第三代天玑骨科机器人辅助下经皮置钉在经肌间隙入路腰椎融合内固定术中的应用

Application of the Third Generation TiRobot-Assisted Percutaneous Screw Placement in Lumbar Fusion and Internal Fixation via Wiltse Approach

目的:探讨第三代天玑骨科机器人辅助下经皮置钉腰椎经肌间隙入路融合内固定术的安全性及临床疗效。方法:选择2021年12月至2022年7月天玑骨科机器人辅助下经Wiltse入路融合内固定术治疗的腰椎患者48例,男28例,女20例;年龄为32~74岁。48例患者均为单侧神经压迫症状,一侧采用机器人辅助下经皮置入椎弓根螺钉,另一侧采用经Wiltse入路置钉。比较48例患者术前、末次随访视觉模拟量表(VAS)评分和腰椎日本骨科协会(JOA)评分,采用Richter分类标准及螺钉内聚角对比两侧椎弓根螺钉置入准确度,统计分析两侧置钉时间及出血量。结果:患者术后末次随访的VAS评分和JOA评分均较术前明显改善,差异有统计学意义(P<0.05);术后2 d采用Richter分类标准评价置钉准确度,机器人辅助下共置钉108枚,其中Ⅰ级101枚,Ⅱ级6枚,Ⅲ级1枚。徒手置钉104枚,其中Ⅰ级80枚,Ⅱ级20枚,Ⅲ级4枚。机器人辅助下置钉准确率为93.52%,徒手置钉准确率为76.92%,机器人辅助下置钉准确率显著优于徒手置钉,差异有统计学意义(χ^(2)=7.727,P=0.005)。机器人辅助下置入椎弓根螺钉平均内聚角为25.19°±3.85°,徒手置入椎弓根螺钉平均内聚角为29.19°±4.37°,差异有统计学意义(t=10.24,P=0.03)。机器人辅助下置钉出血量、置钉时间均优于徒手置钉(P<0.05)。结论:机器人辅助经皮置钉相比徒手置钉可进一步提升手术安全性,提高临床疗效。

Objective:To investigate the safety and clinical efficacy of the third generation TiRobot-assisted percutaneous screw placement versus freehand placement of screws in lumbar spine fusion and internal fixation via Wiltse approach.Methods:48patients with lumbar spine who underwent the third generation TiRobot-assisted fusion and internal fixation via Wiltse approach from December 2021to July 2022were selected,including 28males and 20females,aged 3274years old.All 48patients had symptoms of unilateral nerve compression.Robot-assisted percutaneous pedicle screw placement was used on the side of the lumbar spine,and the lumbar spine on the other side was placed with screws through the Wiltse approach.The preoperative and last follow-up visual analogue scale(VAS)and lumbar Japanese orthopedic association(JOA)scores of 48patients were compared,and the Richter classification criteria and screw cohesion angle were used to compare the accuracy of pedicle screw placement on the both sides.The time and bleeding volume of bilateral nail placement were statistically analyzed.Results:The VAS score and JOA score of the patients at the last follow-up after operation were significantly improved compared with those before operation(P<0.05).The Richter classification criteria were used to evaluate the accuracy of screw placement 2d 20 Chinese J Trad Med Traum&Orthop,Feb.2024,Vol.32,No.2 after surgery.There were 108nails placed on the healthy side,and 101were gradeⅠ,6of gradeⅡand 1of gradeⅢ.There were 104nails placed on the affected side,including 80of gradeⅠ,20of gradeⅡ,and 4of gradeⅢ.The accuracy of robot assisted nailing was 93.52%,and that of manual nailing was 76.92%.The accuracy of robot assisted nailing was significantly better than manual nailing,and the difference was statistically significant(χ^(2)=7.727,P=0.005).The average cohesion angle of pedicle screws placed under robotic assistance was 25.19°±3.85°,and the average cohesion angle of pedicle screws placed was 29.19°±4.37°,and the difference was statistically significant(t=10.24,P=0.03).The amount of bleeding and the time of placing nails assisted by robot are better than those of unarmed nails(P<0.05).Conclusion:The results show that the robot-assisted percutaneous nail placement can further improve the safety of surgery and improve the clinical efficacy compared with manual nail placement.