机器人辅助与徒手经皮椎弓根螺钉内固定治疗胸腰椎骨折的疗效比较

Comparison of efficacy between robot-assisted and fluoroscopy-guided free-hand percutaneous pedicle screw fixation in the treatment of thoracolumbar fractures

摘要

目的 比较机器人辅助与徒手经皮椎弓根螺钉内固定治疗胸腰椎骨折的手术指标及影像学数据，并探讨其优势。方法 回顾性分析2021年1月至2023年1月于山西医科大学第二医院骨科行经皮椎弓根螺钉内固定手术治疗的60例胸腰椎骨折患者的临床资料，其中机器人辅助经皮椎弓根螺钉内固定患者（机器人辅助组）30例，男18例，女12例，年龄32~64（47.3±9.2）岁；透视下徒手经皮椎弓根螺钉内固定患者（徒手组）30例，男16例，女14例，年龄23~62（43.6±7.8）岁。比较两组手术时间、出血量、辐射剂量、伤椎前缘高度百分比、矢状面Cobb角、置钉准确率、关节突侵犯率、视觉模拟评分法（VAS）评分、Oswestry功能障碍指数（ODI）等指标。结果 所有患者均获随访12~24（14.0±3.4）个月。手术时间与出血量两组间相比差异无统计学意义（P>0.05）；机器人辅助组辐射剂量为（14.2±2.8）mGy，少于徒手组辐射剂量（28.4±5.2）mGy（t=13.169，P<0.05）；两组患者术前术后伤椎高度百分比相比差异有统计学意义（P<0.05）；两组在术前、术后即刻和末次随访中伤椎高度百分比组间比较差异无统计学意义（P>0.05）；两组组内伤椎矢状面Cobb角术前术后相比差异有统计学意义（P<0.05）；机器人辅助组与徒手组伤椎矢状面Cobb角在术前、术后即刻、末次随访组间相比差异无统计学意义（P>0.05）；机器人辅助组置入180枚螺钉置钉准确率为97.2%，关节突侵犯率为1.7%。徒手组置入180枚螺钉置钉准确率为91.1%，关节突侵犯率为5.6%。机器人辅助组置钉准确率高于徒手组（χ²=6.119，P<0.05），关节突侵犯率低于徒手组（χ²=3.910，P<0.05）；两组患者VAS评分和ODI均随时间改善，差异有统计学意义（P<0.001），但组间差异无统计学意义（F_VAS=0.053，F_ODI=3.212，均P>0.05）。结论 机器人辅助和透视下徒手经皮置钉治疗胸腰椎骨折均可获得较好的骨折复位效果，并能有效维持伤椎高度。与透视下徒手经皮置钉相比，机器人辅助经皮置钉可降低术中辐射剂量、提高置钉准确率，关节突侵犯率呈降低趋势。

Abstract

Objective To compare the surgical indicators and imaging data of robot assisted percutaneous pedicle screw fixation and manual percutaneous pedicle screw fixation under fluoroscopy for the treatment of thoracolumbar fractures, and to explore their technical advantages. Methods The clinical data of 60 patients with thoracolumbar fractures who underwent percutaneous pedicle screw fixation in the Department of Orthopedics, the Second Hospital of Shanxi Medical University from January 2021 to January 2023 were retrospectively analyzed. The patients with robot-assisted percutaneous pedicle screw fixation (robot-assisted group) included 30, comprising 18 males and 12 females, aged 32-64 years, with a mean age of (47.3±9.2) years. The patients with fluoroscopy-guided freehand percutaneous screw fixation (free-hand group) included 30 patients, comprising 16 males and 14 females, aged 23-62 years, with a mean age of (43.6±7.8) years. Operation time, blood loss, radiation dose, anterior vertebral height percentage, sagittal Cobb angle, screw placement accuracy, facet joint violation rate, visual analogue scale (VAS), and Oswestry disability index (ODI) were compared between the two groups. Results All patients were followed up for 12-24 months, with a mean follow-up of (14.0±3.4) months. There were no significant differences in operation time or blood loss between the two groups (P>0.05). The radiation dose was lower in the robot-assisted group than in the free-hand group [(14.2±2.8) mGyvs. (28.4±5.2) mGy, t=13.169, P<0.05]. The anterior vertebral height percentage significantly improved after surgery in both groups (P<0.05), whereas no significant between-group difference was found before surgery, immediately postoperatively, or at the final follow-up (P>0.05). The sagittal Cobb angle significantly improved after surgery in both groups (P<0.05), whereas no significant between-group difference was found before surgery, immediately postoperatively, or at the final follow-up (P>0.05). A total of 180 screws were inserted in the robot-assisted group, with a screw placement accuracy rate of 97.20% and a facet joint violation rate of 1.7%. A total of 180 screws were inserted in the free-hand group, with a screw placement accuracy rate of 91.1% and a facet joint violation rate of 5.6%. The screw placement accuracy rate was higher in the robot-assisted group than in the free-hand group (χ²=6.119, P<0.05), while the facet joint violation rate was lower in the robot-assisted group, but the difference was not statistically significant (χ²=3.910, P<0.05). VAS and ODI improved over time in both groups (bothP<0.001), with no significant between-group differences (F _VAS=0.053, F _ODI=3.212, both P>0.05). Conclusions Both robot-assisted and fluoroscopy-guided freehand percutaneous screw fixation can achieve satisfactory fracture reduction and effectively maintain the height of the injured vertebra. Compared with fluoroscopy-guided freehand percutaneous screw fixation, robot-assisted percutaneous screw fixation can reduce intraoperative radiation exposure and improve screw placement accuracy, with a trend toward a lower facet joint violation rate.

关键词

腰椎 / 胸椎 / 脊柱骨折 / 机器人手术

Key words

Lumbar vertebrae / Thoracic vertebrae / Spinal fractures / Robotic surgical procedures

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