基于5G技术的机器人辅助远程胸腰椎内固定手术的应用效果

Effectiveness of 5G-based robot-assisted remote thoracolumbar internal fixation surgery

目的评估基于5G技术的机器人辅助远程胸腰椎内固定手术的应用效果,探讨该技术在临床应用中的可行性和优缺点。方法采用回顾性病例系列研究,研究对象为2021年4至12月接受机器人辅助远程胸腰椎内固定手术的61例患者。采用以北京积水潭医院为中心构建的骨科机器人远程手术系统,并应用5G移动通信技术进行网络传输,操控异地的骨科手术机器人辅助完成螺钉置入。共有10家医院参与了远程手术,远程操作中心与手术现场的平均距离为1617 km/例,最远距离超过3000 km。采用Gertzbein-Robbins分级标准评估椎弓根螺钉置入的准确性,通过分析螺钉位置的优秀率与临床可接受率、术中通信、并发症等指标评价手术效果,并与参与医院完成的本地机器人辅助胸腰椎内固定手术进行对照分析。结果所有患者的远程手术均顺利完成,手术时间为(92±32)min,共置入354枚胸腰椎椎弓根螺钉,螺钉位置的优秀率为89.8%,临床可接受率为97.5%。61例患者均获得随访,随访时间(18.9±1.9)个月(范围16~24个月)。术前疼痛视觉模拟评分(visual analogue scale,VAS)评分为(5.74±1.30)分,出院时改善至(2.30±0.90)分,差异有统计学意义(t=11.002,P<0.001)。6例胸腰椎退行性疾病患者术后跛行及疼痛症状均明显缓解。55例胸腰椎骨折患者术前伤椎前缘高度比为62.78%±12.60%,术后恢复至85.36%±8.35%,差异有统计学意义(t=16.977,P<0.001)。末次随访时骨折均愈合。围手术期未出现血管、神经损伤或感染等并发症,无机器人使用相关的并发症。5G网络确保了手术过程中机器人控制信号、图像和音频信号的稳定传输,未观察到信号延迟或通信故障。参与医院1(汕头新圣骨科医院)远程与本地机器人辅助手术螺钉位置的优秀率(90.2%和93.8%,χ^(2)=0.169,P=0.681)和临床可接受率(99.0%和100.0%,P=1.000)相似,参与医院2(贵州省人民医院)远程与本地机器人辅助手术螺钉位置的优秀率(87.0%和85.4%,χ^(2)=0.075,P=0.784)和临床可接受率(100.0%和96.6%,χ^(2)=0.580,P=0.446)相似。结论基于5G移动通信技术的远程机器人辅助胸腰椎内固定手术的临床应用效果良好,未出现相关术后并发症。

ObjectiveTo assess the effectiveness and viability of 5G-enabled robot-assisted thoracolumbar internal fixation surgery,scrutinizing its benefits and potential limitations in a clinical setting.MethodsThis retrospective case series study analyzed 61 patients who underwent robot-assisted remote thoracolumbar internal fixation surgery between April and December 2021.The orthopaedic robotic telesurgery system,centered at Beijing Jishuitan Hospital and utilizing 5G technology for network transmission,was used to assist in screw placement.The surgeries,distributed across ten hospitals and executed over an average distance of 1617 km(maximum exceeding 3000 km),were appraised by examining the accuracy of screw placement,intraoperative communication efficacy,complication rates,among other metrics,and benchmarked against traditional local procedures.ResultsTelesurgery was completed successfully in all patients,averaging 92±32 minutes per operation.Out of 354 screws placed,89.8%were positioned perfectly and 97.5%were deemed clinically acceptable.The 61 patients,followed-up for an average of 18.9±1.9 months,exhibited significant postoperative improvement in pain.The preoperative visual analogue scale(VAS)pain score was 5.74±1.30 and improved to 2.30±0.90 at discharge,a statistically significant difference(t=11.002,P<0.001).6 patients with thoracolumbar degenerative spine disease showed significant relief of claudication and pain symptoms postoperatively.55 patients with thoracolumbar spine fractures had a preoperative height ratio of 62.78%±12.60%at the anterior margin of the injured vertebrae,which recovered to 85.36%±8.35%postoperatively,a statistically significant difference(t=16.977,P<0.001).All fractures were healed at final follow-up.No perioperative complications,such as vascular or nerve injuries or infections,occurred.Additionally,there were no complications related to the use of the robot.The 5G network ensured stable transmission of robotic control signals,images,and audio signals during the procedure,with no signal delays or communication failures observed.The perfect rate(90.2%vs.93.8%,χ^(2)=0.169,P=0.681)and clinical acceptability rate(99.0%vs.100.0%,P=1.000)of remote versus local robotic-assisted screw placement in participating hospital 1(Shantou Xin Sheng Orthopaedic Hospital)were similar.The perfect rate(87.0%vs.85.4%,χ^(2)=0.075,P=0.784)and clinical acceptability rate(100.0%vs.96.6%,χ^(2)=0.580,P=0.446)of remote versus local robotic-assisted screw placement in participating hospital 2(Guizhou Provincial People's Hospital)were similar.Conclusion5G technology enhances the remote application of robotic thoracolumbar surgery without compromising patient safety or outcome quality.It underscores the potential for broader adoption of surgical robotics,aiding in the standardization of medical practices across China,boosting healthcare efficiency,and aligning with the Healthy China strategy.