机器人导航伤椎置钉固定胸腰椎骨折△

Robot navigated pedicle screw fixation of thoracolumbar fractures with fractured-vertebrae screw placement

摘要:

[目的] 评价Tinavi 骨科机器人导航下加大伤椎螺钉矢状位置入头倾角治疗胸腰椎骨折疗效。[方法] 回顾性分析2018 年8 月—2021 年6 月，本院行经皮椎弓根螺钉治疗单节段胸腰椎骨折上终板塌陷的60 例患者的临床资料，按术前医患沟通结果，25 例采用机器人辅助加大伤椎椎弓根钉头倾角治疗，35 例常规透视引导下置钉。比较两组临床及影像资料。[结果]所有手术顺利完成，无严重并发症。机器人组在手术时间[(90.8±3.4) min vs (93.6±4.5) min, P＜0.05]、术中出血量[(96.4±8.6) mlvs (115.7±23.6) ml, P＜0.05] 显著优于常规组。随时间推移，两组VAS 评分均显著减少（P＜0.05)，相应时间点，两组间VAS 评分的差异均无统计学意义（P＞0.05）。影像方面，机器人组螺钉置入精准度Gertzbein-Robbins 评级显著优于常规组[A/B/C, (138/2/0) vs (174/20/2) , P＜0.05]。与术前相比，术后两组患者伤椎前缘相对高度及局部后凸Cobb 角均显著改善（P＜0.05）。术后3 个月，机器人组伤椎前缘相对高度[(27.0±2.2) mm vs (21.9±4.1) mm, P＜0.05] 及局部后凸Cobb 角[(7.8±2.1)° vs (10.2±2.6)°, P＜0.05] 均显著优于常规组。[结论] Tinavi 骨科机器人导航下加大伤椎椎弓根螺钉矢状位置入头倾角治疗上终板塌陷的胸腰椎骨折，能取得更好疗效。

Abstract:

[Objective] To evaluate the clinical outcomes of Tinavi orthopedic robot assisted pedicle screw fixation with increasing ce-phalic tilting in the fractured segment for thoracolumbar fractures. [Methods] A retrospective study was performed on 60 patients who re-ceived percutaneous pedicle screw fixation for single-segment thoracolumbar fractures with upper endplate collapse in our hospital fromAugust 2018 to June 2021. According to preoperative doctor-patient communication, 25 patients received robot-assisted pedicle screwplacement with increasing cephalic tilting in the fractured segment, while the other 35 patients received routine fluoroscopy-guidancescrew placement. The clinical and imaging data of the two groups were compared. [Results] All patients had operations performed success-fully without serious complications. The robot group proved significantly superior to the routine group in terms of operative time [(90.8±3.4)min vs (93.6±4.5) min, P＜0.05] and intraoperative blood loss [(96.4±8.6) ml vs (115.7±23.6) ml, P＜0.05]. The VAS scores in both groupswere significantly decreased over time (P＜0.05), which were not significant different between the two groups at any time points accordingly(P＞0.05). Regarding imaging, the robot group was significantly better than the routine group in term of Gertzbein-Robbins scale of screw in-sertion accuracy [A/B/C, (138/2/0) vs (174/20/2), P＜0.05]. Compared with those preoperatively, the relative vertebral height and local ky-photic Cobb angle of injured vertebra significantly improved in both groups postoperatively (P＜0.05). The robot group was significantly bet-ter than the routine group regarding to the relative height of the injured vertebra [(27.0±2.2) mm vs (21.9±4.1) mm, P＜0.05] and local ky-photic Cobb angle [(7.8±2.1)° vs (10.2±2.6)°, P＜0.05] 3 months after surgery. [Conclusion] For thoracolumbar fracture with upper endplatecollapse, fractured-segment pedicle screw placement with increasing cephalic tilting under Tinavi orthopaedic robot does achieve betterclinical consequences.