骨科手术机器人辅助与X线透视辅助下徒手皮质骨轨迹螺钉置入治疗单节段退行性腰椎疾病的临床对比研究

Clinical comparative study of robot-assisted and fluoroscopy-assisted free-hand cortical bone trajectory screw placement in the treatment of single-level degenerative lumbar diseases

目的对比骨科手术机器人辅助与徒手皮质骨螺钉置钉在脊柱内固定手术中的安全性与准确性。方法回顾分析2019年12月至2021年6月于首都医科大学附属北京朝阳医院骨科接受皮质骨轨迹螺钉(cortical bone trajectory,CBT)治疗单节段退行性腰椎疾病的71例患者。将接受X线透视辅助徒手CBT螺钉置入的患者作为徒手组(n=35),接受机器人辅助CBT螺钉置入的作为机器人组(n=36)。螺钉置钉准确性和关节突侵犯情况通过术后电子计算机断层扫描(computed tomography,CT)三维重建评估。对比两组平均单枚螺钉的置钉时间、术中出血量及医务人员术中射线暴露情况。结果71例患者一共植入284枚CBT螺钉,其中140枚由徒手组完成,144枚由机器人组完成。机器人组的准确率显著高于徒手组(92.36%vs 82.86%,P=0.015)。机器人组关节突侵犯发生率显著低于徒手组(22.22%vs 40.00%,P=0.022)。但是,单颗螺钉置钉时间机器人组显著长于徒手组[(501.92±70.08)s vs(382.54±63.21)s,P=0.000]。术中医务人员辐射暴露时间徒手组明显高于机器人组[(56.81±16.09)s vs(34.43±16.91)s,P=0.000]。结论机器人辅助植入CBT螺钉可以有效提高螺钉置入准确性并减少了上关节突的侵犯率和医务人员的辐射暴露,但会增加螺钉的置钉时间与手术时间。本中心大约在12台手术后获得了平稳的机器人辅助CBT技术学习曲线。

Objective To compare the safety and accuracy of robotic-assisted and free-hand cortical screw placement in spinal internal fixation.Methods A total of 71 patients who underwent cortical bone trajectory screw(CBT)for single-level degenerative lumbar spine disease at our center from December 2019 to June 2021 were retrospectively analyzed.Patients receiving fluoroscopy-assisted free-hand CBT screw placement were assigned to the free-hand group(FG,n=35)and robot-assisted CBT screw placement was assigned to the robot-assisted group(RG,n=36).Screw placement accuracy and facet violation were assessed by three-dimensional reconstruction of postoperative computed tomography(CT).The average screw placement time,intraoperative blood loss,and intraoperative radiation exposure of medical staff were compared between the two groups.Results A total of 284 CBT screws were implanted in 71 patients,140 of which were completed by the FG and 144 screws by the RG.Robot-assisted nailing was significantly more accurate than free-hand nailing(92.36%vs 82.86%,P=0.015).The incidence of facet joint violation was significantly lower in the RG than in the FG(22.22%vs 40.00%,P=0.022).However,the single screw placement time was significantly longer in the RG than in the FG[(501.92±70.08)s vs(382.54±63.21)s,P=0.000].The radiation exposure time of medical staff during surgery was significantly lower in the RG than in the FG[(56.81±16.09)s vs(34.43±16.91)s,P=0.000].Conclusions Robot-assisted CBT screw implantation can effectively improve the accuracy of screw placement and reduce the invasion rate of superior facet and radiation exposure of medical staff,but it will increase the screw placement time and operation time of screws.Our center achieved a smooth learning curve after approximately 12 procedures.