机器人辅助经皮椎弓根螺钉内固定在基层医院的应用

Robot assisted percutaneous pedicle screw placment in primary medical institution

[目的]探讨机器人辅助经皮椎弓根螺钉内固定在基层医院的应用价值。[方法]南昌县人民医院2020年9月-2021年9月内固定治疗46例胸腰椎骨折患者,根据医患沟通结果,22例采用机器人辅助置钉,24例采用传统徒手置钉,比较两组早期临床和影像资料。[结果]机器人组平均透视次数和手术时间均显著少于徒手组(P<0.05)。机器人组置钉准确率Gertz⁃bein-Robbins分级显著优于徒手组(P<0.05)。两组患者均随访6~8个月,两组完全负重活动时间的差异无统计学意义(P>0.05),两组术后VAS和ODI评分均较术前显著降低(P<0.05),但相应时间点两组间比较差异均无统计学意义(P>0.05)。两组患者术后伤椎前缘高度和Cobb角均较术前显著改善(P<0.05),相应时间点两组间影像测量指标的差异均无统计学意义(P>0.05)。[结论]机器人辅助基层医生行经皮椎弓根螺钉内固定,能够减少透视次数和手术时间,提高置钉准确率,对于基层医院具有应用价值。

[Objective]To explore and analyze the application value of robot-guided percutaneous pedicle screw placement in the pri⁃mary medical institution.[Methods]A total of 46 patients received internal fixation of thoracolumbar fracture in People's Hospital of Nan⁃chang County from September 2020 to September 2021.Based on preoperative patient-doctor communication,22 patients underwent robot assisted pedicle screw placement,while the remaining 24 patients had pedicle screw placed by traditional free-hand technique.The clini⁃cal and image data were compared between the two groups.[Results]The robot group proved significantly superior to the free-hand group in terms of number of fluoroscopy and operation time(P<0.05).The two groups were followed up for 6~8 months,and there was no signifi⁃cant difference in the fracture healing time between the two groups(P>0.05).The VAS scores and ODI scores significantly reduced in both groups postoperatively(P<0.05),nevertheless there was no significant difference between the two groups at the corresponding time points(P>0.05).The robot group was significantly superior to the free-hand group in Gertzbein-Robbins scale of screw placement accuracy(P<0.05).The anterior vertebral height and local kyphotic Cobb angle of the injured vertebrae in the two groups were significantly improved af⁃ter operation(P<0.05),whereas which were not significantly different between the two groups at the corresponding time points(P>0.05).[Conclusion]The robot-assisted percutaneous pedicle screw insertion does reduce the number of fluoroscopy and operation time,improve the accuracy of screw placement,which has application value for primary hospitals.