机器人辅助引导经皮椎体成形术联合椎弓根成形术治疗无神经功能损害的症状性陈旧性胸腰椎骨质疏松性骨折

Robot‑assisted percutaneous vertebroplasty combined with pediculoplasty in treating symptomatic chronic thoracolumbar osteoporotic vertebral fracture without neurological impairment

目的比较机器人辅助和传统透视引导经皮椎体成形术(PVP)联合椎弓根成形术治疗无神经功能损害的症状性陈旧性胸腰椎骨质疏松性骨折(SCOVF)的疗效。方法采用回顾性队列研究分析2015年1月至2020年1月西安交通大学附属红会医院收治的120例无神经功能损害的SCOVF患者的临床资料,其中男34例,女86例;年龄63~85岁[(72.9±5.7)岁]。均采用PVP联合椎弓根成形术治疗,其中87例采用机器人辅助C形臂X线机引导穿刺(机器人组),33例采用C形臂X线机透视引导穿刺(传统组)。比较两组手术时间、骨水泥注射量、穿刺准确率;术前、术后1 d、1年及末次随访时椎体指数、后凸Cobb角、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);骨水泥渗漏或移位等并发症发生情况。结果患者均获随访24~36个月[(29.4±3.4)个月]。机器人组手术时间为(85.2±10.5)min,长于传统组的(37.2±3.7)min(P<0.01)。机器人组骨水泥注射量为(5.0±0.7)ml,少于传统组的(5.3±0.8)ml(P<0.05)。机器人组穿刺准确率为95.4%(83/87),高于传统组的81.8%(27/33)(P<0.01)。术前两组间椎体指数、后凸Cobb角、VAS及ODI差异无统计学意义(P均>0.05)。术后1 d、1年及末次随访时机器人组椎体指数分别为87.1±4.5、86.9±4.3、86.8±4.3,高于传统组的83.6±4.4、84.1±3.8、84.4±3.9(P均<0.01)。两组术后1 d、1年及末次随访时后凸Cobb角和ODI比较,差异无统计学意义(P均>0.05)。术后1 d、1年及末次随访时机器人组VAS分别为(2.9±1.0)分、(1.8±0.7)分、(1.8±0.7)分,低于传统组的(4.4±1.1)分、(3.1±0.8)分、(3.0±0.9)分(P均<0.01)。机器人组7例术中发生骨水泥渗漏[8.0%(7/87)];传统组10例术中发生骨水泥渗漏[30.3%(10/33)](P<0.01)。机器人组术后1 d至末次随访期间,未出现迟发性骨水泥移位[0.0%(0/87)],传统组3例出现迟发性骨水泥移位[9.1%(3/33)](P<0.05)。结论机器人辅助和传统透视引导PVP联合椎弓根成形术治疗无神经功能损害的SCOVF均可获得满意疗效,但前者具有穿刺准确率更高、伤椎高度恢复更满意、疼痛缓解更快、骨水泥渗漏率更低及有效避免出现骨水泥移位等优势。

Objective To compare the efficacy of robot‑assisted and conventional fluoroscopy‑guided percutaneous vertebroplasty(PVP)combined with pediculoplasty in treating symptomatic chronic thoracolumbar osteoporotic vertebral fracture(SCOVF)without neurological symptoms.Methods A retrospective cohort study was used to analyze the clinical data of 120 patients with thoracolumbar SCOVF without neurological symptoms,who were admitted to Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020.The patients included 34 males and 86 females,aged 63‑85 years[(72.9±5.7)years].All patients were treated with PVP combined with pediculoplasty.A total of 87 patients were treated with robot‑assisted and C‑arm X‑ray machine guided puncture(robot group)and 33 patients with C‑arm X‑ray machine fluoroscopic‑guided puncture(conventional group).The operation time,amount of bone cement injection and puncture accuracy were compared between the two groups.The results of vertebral body index,Cobb angle,visual analogue scale(VAS),and Oswestry disability index(ODI)were also compared before operation,at 1 day and 1 year after operation and at the final follow‑up.Complications such as bone cement leakage and displacement were observed.Results All patients were followed up for 24‑36 months[(29.4±3.4)months].The operation time was(85.2±10.5)minutes in the robot group,significantly longer than(37.2±3.7)minutes in the conventional group(P<0.01).The amount of bone cement injection was(5.0±0.7)ml in the robot group,significantly less than(5.3±0.8)ml in the conventional group(P<0.05).The puncture accuracy in the robot group was 95.4%(83/87),significantly higher than 81.8%(27/33)in the conventional group(P<0.01).There were no significant differences in vertebral body index,Cobb angle,VAS or ODI between the two groups before operation(all P>0.05).The values of vertebral body index were 87.1±4.5,86.9±4.3,86.8±4.3 in the robot group at 1 day after operation,1 year after operation and the final follow up,respectively,which were significantly higher than 83.6±4.4,84.1±3.8,84.4±3.9 in the conventional group(all P<0.01).There were no significant differences in Cobb angle or ODI between the two groups at 1 day after operation,1 year after operation or the final follow‑up(all P>0.05).The values of VAS were(2.9±1.0)points,(1.8±0.7)points,(1.8±0.7)points in the robot group at 1 day after operation,1 year after operation and the final follow‑up,respectively,which were significantly lower than(4.4±1.1)points,(3.1±0.8)points,(3.0±0.9)points in the conventional group(all P<0.01).The bone cement leakage occurred in 7 patients in the robot group[8.0%(7/87)]and in 10 in the conventional group[30.3%(10/33)](P<0.01).No delayed bone cement displacement[0.0%(0/87)]occurred in the robot group from 1 day after operation to the final follow‑up,but 3 patients[9.1%(3/33)]were noted in the conventional group(P<0.05).Conclusion Both robot‑assisted and conventional fluoroscopy‑guided PVP combined with pediculoplasty have satisfactory effect for SCOVF patients without neurological impairment,but the robot‑assisted one has the advantages of higher puncture accuracy,more satisfactory vertebral height recovery,more rapid pain relief,lower incidence of bone cement leakage and effective avoidance of cement displacement.