机器人辅助手术矫正青少年重度特发性脊柱侧弯（开放获取）

Robot-assisted surgical correction of severe idiopathic scoliosis in adolescents

摘要:

[目的]评估骨科机器人辅助后路全椎体截骨术（posterior vertebral column resection, PVCR）椎弓钉-棒系统矫正重度青少年特发性脊柱侧弯（adolescent idiopathic scoliosis, AIS）的临床效果。[方法]回顾性分析 2018 年 9 月—2022 年 6 月收治的 26 例重度 AIS 患者临床资料。依据术前医患沟通结果，11 例采用机器人辅助椎弓钉置入 （机器人组）；15 例采用徒手椎弓钉置入（徒手组）。比较两组临床与影像资料。[结果]所有患者均顺利完成手术，两组共切除 28 个椎体；机器人组共置入 242 枚螺钉，徒手组置入 311 枚。术中两组患者均未发生脊髓损伤、死亡等严重并发症。虽然机器人组手术时间明显长于徒手组 [(760.3±43.8) min vs (637.3±37.9) min, P＜0.001]，但机器人组术中透视次数明显少于徒手组 [(10±1.7) 次 vs (18.8±1.5) 次, P＜0.001]， 两组术中出血量差异无统计学意义（P＞0.05）。两组患者随访至少 12 个月，术后患者躯干平衡显著改善，身高和坐高显著增加， 生活与运动能力改善。随访过程中，两组患者均未出畸形矫正明显丢失，均无手术翻修。影像方面，机器人组置钉准确率显著高于徒手组 [(95.1±2.1)% vs (85.6±3.3)%, P＜0.001]。与术前相比，术后两组冠状面主弯 Cobb 角、矢状面后凸 Cobb 角、C₇PL-CSVL、 SVA 均明显减少（P＜0.05）。相应时间点，两组间上述指标的差异均无统计学意义（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 clinical value of robot-assisted posterior vertebral column resection (PVCR) and pedicle screwrod system for correction of severe idiopathic scoliosis (AIS) in adolescent. [Methods] A retrospective study was performed on 26 patients who received PVCR with pedicle screw-rod correction of severe AIS from September 2018 to June 2022. According to preoperative doctorpatient communication, 11 patients underwent robotassisted pedicle screw placement (the robot group), while other 15 patients had the screws placed by conventional free-hand technique (the free-hand group). Clinical and imaging data were compared between the two groups. [Results] All the patients had operation performed successfully with a total of 28 segments of PVCR conducted in the two groups, with a total of 242 screws placed in the robot group, whereas 311 screws inserted in the free-hand group. No serious complications such as spinal cord injury and death occurred in anyone of both groups during the operation. Although the robot group consumed significantly longer operation time than the free-hand group [(760±43.8) min vs (637.3±37.9) min, P＜0.001], the former had significantly less intraoperative fluoroscopy times than the latter [(10±1.7) times vs (18.8±1.5) times, P＜0.001], and there was no significant difference in intraoperative blood loss between the two groups (P＞0.05). All patients in both groups were followed up for more than 12 months, and got considerable improvement in terms of trunk balance, height and sitting height, as well as life and exercise ability postoperatively, with no significant loss of deformity correction, and no surgical revision in both groups. Radiographically, the robot group proved significantly superior to the free-hand group regarding the accuracy of screw placement [(95.1±2.1)% vs (85.6±3.3)%, P＜0.001]. Compared with those preoperatively, the Cobb angle of coronal main curvature, Cobb angle of sagittal kyphosis, C₇PL-CSVL and SVA were significantly decreased in both groups after operation (P＜ 0.05), while which were not statistically significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The PVCR considerably facilitates correction of severe AIS. The intraoperative robot-assisted pedicle screw placement does effectively improve the accuracy, despite learning curve and time consuming in the initial stage.