骨科机器人辅助置钉在青少年特发性脊柱侧弯矫形中的应用

Application of orthopedic robot-assisted screw placement in the correction of adolescent idiopathic scoliosis

背景:青少年型特发性脊柱侧弯矫形术中置入椎弓根螺钉的难度大,研究表明机器人辅助青少年型特发性脊柱侧弯手术可提高椎弓根置钉的准确性、减少术中出血量。目的:探讨骨科天玑机器人在青少年特发性脊柱侧弯矫形术中辅助置钉的安全性及准确性。方法:回顾性分析2018年6月至2022年3月40例采用后入路椎弓根钉固定矫形术符合选择标准青少年特发性脊柱侧弯患者的临床资料。依据辅助设备的不同分为C形臂X射线配合天玑机器人辅助置钉组(机器人组18例)和单纯C形臂X射线辅助下徒手置钉组(徒手组22例)。比较两组患者围术期、随访时的各项指标及影像学资料,包括目测类比评分、日本骨科协会(JOA)评分、手术时间,术中出血量、术中透视次数、住院时间、脊柱矫正率、置钉准确率。结果与结论:(1)两组手术均顺利完成,术后平均随访(8.45±1.81)个月;(2)机器人组患者术中透视次数、术中出血量显著少于徒手组,手术时间长于徒手组,差异均有显著性意义(P<0.05);(3)与术前相比,两组末次随访时目测类比评分、JOA评分均明显改善(P<0.05);(4)术后影像学复查显示,两组患者术后主弯Cobb角均较术前明显减小(P<0.05);(5)机器人组置入306枚螺钉,置钉准确率为95.8%,其中A级螺钉置钉准确率为90.2%;徒手组置入354枚,置钉准确率为91.0%,其中A级螺钉置钉准确率为81.4%;两组之间置钉准确率比较差异有显著性意义(P<0.05),机器人组A级螺钉置入准确率明显高于徒手组(P<0.05);(6)与单纯X射线辅助下徒手置钉相比,天玑机器人辅助下椎弓根螺钉置入更加安全、准确。

BACKGROUND:It is difficult to insert pedicle screws in the correction of adolescent idiopathic scoliosis.Research shows that robot-assisted surgery for adolescent idiopathic scoliosis can improve the accuracy of pedicle screw placement and reduce intraoperative bleeding.OBJECTIVE:To explore the safety and accuracy of the orthopedic Tianji robot in the correction of adolescent idiopathic scoliosis.METHODS:The clinical data of 40 cases of adolescent idiopathic scoliosis treated with posterior pedicle screw fixation from June 2018 to March 2022 were analyzed retrospectively.According to the difference in auxiliary equipment,the patients were divided into a robot group(C-arm X-ray combined with a robotassisted screw placement;n=18)and an unarmed group(simple C-arm X-ray-assisted screw placement;n=22).The indexes and imaging data of patients of the two groups during the perioperative period and follow-up period were compared,including the visual analog scale score,the Japanese Orthopaedic Association score,the operation time,the intraoperative blood loss,the number of intraoperative fluoroscopy times,the length of hospital stay,the spinal correction rate,and the accuracy rate of nail placement.RESULTS AND CONCLUSION:(1)The operations of the two groups were completed successfully,and all the patients were followed up for(8.45±1.81)months after the procedure.(2)The number of intraoperative fluoroscopy times and intraoperative blood loss were significantly less and operation time was significantly longer in the robot group compared with the unarmed group(P<0.05).(3)Compared with the preoperative procedure,the visual analog scale score and Japanese Orthopaedic Association score of the two groups were significantly improved at the last follow-up(P<0.05).(4)Postoperative imaging examination showed that the Cobb angle of the main bend in both groups was significantly lower than that before the operation(P<0.05).(5)Three hundred and six screws were placed in the robot group,and the accuracy of placing screws was 95.8%,while the accuracy of grade A screws was 90.2%.Three hundred fifty-four nails were implanted in the unarmed group,and the accuracy of nail implantation was 91.0%,while the accuracy of grade A screw implantation was 81.4%.There was a significant difference in the accuracy of nail implantation between the two groups(P<0.05),and the accuracy of grade A screw implantation in the robot group was significantly higher than that in the unarmed group(P<0.05).(6)The C-arm X-ray combined with a robot-assisted screw placement is safer and more accurate than the simple C-arm X-ray-assisted screw placement.