机器人辅助经皮椎弓根螺钉内固定在基层医院的应用

Robot assisted percutaneous pedicle screw placment in primary medical institution

摘要:

［目的］探讨机器人辅助经皮椎弓根螺钉内固定在基层医院的应用价值。［方法］南昌县人民医院 2020 年 9 月-2021 年 9 月内固定治疗 46 例胸腰椎骨折患者，根据医患沟通结果，22 例采用机器人辅助置钉，24 例采用传统徒手置钉，比较两组早期临床和影像资料。［结果］ 机器人组平均透视次数和手术时间均显著少于徒手组 （P<0.05）。机器人组置钉准确率 Gertz- bein-Robbins 分级显著优于徒手组 （P<0.05）。两组患者均随访 6~8 个月，两组完全负重活动时间的差异无统计学意义 （P> 0.05），两组术后 VAS 和 ODI 评分均较术前显著降低 （P<0.05），但相应时间点两组间比较差异均无统计学意义 （P>0.05）。两组患者术后伤椎前缘高度和 Cobb 角均较术前显著改善（P<0.05），相应时间点两组间影像测量指标的差异均无统计学意义（P> 0.05）。［结论］机器人辅助基层医生行经皮椎弓根螺钉内固定，能够减少透视次数和手术时间，提高置钉准确率，对于基层医院具有应用价值。

Abstract:

[Objective] To explore and analyze the application value of robot-guided percutaneous pedicle screw placement in the pri- mary medical institution. [Methods] A total of 46 patients received internal fixation of thoracolumbar fracture in People's Hospital of Nan- chang County from September 2020 to September 2021. Based on preoperative patient-doctor communication, 22 patients underwent robot assisted pedicle screw placement, while the remaining 24 patients had pedicle screw placed by traditional free-hand technique. The clini- cal and image data were compared between the two groups. [Results] The robot group proved significantly superior to the free-hand group in terms of number of fluoroscopy and operation time (P＜0.05) . The two groups were followed up for 6~8 months, and there was no signifi- cant difference in the fracture healing time between the two groups (P＞0.05) . The VAS scores and ODI scores significantly reduced in both groups postoperatively (P＜0.05) , nevertheless there was no significant difference between the two groups at the corresponding time points (P＞0.05) . The robot group was significantly superior to the free-hand group in Gertzbein-Robbins scale of screw placement accuracy (P＜ 0.05) . The anterior vertebral height and local kyphotic Cobb angle of the injured vertebrae in the two groups were significantly improved af- ter operation (P＜0.05) , whereas which were not significantly different between the two groups at the corresponding time points (P＞0.05) . [Conclusion] The robot-assisted percutaneous pedicle screw insertion does reduce the number of fluoroscopy and operation time, improve the accuracy of screw placement, which has application value for primary hospitals.