机器人辅助经肌间隙置入椎弓根螺钉在胸腰段骨折手术治疗的临床研究

Effects of robot-assisted pedicle screw placement through wiltse approach in the surgical treatment of thoracolumbar fractures

目的 研究经肌间隙入路行胸腰椎骨折内固定术时采用骨科机器人辅助置钉对手术相关临床效果的影响。方法 前瞻性队列研究2019年1月至2021年3月,我院脊柱外科收治的胸腰椎骨折患者84例,均行经肌间隙椎弓根螺钉内固定术,在置入椎弓根螺钉时,43例(试验组)采取的置钉方式为骨科机器人辅助下置钉,41例(对照组)采取的置钉方式为X线透视辅助下徒手置钉,比较两组间的置钉精确性、椎体高度恢复、椎管内占位减少、手术时间、辐射剂量、术中出血量、疼痛视觉模拟评分(visual analogue scale,VAS)的差异。结果 试验组置钉精确性高于对照组,差异有统计学意义(P <0.05);试验组手术时间长于对照组,差异有统计学意义(P <0.05);两组间椎体高度恢复程度、椎管内占位减少程度、辐射剂量、术中出血量和VAS评分的差异无统计学意义(P> 0.05)。结论 在胸腰段骨折手术中,经肌间隙行椎弓根螺钉内固定时,采取骨科机器人辅助置入椎弓根螺钉的手术方式可以提高置钉的精确性、提升手术安全性、降低手术并发症的风险,但是会在一定程度上延长手术时间。

Objective To study the effect of orthopedic robot-assisted screw placement on thoracolumbar fracture internal fixation through Wiltse approach.Methods A cohort of 84 patients with thoracolumbar fracture were prospectively studied in Beijing Jishuitan hospital.All of them underwent internal fixation and pedicle screw placement through Wiltse approach.Patients were grouped according to robot-assisted pedicle screw placement (experimental group,n=43) or freehand fluoroscopy-assisted pedicle screw placement by a traditional technique (control group,n=41).The accuracy of screw placement,recovery of vertebral body height,reduction of space occupied in vertebral canal,operation time,radiation,intraoperative blood loss and VAS scores were compared between the two groups.Results The accuracy of screw placement in the experimental group was higher than that in the control group,and the differences were statistically significant (P < 0.05).The operation time of the experimental group was longer than that of the control group,and the differences were statistically significant (P < 0.05).There were no significant differences between the two groups in the recovery of vertebral body height,reduction of vertebral canal space,radiation dose,intraoperative blood loss and VAS.(P > 0.05).Conclusions In thoracolumbar fracture surgery,orthopedicrobot-assisted pedicle screw placement can improve the accuracy,enhance the surgical safety and reduce the risk of surgical complications,but it will prolong the operation time.