| 于笑笙,陈修远,陈皓,劳立峰,王淑容,涂志朋,韩应超,陈智,张煜辉,沈洪兴*.骨科机器人辅助微创精准手术治疗胸腰段骨折的初步经验[J].脊柱外科杂志,2020,18(6):369-375. |
骨科机器人辅助微创精准手术治疗胸腰段骨折的初步经验  点此下载全文 (Fulltext) |
| 于笑笙 陈修远 陈皓 劳立峰 王淑容 涂志朋 韩应超 陈智 张煜辉 沈洪兴* |
| 上海交通大学医学院附属仁济医院脊柱外科, 上海 200127 |
| 基金项目：上海市科学技术委员会科研计划项目（18XD1402300）；上海申康医院发展中心临床科技创新项目（SHDC12015103）；上海交通大学多学科交叉项目（YG2017ZD07） |
| DOI：10.3969/j.issn.1672-2957.2020.06.002 |
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| 摘要： |
| 目的 比较骨科机器人辅助经皮椎弓根螺钉内固定术治疗胸腰段骨折与传统后路椎弓根螺钉内固定术、C形臂X线机透视导航经皮椎弓根螺钉内固定术的临床疗效，探讨机器人辅助手术治疗胸腰段骨折的微创化与精准化价值。方法 2018年2月—2019年6月，收治无神经症状胸腰段骨折患者52例，18例接受机器人辅助经皮椎弓根螺钉内固定术治疗（机器人组），15例接受C形臂X线机透视导航经皮椎弓根螺钉内固定术治疗（透视组），19例接受传统后路椎弓根螺钉内固定术治疗（传统组）。记录并比较3组的手术时间、透视时间、辐射剂量、术中出血量、置钉准确率、卧床时间、住院天数，术前、术后6个月伤椎前缘相对高度及Cobb角，以及术前、术后3 d、术后6个月的疼痛视觉模拟量表（VAS）评分和日本骨科学会（JOA）评分。结果 所有手术顺利完成，未出现手术相关并发症。所有患者随访6~12个月，平均8个月。机器人组和透视组的手术时间、术中出血量、卧床时间、住院天数均少于传统组，差异有统计学意义（P<0.05）；透视组透视时间最长、辐射剂量最大，机器人组透视时间最短、辐射剂量最少，差异有统计学意义（P<0.05）；机器人组置钉准确率高于透视组和传统组，差异有统计学意义（P<0.05）。3组患者术后6个月伤椎前缘相对高度、Cobb角、VAS评分和JOA评分均较术前改善，差异有统计学意义（P<0.05）。3组术前、术后3 d和术后6个月伤椎前缘相对高度、Cobb角及JOA评分差异无统计学意义（P>0.05）；机器人组与透视组术后3 d VAS评分优于传统组且差异有统计学意义（P<0.05），术前及术后6个月3组VAS评分差异无统计学意义（P>0.05）。结论 机器人辅助经皮内固定术是治疗无神经症状胸腰段骨折的有效方法，具有手术时间短、精度高、创伤小、辐射少、患者术后恢复快等优势，满足适应证时可作为优先选择。 |
| 关键词：胸椎 腰椎 脊柱骨折 内固定器 外科手术，微创 机器人 |
| Precision and minimally invasive features of robot-assisted spinal surgery for thoracolumbar fractures: a preliminary study Fulltext |
| YU Xiao-sheng CHEN Xiu-yuan CHEN Hao LAO Li-feng WANG Shu-rong TU Zhi-peng HAN Ying-chao CHEN Zhi ZHANG Yu-hui SHEN Hong-xing* |
| Department of Spinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical effects of robot-assisted percutaneous pedicle screw fixation with traditional posterior pedicle screw fixation and C-arm X-ray fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar fractures without neurological symptoms. Methods From February 2018 to June 2019,52 patients with asymptomatic thoracolumbar fractures were treated. Eighteen patients received robot-assisted percutaneous pedicle screw fixation(robot group);15 patients received C-arm X-ray fluoroscopy-guided percutaneous pedicle screw fixation(fluoroscopy group);19 patients received traditional posterior pedicle screw fixation(traditional group). The operation time,fluoroscopy time,radiation exposure,intraoperative blood loss,accuracy of screw placement,bed rest time,length of hospitalization,relative anterior height of injured vertebra and Cobb's angle at preoperative and postoperative 6 months,visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores at preoperative,postoperative 3 d and postoperative 6 months were compared between the 3 groups. Results All the operations were successfully completed without any complications. All the patients were followed up for 6-12 months,with an average of 8 months. The operating time,blood loss,bed rest time and length of hospitalization of robot and fluoroscopy groups were significantly less than those of the traditional group,and the difference was statistically significant(P<0.05). The fluoroscopy group had the most fluoroscopy time and radiation exposure,and the robot group had the lest,with significant differences(P<0.05). The accuracy of screw placement in the robot group was significantly higher than that in fluoroscopy and traditional groups,and the differences were statistically significant(P<0.05). The relative anterior height of injured vertebra,Cobb's angle,VAS and JOA scores of the 3 groups at postoperative 6 months were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05). There was no significant difference in the relative anterior height of injured vertebra,Cobb's angle and JOA score between the 3 groups at per-operation,postoperative 3 d and postoperative 6 months(P>0.05). The VAS scores of robot and fluoroscopy groups were significantly better than those of the traditional group at postoperative 3 d,and the differences were statistically significant (P<0.05);and there was no significant difference in VAS score between the 3 groups at peroperative and postoperative 6 months(P>0.05). Conclusion Robot-assisted percutaneous pedicle screw fixation is an effective method for treating thoracolumbar fractures. Due to its certain advantages such as shorter operating time,less radiation,higher precision,less trauma,and quicker recovery,it should be a prior choice if it meets the indications. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Spinal fractures Internal fixators Surgical procedure,minimally invasive Robotics |
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