机器人与传统透视辅助内固定手术治疗强直性脊柱炎胸腰椎骨折的回顾性研究

Robot-assisted versus traditional fluoroscopy-assisted posterior fixation in treatment of thoracolumbar fractures with ankylosing spondylitis:a retrospective study

目的比较机器人辅助微创与传统透视辅助开放后路内固定手术治疗强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎骨折的临床疗效。方法回顾性分析2016年12月—2023年12月收治且符合选择标准的21例AS胸腰椎骨折患者临床资料。其中10例接受机器人辅助微创后路内固定手术(机器人组),11例接受传统透视辅助开放后路内固定手术(透视组)。两组患者性别、年龄、骨折椎体节段分布、骨折AO分型、受伤至手术时间以及术前疼痛视觉模拟评分(VAS)、美国脊髓损伤学会(ASIA)分级等基线资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中出血量、辐射暴露时间、辐射剂量、住院时间、并发症发生情况;基于术后1周内CT参照Gertzbein-Robbins标准评价螺钉植入精准度;随访期间采用VAS评分和ASIA分级评价疼痛及神经功能状态。结果两组手术均顺利完成,手术时间差异无统计学意义(P>0.05);机器人组术中出血量及住院时间均较透视组减少,辐射暴露时间及辐射剂量增加,差异均有统计学意义(P<0.05)。两组共植入249枚椎弓根螺钉,其中机器人组118枚、透视组131枚。参照Gertzbein-Robbins标准,机器人组临床可接受螺钉(A、B级)占比明显高于透视组(P<0.05)。两组患者术后均获随访,随访时间3~12个月,平均6.8个月。两组术后VAS评分均较术前下降(P<0.05),且术后1周及3个月机器人组评分均低于透视组(P<0.05)。术后两组神经功能差异均无统计学意义(P>0.05)。透视组1例发生手术部位深部感染、1例下肢深静脉血栓形成,机器人组无并发症发生,两组并发症发生率比较差异无统计学意义(P>0.05)。结论机器人辅助微创手术和传统透视开放手术治疗AS胸腰椎骨折均可获得较好疗效。但与后者相比,前者在减少术中出血量、缩短住院时间、提高椎弓根螺钉植入准确性等方面更具优势。

Objective To compare the effectiveness of robot-assisted(RA)minimally invasive surgery versus traditional fluoroscopy-assisted(FA)open posterior fixation surgery in treating thoracolumbar fractures with ankylosing spondylitis(AS).Methods A clinical data of 21 cases of thoracolumbar fractures with AS who met the selection criteria between December 2016 and December 2023 was retrospectively analyzed.Ten cases underwent RA minimally invasive surgery group(RA group)and 11 cases underwent FA open posterior fixation surgery(FA group).There was no significant difference in gender,age,fracture segment distribution,fracture type,time from injury to surgery,visual analogue scale(VAS)score,and American Spinal Injury Association(ASIA)grading between RA group and FA group(P>0.05).The operation time,intraoperative blood loss,radiation exposure time,radiation dose,hospital stay,and complications of the two groups were recorded.According to Gertzbein-Robbins criteria,the accuracy of screw implantation was evaluated by CT within 1 week after surgery.During follow-up,pain and nerve function were evaluated by VAS score and ASIA grading.Results All patients underwent surgery successfully,and there was no significant difference in operation time(P>0.05).The intraoperative blood loss and hospital stay in the RA group were significantly less than those in the FA group(P<0.05),and the radiation exposure time and radiation dose were significantly more than those in the FA group(P<0.05).A total of 249 pedicle screws were implanted in the two groups,including 118 in the RA group and 131 in the FA group.According to the Gertzbein-Robbins criteria,the proportion of clinically acceptable screws(grades A and B)in the RA group was significantly higher than that in the FA group(P<0.05).Patients in both groups were followed up 3-12 months,with an average of 6.8 months.The VAS scores of the two groups after surgery were significantly lower than those before surgery,and the differences were significant(P<0.05).The RA group had lower scores than the fluoroscopy group at 1 week and 3 months after surgery(P<0.05).There was no significant difference in neurological function grading between groups at 1 week and 3 months after surgery(P>0.05).In the FA group,1 case of deep infection and 1 case of deep vein thrombosis of lower extremity occurred,while no complication occurred in the RA group,and there was no significant difference in the incidence of complications between groups(P>0.05).Conclusion Both RA minimally invasive surgery and FA open posterior fixation surgery can achieve good effectiveness.Compared with the latter,the former has more advantages in terms of intraoperative blood loss,hospital stay,and accuracy of pedicle screw insertion.