骨科机器人辅助经皮椎体成形术的学习曲线分析

Analysis of learning curve in percutaneous vertebroplasty assisted by orthopaedic robot

目的 总结骨科机器人辅助经皮椎体成形术治疗骨质疏松性胸腰椎压缩骨折的操作要点并分析其学习曲线。方法 回顾性分析自2018-08—2019-08连续采用“天玑”骨科机器人辅助经皮椎体成形术治疗的50例骨质疏松性胸腰椎压缩骨折,记录图像采集时间、规划时间,同时分析临床医师操作骨科机器人系统的学习曲线。结果 当手术量达到12例时,图像采集时间发生变化,维持在(23.6±3.2)min。当手术量达到20例时,规划时间明显减少,维持在(1.5±0.2)min。当手术量增加时,图像采集时间和规划时间会减少,并且进入一个平台期。根据上述学习曲线分析结果可以将前20例定为新手期组,第21~50例定为熟练期组。熟练期组图像采集时间、规划时间短于新手期组,骨水泥渗漏患者比例低于新手期组,差异有统计学意义(P<0.05)。体质量指数≥25 kg/m2、胸椎骨折患者的图像采集时间更长,体质量指数≥25 kg/m^(2)、胸椎骨折、2个椎体骨折患者的规划时间更长,差异有统计学意义(P<0.05)。结论 “天玑”骨科机器人辅助经皮椎体成形术的学习曲线的平台期大约为20例,术者与助手需要不断改进和完善术前准备,熟练掌握图像采集与路径规划操作,进而提高手术效率,缩短手术时间并减少并发症发生。

Objective To summarize the essential operations of‘Tianji’orthopaedic robot during percutaneous vertebroplasty(PVP)in treatment of osteoporotic thoracolumbar compression fractures,and to analyse the learning curve.Methods Fifty cas⁃es of osteoporotic thoracolumbar compression fractures treated with PVP assisted by a‘Tianji’orthopaedic robot from August 2018 to August 2019 were retrospectively analyzed.Image acquisition time and planning time were recorded,and the learning curve of the orthopedic robot system operated by clinician was analyzed.Results When 12 surgical cases were completed,the image acquisition time changed and was maintained at(23.6±3.2)min.When operations amounted to 20 surgical cases,the plan⁃ning time was significantly reduced and maintained at(1.5±0.2)min.When the surgical cases increased,the image acquisition time and planning time decreased and entered the plateau period.According to the above learning curve analysis results,the first 20 cases were divided into novice group,and the 21st to 50th cases proficiency group.The image acquisition time and plan⁃ning time of the proficiency group were shorter than that of the novice group,and the proportion of patients with bone cement leakage was lower than that of the novice group,the differences of two groups is statistically significant(P<0.05).Image acquisi⁃tion time was longer for patients with thoracic fractures body of mass index 25 kg/m2,the planning time was longer for patients with thoracic fracture and 2 vertebral fractures of body mass index 25 kg/m2,and the differences of those patients were statisti⁃cally significant(P<0.05).Conclusion The plateau period of the learning curve of‘Tianji’orthopedic robot is about 20 cases.The surgeon and assistant need to continuously improve and perfect the preoperative preparation,master the image acquisition and path-planning operation,so as to improve the operation efficiency,shorten the operation time and reduce the occurrence of complications.