直观图像定位机器人辅助经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折

Intuitive visual navigation orthopaedic surgery robot-assisted percutaneous kyphoplasty treatment of osteoporotic vertebral compression fractures

目的探讨应用直观图像定位机器人辅助穿刺完成经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法回顾性分析2021年6月至2022年11月北京大学第三医院应用直观图像定位机器人辅助和"C"型臂X线机透视下徒手穿刺行PKP治疗78例OVCF,根据穿刺的方法分为机器人组和徒手组。机器人组36例,男7例、女29例,年龄(74.50±5.87)岁,单节段椎体骨折32例、双节段椎体骨折4例,T_(8)1例、T_(10)2例、T_(11)2例、T_(12)11例、L_(1)10例、L_(2)8例、L_(3)2例、L_(4)3例、L_(5)1例,骨密度T值为-2.94±0.50;徒手组42例,男9例、女33例,年龄(72.86±8.84)岁,单节段骨折36例、双节段骨折6例,T_(6)1例、T_(7)2例、T_(11)3例、T_(12)9例、L_(1)8例、L_(2)9例、L_(3)5例、L_(4)6例、L_(5)5例,骨密度T值为-3.00±0.50。比较两组患者的手术时间、X线透视次数、住院时间、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及伤椎椎体前缘高度。结果两组患者均顺利完成手术。徒手组手术时间(29.69±2.40)min,较机器人组的(33.44±2.50)min缩短(t=6.491,P<0.001);机器人组术中出血量(3.54±0.89)ml,少于徒手组的(6.72±1.89)ml(t=9.110,P<0.001);机器人组X线透视次数为(26.81±7.76)次,较徒手组的(42.61±6.62)次减少(t=9.294,P<0.001);徒手组术后椎体前缘高度为(18.64±0.32)mm,机器人组为(18.79±0.36)mm,差异无统计学意义(t=2.673,P=0.067)。所有患者均获得随访,随访时间(8.3±2.9)个月(范围6~13个月)。机器人组术前、术后第1天、术后6个月VAS评分分别为(7.64±0.76)分、(2.50±0.51)分、(0.36±0.49)分,徒手组分别为(7.75±0.69)分、(2.56±0.50)分、(0.58±0.60)分,两组术后VAS评分均较术前明显改善(P<0.05),两组间术后VAS评分的差异无统计学意义(P>0.05)。徒手组和机器人组术后6个月时ODI分别为11.67%±2.13%和12.11%±2.33%,均较术前明显降低(P<0.05),两组间术后ODI的差异无统计学意义(P>0.05)。术中均未发现明显骨水泥渗漏。结论与"C"型臂X线机透视下徒手穿刺行PKP手术治疗OVCF比较,直观图像定位机器人可以安全、有效地辅助完成手术过程,同时具有术中出血量少、透视次数少的优势。

ObjectiveTo investigate the clinical efficacy of percutaneous kyphoplasty(PKP)assisted by intuitive visual navigation orthopaedic surgery robot in the treatment of osteoporotic vertebral compression fracture(OVCF).MethodsA retrospective analysis was conducted in Peking University Third Hospital from June 2021 to November 2022,78 patients with OVCF were treated by the intuitive visual navigation orthopaedic surgery robot or freehand surgery with a"C"arm X-ray machine.According to the method of puncture,they were divided into robot group and freehand group.In the robot group,there were 36 cases,including 7 males and 29 females,aged 74.50±5.87 years,32 cases of single vertebral fractures,4 cases of double vertebral fractures,1 case of T 8,2 cases of T 10,2 cases of T_(1)1,11 cases of T_(1)2,10 cases of L_(1),8 cases of L_(2),2 cases of L_(3),3 cases of L_(4),and 1 case of L_(5).Bone mineral density T value was-2.94±0.50;In the freehand group,there were 42 cases,including 9 males and 33 females,aged 72.86±8.84 years,36 cases of single fracture and 6 cases of double fracture,1 case of T_(6),2 cases of T_(7),3 cases of T_(11),9 cases of T_(12),8 cases of L_(1),9 cases of L_(2),5 cases of L_(3),6 cases of L_(4),and 5 cases of L_(5).Bone mineral density T value was-3.00±0.50.The effectiveness evaluation indexes of the two groups were compared,which included surgery duration,X-ray fluoroscopy times,hospitalization time,lumbar pain visual analogue scale(VAS),Oswestry disability index(ODI)and height of fractured anterior vertebrae(HFAV).ResultsBoth groups of patients successfully received surgical treatment.The mean operating time of the robot group was 33.44±2.50 min,which was significantly longer than that of the free hand group,which was 29.69±2.40 min(t=6.491,P<0.001).Meanwhile,the intraoperative blood loss of the robot group was 3.54±0.89 ml,which was significantly less than that of the freehand group,which was 6.72±1.89 ml(t=9.110,P<0.001).In terms of radiographic fluoroscopy times,the average of the robot group was 26.81±7.76 times,which was significantly less than the freehand group's 42.61±6.62 times(t=9.294,P<0.001).The postoperative vertebral front edge height in the free hand group was 18.64±0.32 mm and in the robot group was 18.79±0.36 mm.The difference was not statistically significant(t=2.673,P=0.067).All patients were followed up for 8.3±2.9 months(range,6-13 months).The VAS scores of low back pain in the two groups at 1 day and 6 months after operation were significantly improved compared with those before operation(P<0.05),and there was no significant difference between the two groups in VAS score after operation(P>0.05).Six months after surgery,the ODI of the free hand group and the robot group were 11.67%±2.13%and 12.11%±2.33%,respectively.The ODI scores of the two groups were significantly lower at 6 months postoperative follow-up than that before surgery,and the postoperative follow-up at all had significant differences compared with that before surgery(P<0.05),and there was no difference between the two groups in postoperative ODI scores(P>0.05).No obvious bone cement leakage was found in all patients during operation.ConclusionCompared with the traditional C-arm X-ray for PKP treatment of OVCF by free hand,intuitive visual navigation orthopedic robot can safely and effectively assist in the completion of the operation process,and has the advantages of less intraoperative blood loss,fewer fluoroscopy times.