【摘要】 目的比较胸腰椎骨折内固定手术中机器人辅助(robot-assisted,RA)与徒手(free-hand,FH)置入椎弓根螺钉的精度及手术即时效果。方法采用前瞻性研究,选择我院2015年5月～2020年1月146例椎弓根内固定术,其中65例选择RA螺钉置入(RA组),81例选择FH螺钉置入(FH组)。根据Gertzbein与Robbins量表评价椎弓根螺钉置入的准确性,对2组螺钉置入准确性和围手术期指标包括手术时间、术中出血量、疼痛视觉模拟评分(Visual Analogue Scale,VAS)、骨折节段Cobb角、椎体前缘相对高度和是否翻修等进行比较。结果 RA组置入331枚螺钉,其中325枚螺钉A级,5枚B级,1枚C级;FH组置入484枚螺钉,其中431枚螺钉A级,44枚B级,9枚C级。RA组螺钉位置优秀(A级)率明显高于FH组[98.2%(325/331) vs. 89.0%(431/484),χ~2=24.442,P=0.000]。FH组475枚螺钉(98.1%)的位置在临床上是可接受的(A+B级),RA组为330枚(99.7%)。RA组手术时间(119.8±38.9)min,显著多于FH组(92.6±25.0)min(t=4.822,P=0.000);术中出血量中位数50.0(25.0, 100.0)ml,显著少于FH组100.0(100.0, 200.0)ml(Z=-6.261,P=0.000)。2组内术后1 d疼痛VAS评分中位数较术前明显降低[RA组:3.0(3.0,3.5)分vs. 6.0(6.0,7.0)分,Z=-7.066,P=0.000;FH组:3.0(3.0,4.0)分vs. 6.0(6.0,7.0)分,Z=-7.939,P=0.000],但2组间比较差异无显著性(P>0.05)。2组内骨折节段Cobb角术后3～5 d较术前明显改善[RA组:9.4°±3.3°vs. 20.3°±3.8°,t=23.173,P=0.000;FH组:9.7°±3.4°vs. 20.0°±3.8°,t=23.407,P=0.000],但2组间比较差异无显著性(P>0.05)。2组内骨折椎体前缘相对高度出院前较术前明显改善[RA组:(89.2±4.6)%vs.(63.6±4.6)%,t=-174.651,P=0.000;FH组:(89.4±4.9)%vs.(64.1±5.2)%,t=-169.251,P=0.000],但2组间比较差异无显著性(P>0.05)。2组患者均未出现手术并发症、术式变更或因手术并发症造成的术后翻修。结论胸腰椎骨折椎弓根螺钉内固定术中,RA置钉是准确和安全的。更多还原

【Abstract】 Objective To compare the surgical accuracy and immediate effect of robot-assisted(RA) and free-hand(FH) pedicle screw insertion internal fixation for thoracolumbar fractures. Methods A total of 146 patients with RA(65 patients) and FH(81 patients) undergoing pedicle fixation between May 2015 and January 2020 in our hospital were enrolled in this prospective study. The screw accuracy and perioperative indicators were recorded and compared. The accuracy of pedicle screw placement was evaluated by the Gertzbein and Robbins scales. The perioperative indicators mainly included the operation time, intraoperative blood loss, Visual Analogue Scale(VAS), Cobb angle of racture segment,relative height of the anterior border of the fractured vertebra and whether or not to renovate. Results Of the 331 screws in the RA group, 325 were class A, 5 were class B, and 1 was class C. Of the 484 screws in the FH group, 431 were class A, 44 were class B, and 9 were class C. The excellence rate of screw position(grade A) in the RA group was significantly higher than that in the FH group(98.2% vs. 89.0%, χ~2=24.442, P=0.000). The position of 475 screws(98.1%) in the FH group was clinically acceptable(grade A+B), while the position of 330 screws(99.7%) in the RA group was clinically acceptable. The operation time of the RA group was(119.8±38.9) minutes, which was significantly longer than that of the FH group(92.6±25.0) minutes(t=4.822, P=0.000). The median intraoperative blood loss of the RA group was 50.0(25.0,100.0) ml, which was significantly lower than that of the FH group 100.0(100.0,200.0) ml(Z=-6.261, P=0.000). The VAS score on the first day postoperatively significantly decreased in both groups as compared to that before surgery [RA group: 3.0(3.0,3.5) points vs. 6.0(6.0,7.0) points, Z=-7.066, P=0.000; FH group: 3.0(3.0,4.0) points vs. 6.0(6.0,7.0) points, Z=-7.939, P=0.000]; the Cobb angle of fracture segment was significantly improved after surgery(RA group: 9.4°±3.3° vs. 20.3°±3.8°, t=23.173, P=0.000; FH group: 9.7°±3.4° vs. 20.0°±3.8°, t=23.407, P=0.000), and the relative height of the anterior border of the fractured vertebra was also significantly improved after surgery [RA group:(89.2±4.6)% vs.(63.6±4.6)%, t=-174.651, P=0.000; FH group:(89.4±4.9)% vs.(64.1±5.2)%, t=-169.251, P=0.000], but there were no significant differences between the two groups(P>0.05). There were no surgical complications, surgical changes or postoperative revision due to surgical complications in both RA group and FH group. Conclusion The internal fixation with pedicle screw insertion assisted by the orthopedic robot system is accurate and safe in the treatment of thoracolumbar fracture.更多还原