机器人辅助椎弓根钉固定治疗颈椎骨折脱位△

Robot-assisted pedicle screw fixation for cervical fracture and dislocation

摘要:

［目的］比较经肌间隙入路机器人导航辅助置钉与徒手置钉固定颈椎骨折脱位的疗效与安全性。［方法］回顾性分析本院 2016 年 1 月—2020 年 1 月收治的 32 例颈椎骨折脱位患者的临床资料，根据医患沟通结果，14 例采用机器人辅助置钉 （机器人组），18 例采用传统徒手置钉（传统组）。比较两组患者围手术期、随访及影像结果。［结果］两组均顺利完成手术，术中均无严重并发症。机器人组手术时间、术中出血量、透视次数、置钉成功率及住院时间均显著优于传统组（P<0.05）。所有患者随访平均（27.35±4.37）个月，两组完全负重活动时间的差异无统计学意义（P>0.05）。随时间推移，两组 VAS 评分均显著减少 （P<0.05），ASIA 评级及锥体束征显著改善（P<0.05）。术前两组间上述指标的差异均无统计学意义（P>0.05）。术后 3、6 个月， 机器人组 VAS 评分显著优于传统组（P<0.05），至末次随访时，两组 VAS 评分差异无明显统计学意义（P>0.05）。相应时间点， 两组间 JOA 评分、ASIA 评级及锥体束征差异均无统计学意义（P>0.05）。影像方面，机器人组置钉准确比率显著优于传统组（P< 0.05）；两组骨性融合时间的差异无统计学意义（P>0.05）。与术前相比，末次随访时两组颈椎前曲、损伤节段滑移率及最小椎管矢状径较术前均显著改善（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］ 与徒手置入颈椎椎弓根钉手术方式相比，“天玑”机器人导航辅助置钉可以有效缩短手术时间，减少手术创伤，提高置钉准确率，利于术后康复。

Abstract:

[Objective] To compare the efficacy and safety of robot -assisted screw placement through intermuscular approach versus freehand screw placement in the fixation of cervical fracture and dislocation. [Methods] A retrospective study was done on 32 patients who received surgical treatment of cervical fracture and dislocation in our hospital from January 2016 to January 2020. According to the results of doctor- patient communication, 14 patients were treated with robot- assisted screw placement (the robot group) , while the other 18 cases were treated with traditional freehand screw placement (traditional group) . The perioperative period, follow-up and imaging consequences were compared between the two groups. [Results] All patients in both groups were operated on successfully with no serious complications. The robot group proved significantly superior to the traditional group in terms of operation time, intraoperative blood loss, fluoroscopy times, success rate of screw placement in the first time and hospital stay (P＜0.05) . All patients were followed up for an average of (27.35±4.37) months, and there was no significant difference in the time of resuming full weight-bearing activity between the two groups (P＞0.05) . The VAS scores were decreased significantly (P＜0.05) , while ASIA grade for neurological function and pyramidal tract sign were significantly im- proved in both groups over time (P＜0.05) . There was no significant difference in the above indexes between the two groups before operation (P＞0.05) . The robot group was significantly superior to the traditional group in VAS score at 3 months and 6 months after surgery (P＜0.05) , whereas which became not statistically significant between the two groups at the latest follow up (P＞0.05) . However, there were no signifi- cant differences in JOA score, ASIA grade and pyramidal tract sign between the two groups at any corresponding time points (P＞0.05) . In terms of imaging, the accuracy ratio of screw placement of the robot group was significantly better than that of the traditional group (P＜0.05) . There was no significant difference in bone fusion time between the two groups (P＞0.05) . Radiographically, thecervical curvature, segmental slip ratio and minimum sagittal diameter of spinal canal were significantly improved in both groups at last follow-up compared with those pre- operatively (P＜0.05) , which were not significantly different between the two groups at the two corresponding time points postoperatively (P＞ 0.05) . [Conclusion] Compared with free-hand screw placement, Tianji robot assisted screw placement does effectively shorten the opera- tion time, reduce surgical trauma, improve the accuracy of screw placement, and facilitate postoperative rehabilitation of patients..