骨科手术机器人系统辅助置入颈椎椎弓根螺钉的安全性研究

Surgical safety of cervical pedicle screw placement with orthopaedic surgery robot system

目的评估骨科手术机器人辅助置入颈椎椎弓根螺钉的准确性与安全性。方法回顾性分析2019年3月至2021年2月经颈椎后路在骨科手术机器人辅助下采用椎弓根螺钉固定技术治疗的33例患者资料,男19例、女14例;年龄26~75岁,平均50.5岁。上颈椎骨折脱位14例(其中骨折不愈合2例)、上颈椎及下颈椎同时骨折脱位1例、颈椎脊髓损伤合并椎管狭窄2例、颈椎管狭窄9例、枕颈部畸形2例、颈椎病术后翻修2例、颈椎椎管内肿瘤3例。使用基于术中三维"C"型臂X线机透视的导航机器人系统辅助颈椎后路手术置钉,于C1~C7共置入151枚椎弓根螺钉。其中上颈椎置入螺钉74枚,下颈椎置入螺钉77枚。术后7 d内使用CT扫描获取影像数据,采用Neo分级评估颈椎椎弓根螺钉置入的准确性。术后随访2周观察患者临床症状和体征,判断有无神经、血管损伤和切口感染等手术并发症。结果根据Neo分级,术后138枚螺钉完全包含在椎弓根中,未突破椎弓根皮质,评价为Neo 0级,占91.4%(138/151)。其中C_(1)螺钉置入准确率为97.1%(34/35),C_(2)为92.3%(36/39),C_(3)为88.2%(15/17),C_(4)为71.4%(10/14),C5为85.7%(12/14),C_(6)为93.3%(14/15),C_(7)为100.0%(17/17)。螺钉置入准确率最高的是C7,最低的是C4。对C_(1)~C_(7)置钉准确性行Kruskal-Wallis秩和检验,差异无统计学意义(χ^(2)=1.31,P=0.971)。共13枚螺钉突破椎弓根皮质,其中9枚突破外侧皮质,4枚突破内侧皮质,未发生任何与椎弓根螺钉相关的神经或血管并发症。术后无一例发生切口感染。结论骨科手术机器人系统辅助可以有效保障颈椎椎弓根螺钉置入的安全性。

Objective To evaluate the accuracy and safety of cervical pedicle screw(CPS)placement under orthopaedic robot navigation system guidance.Methods From March 2019 to February 2021,the data of 33 patients(19 males and 14 females,aged from 26 to 75 years,with an average age of 50.5 years)treated with pedicle screw fixation with the assistance of orthopaedic surgery robot through the posterior cervical spine were retrospectively analyzed.In clinical diagnosis,there was upper cervical fracture with instability in 14 patients(fracture nonunion in 2 patients),upper&subaxial cervical fracture in 1 patient,cervical spinal cord injury with spinal stenosis in 2 patients,cervical spinal stenosis in 9 patients,occipitocervical deformity in 2 patients,post-operative revision of cervical spondylosis in 2 patients,cervical intraspinal tumor in 3 patients.A total of 151 CPSs were inserted in C_(1)-C_(7) using robot navigation system based on intraoperative three-dimensional C-arm fluoroscopy to assist in screw placement in posterior cervical surgery.Among them,74 screws were implanted into upper cervical spine;77 screws were implanted in the lower cervical spine.CT was used to obtain image data within 7 days after operation,and Neo classification was used to evaluate the accuracy of cervical pedicle screw placement.The patients were followed up for 2 weeks to observe the clinical symptoms and signs,and to determine whether there were surgical complications such as nerve and blood vessel injury and incision infection.Results According to Neo classification,91.4%(138/151)screws were completely contained in the pedicle without breaking through the pedicle cortex(grade 0).Among them,the accuracy of C_(1) screws was 97.1%(34/35),C_(2) screws was 92.3%(36/39),C_(3) screws was 88.2%(15/17),C_(4) screws was 71.4%(10/14),C_(5) screws was 85.7%(12/14),C_(6) screws was 93.3%(14/15),C_(7) screws was 100.0%(17/17).The screw accuracy was highest in C_(7),the lowest in C4.The Kruskal-Wallis H test was performed on the accuracy of screw placement in different cervical level,and the results showed that there was no statistical difference(χ2=1.31,P=0.971).However,a total of 13 screws were found to perforate the cortex of pedicle,although any neural or vascular complications associated with CPS placement were not encountered.Among them,9 screws were found to perforate laterally,and 4 screws were found to perforate medially.No postoperative incision infection occurred in all cases.Conclusion The safety of CPS placement can be effectively guaranteed with the assistance of the orthopaedic robot system.