Oswestry dysfunction index(ODI)at 3 days,3 months,6 months postoperatively and at the last follow-up,anterior vertebral body height ratio and sagittal Cobb angle preoperatively,at 3 days postoperatively and at the last follow-up,and rate of screw implantation of grade A and B and rate of facet joint violation at 3 days postoperatively.Results All patients were followed up for 10-24 months[(15.2±4.4)months].Frequency of radiation exposure and operation time showed no statistical differences between the two groups(both P>0.05).Intraoperative blood loss was 100(100,135)ml in Group A,less than 160(120,200)ml in Group B(P<0.01).Length of hospital stay was 8(7,11)days in Group A,shorter than 12(10,16)days in Group B(P<0.01).There were no complications such as infection,spinal nerve injury or cerebrospinal fluid leakage in both group.There were no significant differences between the two groups in the rate of fracture healing at 3 and 6 months postoperatively(all P>0.05).VAS and ODI in Group A was 3(2,4)points and 21(18,23)points at 3 days postoperatively,lower than 4(3,5)points and 27(20,32)points in Group B(P<0.05 or 0.01),and the two groups showed no significant differences in VAS and ODI at other time points(all P>0.05).There were no significant difference in the anterior vertebral body height ratio or sagittal Cobb angle between the two groups at 3 days postoperatively and at the last follow-up(all P>0.05).Rate of screw implantation of grade A and B was 96.5%(191/198)in Group A,higher than 90.4%(206/228)in Group B(P<0.05).Rate of facet joint violation was 4.0%(8/198)in Group A,lower than 11.8%(27/228)in Group B(P<0.01).Conclusion For thoracolumbar fracture,robot-assisted percutaneous screw implantation is superior to free-hand open screw implantation by Wiltse approach in terms of less bleeding,shorter hospitalization,earlier pain alleviation,higher accuracy of screw implantation and lower risk of facet joint violation.