机器人辅助可视化椎弓根置钉技术的精准性及安全性分析

Accuracy and safety analysis of the technique of robot-assisted pedicle screw placement with visualization

目的探讨机器人辅助可视化椎弓根置钉技术与常规机器人辅助置钉技术临床疗效的差异,以及机器人辅助可视化椎弓根置钉的精准性及安全性。方法回顾性收集2020年8月至2022年9月于中国医科大学附属第一医院骨科采用开放脊柱椎弓根螺钉置入内固定术治疗的胸腰椎疾病患者60例,男39例、女21例,年龄(51.03±18.04)岁(范围12~78岁),包括椎管狭窄25例、腰椎骨折15例、胸椎骨折7例、腰椎滑脱3例、脊柱畸形10例。采用机器人辅助可视化置钉技术进行椎弓根实心螺钉置入手术治疗30例(可视化组),采用常规机器人辅助置钉技术进行椎弓根空心螺钉置入手术治疗30例(常规组)。完成置钉后于术中采用"O"型臂X线机扫描验证,根据Gertzbein-Robbins标准评价置钉准确性。记录并比较两组置钉相关时间、透视次数及围手术期并发症。结果可视化组和常规组年龄、性别、脊柱疾病种类构成比的差异无统计学意义(P>0.05)。可视化组共置入椎弓根螺钉178枚、置钉满意172枚、置钉准确率96.6%,常规组共置入椎弓根螺钉254枚、置钉满意240枚、置钉准确率94.5%,两组置钉准确率的差异无统计学意义(χ^(2)=1.087,P=0.297)。可视化组术中透视次数为(2.60±1.03)次,少于常规组的(5.57±2.12)次,差异有统计学意义(t=-6.860,P=0.001);可视化组置钉相关时间为(13.23±3.68)min,少于常规组的(24.68±15.75)min,差异有统计学意义(t=-3.870,P=0.040)。两组患者均顺利完成手术,术后未出现感染、血肿、神经根损伤等并发症。结论机器人辅助可视化椎弓根螺钉置入技术保持了常规机器人辅助手术的高精准性,凭借其可以实时监控螺钉位置的优势可减少透视次数,缩短手术置钉时间从而进一步提高手术效率。

ObjectiveTo compare the clinical efficacy of robot-assisted pedicle screw placement with visualization technology and conventional robot-assisted pedicle screw placement,and analyze the accuracy and safety of robot-assisted pedicle screw placement with visualization.MethodsThis retrospective study analyzed data from 60 patients(39 males and 21 females)with an average age of 51.03±18.04 years(range 12-78 years)who underwent open spinal pedicle screw fixation surgery for thora columbar diseases at the Orthopedic Department of the First Affiliated Hospital of China Medical University between August 2020 and September 2022.The cases included 25 cases of spinal stenosis,15 cases of lumbar fractures,7 cases of thoracic fractures,3 cases of lumbar spondylolisthesis,and 10 cases of spinal deformities.30 patients underwent solid pedicle screw placement using robot-assisted visualization technology(visualization group),while the remaining 30 patients received hollow pedicle screw placement using conventional robot-assisted technology(conventional group).After screw placement,"O"-arm X-ray scans were performed for verification,and screw placement accuracy was evaluated based on the Gertzbein-Robbins standard.The study recorded and compared the time required for screw placement,number of fluoroscopy sessions,and perioperative complications between the two groups to provide a comprehensive assessment of surgical outcomes.ResultsThere were no significant differences in age and gender between the two groups(P>0.05).In the visualization group,a total of 178 pedicle screws were placed,with 172 screws(96.6%)achieving satisfactory placement,while the conventional group placed 254 pedicle screws,with 240 screws(94.5%)achieving satisfactory placement.The difference in accuracy rates between the two groups was not statistically significant(χ^(2)=1.087,P=0.297).The visualization group required a mean of 2.60±1.03 fluoroscopy sessions during surgery,significantly less than the conventional group's mean of 5.57±2.12 sessions(t=-6.860,P=0.001).Moreover,the visualization group had a shorter mean screw placement time of 13.23±3.68 minutes compared to the conventional group's mean of 24.68±15.75 minutes(t=-3.870,P=0.040).All patients in both groups completed the surgery without postoperative complications such as infection,hematoma,or nerve root injury.ConclusionThe technique of robot-assisted pedicle screw placement with visualization effectively preserves the high precision achieved in conventional robotic surgery.With its advantage of real-time monitoring for screw position,it reduces the intraoperative fluoroscopy times and shortens the screw placement time,thereby further enhancing surgical efficiency.