脊柱机器人辅助不同手术入路植钉的初步对比研究

Preliminary comparative study of spinal robot-assisted pedicle screw placement using different surgical approaches

目的比较脊柱机器人辅助不同手术入路植钉的疗效差异,为临床选择合适的机器人辅助入路手术方法提供参考。方法回顾分析2023年1月—8月收治且符合选择标准的14例胸腰椎疾病患者临床资料,均采用Mazor X脊柱外科机器人辅助手术入路植入椎弓根螺钉。根据手术入路不同将患者分为后正中入路(posterior median approach,PMA)组(6例)和经肌间隙入路(intermuscular approach,IMA)组(8例),两组患者年龄、性别、身体质量指数、疾病类型、固定节段等基线资料比较差异无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、螺钉相关并发症及二次手术率;基于术后即刻X线片测量螺钉内倾角、螺钉与中线距离、螺钉尾倾角。结果两组手术时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者术后均未出现神经损伤等螺钉相关并发症,均无二次手术者。术后即刻IMA组患者螺钉内倾角、螺钉与中线距离以及螺钉尾倾角均大于PMA组,差异有统计学意义(P<0.05)。结论脊柱机器人辅助不同手术入路植钉的螺钉位置和内倾角存在差异,这可能是由于皮肤和肌肉等软组织对进钉路线产生阻挡。使用脊柱机器人辅助手术治疗时,应针对不同疾病选择合适的手术入路,使治疗更加合理有效。

Objective To compare the effectiveness of spinal robot-assisted pedicle screw placement through different surgical approaches and to guide the clinical selection of appropriate robot-assisted surgical approaches.Methods The clinical data of 14 patients with thoracolumbar vertebral diseases who met the selection criteria between January 2023 and August 2023 were retrospectively analyzed,and all of them underwent pedicle screw placement under assistant of the Mazor X spinal surgery robot through different surgical approaches.The patients were divided into posterior median approach(PMA)group(n=6)and intermuscular approach(IMA)group(n=8)according to the surgical approaches,and there was no significant difference in age,gender,body mass index,disease type,and fixed segment between the two groups(P>0.05).The operation time,intraoperative blood loss,screw-related complications,and reoperation rate were recorded and compared between the two groups;the inclination angle of the screw,the distance between the screw and the midline,and the caudal inclination angle of the screw were measured based on X-ray films at immediate after operation.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).There was no screw-related complication such as nerve injury in both groups,and no patients underwent secondary surgery.At immediate after operation,the inclination angle of the screw,the distance between the screw and the midline,and the caudal inclination angle of the screw in the IMA group were significantly greater than those in the PMA group(P<0.05).Conclusion There are differences in the position and inclination angle of screws placed with robot-assisted surgery through different surgical approaches,which may be due to the obstruction of the screw path by soft tissues such as skin and muscles.When using spinal robot-assisted surgery,selecting the appropriate surgical approach for different diseases can make the treatment more reasonable and effective.