机器人辅助椎弓根置钉满意度的影响因素分析

Risk factors of robot assisted spinal pedicle screw dislocation

目的探讨机器人辅助椎弓根置钉满意度的危险因素。方法选择2020年1月~2021年9月在本院接受机器人辅助下椎弓根螺钉置入术的166例脊柱疾病患者(1066枚椎弓根螺钉)作为研究对象,所有螺钉置入情况均按Gertzbein-Robbins分类进行评估,A和B级定义为置入满意,C-E级被定义为不满意。收集患者的性别、年龄、体质量指数(body mass index,BMI)、骨密度(bone mineral density,BMD)、疾病类型、椎体旋转程度、螺钉放置类型、手术医师等资料,观察影响螺钉置入满意率的独立影响因素。结果1066枚螺钉置入满意980枚,占91.93%;螺钉置入不满意86枚,占8.07%。螺钉置入满意和不满意组的性别、不同医师等资料差异无统计学意义(P>0.05);两组的年龄、BMI、椎体旋转、手术原因、螺钉置入方式和翻修手术等资料差异存在统计学意义(P<0.05)。多因素Logistic回归分析显示,BMD、BMI、椎体旋转、先天性脊柱侧凸是影响机器人辅助椎弓根螺钉置入不满意的风险因素(P<0.05)。结论机器人辅助椎弓根置钉满意度的影响因素包括骨质疏松、肥胖、椎体旋转、先天性脊柱侧凸等,对于复杂情况,应考虑计算机导航放置等多种技术以提高螺钉置入的准确性。

Objective To explore the risk factors of robot assisted spinal pedicle screw dislocation.Methods A total of166 patients with spinal diseases(1066 pedicle screws)who underwent robot assisted pedicle screw implantation in our hospital from January 2020 to September 2021 were selected as the research objects.All screws were evaluated according to Gertzbein-Robbins classification.The data of gender,age,body mass index(BMI),bone mineral density(BMD),disease type,degree of vertebral rotation,type of screw placement and surgeon were collected to observe the risk factors affecting the satisfaction rate of screw placement.Results Among 1066 screws,980 were satisfactory,accounting for 91.93%,and 86 were unsatisfactory,accounting for 8.07%.There was no significant difference in the satisfaction rate of screw placement between male and female patients(P>0.05).There was no significant difference in the satisfaction rate of screw placement among different doctors(P>0.05).There were significant differences in age,BMI,vertebral rotation,causes of surgery,methods of screw placement and revision surgery between satisfactory and unsatisfactory groups(P<0.05).Multivariate logistic analysis showed that BMD,BMI,vertebral rotation and congenital scoliosis were the risk factors of unsatisfactory robot assisted pedicle screw placement(P<0.05).Conclusion The factors affecting robot assisted pedicle screw placement include osteoporosis,obesity,vertebral rotation,congenital scoliosis and so on.For complex situations,various technologies such as computer navigation placement should be considered to improve the accuracy of screw placement.