机器人在重度青少年特发性脊柱侧弯手术中的应用

Application of robot in severe adolescent idiopathic scoliosis surgery

摘要:

[目的] 评估骨科机器人在后路全椎体截骨术（posteior vertebral column resection，PVCR）矫正重度青少年特发性脊柱侧弯（adolescent idiopathic scoliosis，AIS）术中椎弓根螺钉置入的安全性和准确性，并与传统透视徒手置钉组对比，探讨其在临床和影像学上的差异。[方法] 回顾性分析2018年09月至2022年06月收治的26例重度AIS患者临床资料。11例采用Ｃ型臂联合机器人术中导航置入椎弓根螺钉（机器人组）;15例采用传统Ｃ型臂透视下徒手置入椎弓根螺钉 （徒手组）。记录两组患儿临床数据及影像学资料，包括手术时间，术中出血量、术中透视次数、Cobb角矫正率、置钉准确率。[结果] 所有患儿均顺利完成手术，术中均未发生置钉相关的血管神经损伤，术后均未发生神经系统并发症。术后及术后1年随访时两组Cobb角、C7PL-CSVL 及 SVA影像学测量指标均较术前明显改善（P＜0.05），而两组间差异无统计学意义（P＞0.05）。机器人组置钉准确率显著高于徒手组（95.1％ vs 85.6％, P＜0.05）。机器人组术中透视次数显著少于徒手组，手术时间长于徒手组，差异均有显著性意义（P＜0.05）。机器人组和徒手组术中出血量差异无统计学意义（P＞0.05）。[结论] PVCR对重度AIS具有较好的矫形效果，术中机器人辅助技术可以有效的提高螺钉的精准度，但由于学习曲线处于初级阶段，手术时间可能会增加。

Abstract:

[Objective] To evaluate the safety and accuracy of robot-assisted vertebral pedicle screw placement in posterior vertebral column resection （PVCR） for correction of severe adolescent idiopathic scoliosis （AIS）, and investigate the clinical and radiographic differences compared with traditional X-ray perspective freehand screw insertion. [Methods] The clinical data of 26 patients with severe AIS treated from September 2018 to June 2022 were retrospectively analyzed. 11 patients underwent robot-assisted pedicle screw insertion （robot group）; 15 patients underwent conventional X-ray fluoroscopy-assisted pedicle screw insertion （manual group）. Clinical data and imaging data of the two groups were recorded, including operation time, intraoperative blood loss, intraoperative fluoroscopy times, Cobb Angle correction rate, and screw insertion accuracy rate. [Results] All patients successfully completed the operation, there was no screw -related vascular and nerve injury during the operation, and no neurological complications occurred after the operation. The imaging measurements of Cobb Angle, C7PL-CSVL and SVA in both groups were significantly improved after surgery and 1 year after surgery （P<0.05）, but there was no significant difference between the two groups （P>0.05）. The screw insertion accuracy of robot group was significantly higher than that of manual group （95.1% vs 85.6%, P<0.05）. The number of intraoperative fluoroscopy in the robot group was significantly less than that in the manual group, and the operative time was longer than that in the manual group, with significant differences （P<0.05）. There was no significant difference in intraoperative blood loss between robot group and manual group （P>0.05）. [Conclusion] PVCR could lead to efficient correction for severe AIS, and the intraoperative robot-assisted technology can effectively improve the screw insertion accuracy. However, due to the initial learning curve, the operation time may be increased.