摘要
目的探讨机器人导航下与传统C臂 X 线机透视下微创经皮椎弓根螺钉内固定术治疗胸腰椎压缩性骨折的近期疗效。方法回顾性队列研究。纳入2021年1月—2022年12月蚌埠医科大学第一附属医院骨科胸腰椎压缩性骨折患者30例, 其中男14例、女16例, 年龄20~58(44.6±11.4)岁。30例患者根据手术方式不同分为2组, 采用传统C臂X线机透视经皮椎弓根螺钉内固术治疗的17例为传统组, 采用"天玑"骨科机器人导航下后路经皮椎弓根螺钉内固定术治疗的13例为机器人组。观察指标:(1)比较2组患者性别、年龄、致伤因素、受伤至手术时间、伤椎节段等基线资料;(2)比较2组患者手术时间、术中出血量、术中透视次数和医务人员辐射剂量>0.01 mSv的占比、单枚螺钉置钉时间、住院时间, 以及术后神经损伤、切口感染、内固定松动等并发症的发生情况;(3)比较2组患者术前、术后第7天、术后3个月伤椎前缘高度比、伤椎Cobb 角及腰背部疼痛视觉模拟评分法(VAS)评分。结果 (1)2组患者基线资料比较, 差异均无统计学意义(P值均>0.05)。(2)30例患者手术均顺利完成, 术后无神经损伤、切口感染、内固定松动等并发症发生。机器人组手术时间(125.0±5.8)min大于传统组的(100.1±8.1)min, 住院时间8(7, 8)d、透视次数(9.2±3.2)次、单枚螺钉置钉时间(3.5±0.6)min、工作人员辐射剂>0.01 mSv的占比(3/13)均低于传统组的10(10.0, 10.5)d、(11.5±2.2)次、(5.4±0.7)min、12/17, 差异均有统计学意义(P值均<0.05);2组患者术中出血量比较, 差异无统计学意义(P>0.05)。(3)30例患者均获随访3个月。2组内比较, 患者术后第7天和术后3个月腰背部疼痛VAS 评分、伤椎矢状面Cobb角均低于术前, 伤椎前缘高度比高于术前, 差异均有统计学意义(P值均<0.05);术前、术后第7天和术后3个月, 腰背部疼痛VAS评分、伤椎矢状面Cobb角、伤椎前缘高度比组间比较, 差异均无统计学意义(P值均>0.05)。结论采用机器人导航经皮椎弓根螺钉内固定与传统C臂X线机透视下微创经皮椎弓根螺钉内固定术治疗无神经损伤的胸腰椎压缩性骨折均可获得良好的近期疗效, 且机器人导航下手术在减少术中X线透视次数和医务人员辐射剂量、置钉时间等方面优于传统手术方式。
Objective This study aimed to investigate the short-term efficacy of robot-guided and traditional C-arm X-ray machine fluoroscopy percutaneous pedicle screw fixation in the treatment of thoracolumbar compression fractures.Methods A retrospective cohort design was adopted.From January 2021 to December 2022,30 patients with thoracolumbar compression fracture treated in the Department of Orthopedics of the First Affiliated Hospital of Bengbu Medical University were enrolled in this study.The 30 patients including 14 males and 16 females aged 20-58(44.6±11.4)years were divided into two groups according to different surgical methods:17 cases were treated with traditional C-arm X-ray machine fluoroscopic percutaneous manual nail placement,and 13 cases were treated with posterior percutaneous pedicle screw fixation under the guidance of"TiRobot"orthopedic robot as the robot group.The observation indicators were as follows:(1)baseline data such as gender,age,injury factors,time from injury to operation,and injured vertebral segment were compared between the two groups.(2)The operation time,intraoperative blood loss,number of intraoperative fluoroscopy,proportion of medical staff with radiation dose>0.01 mSv,time of pedicle screw placement,hospital stay,and occurrence of complications such as postoperative nerve injury,incision infection,and loose internal fixation were compared between the two groups.(3)The visual analogue scale(VAS)scores of the anterior edge of the injured vertebrae,Cobb angle of the injured vertebrae,and low back pain were compared between the two groups before surgery,7 days after surgery,and 3 months after surgery.Results(1)No significant difference in the baseline data between the two groups(all P values>0.05).(2)The operation was successfully performed for all 30 patients,and no complications such as nerve damage,incision infection,and internal fixation loosening occurred after the surgery.The operation time of the robot group was(125.0±5.8)min,which was longer than that of the traditional group at(100.1±8.1)min.The robot group had a hospital stay time of(8[7,8])days,fluoroscopy times of([9.2±3.2]times),of screw nailing time([3.5±0.6]min),and proportion of radiation agent of>0.01 mSv(3/13),all of which were statistically significantly lower than those of the traditional group(10[10.0,10.5])days,[11.5±2.2]times,[5.4±0.7]min,[12/17];all (P values<0.05).No significant difference in intraoperative blood loss was observed between the two groups(P>0.05).(3)The 30 patients were followed up for 3 months.Intragroup comparison showed lower VAS score of low back pain and ratio of Cobb angle in the sagittal plane of the injured vertebra but higher height ratio of the anterior edge of the injured vertebra after operation than before operation with statistical significance(all P values<0.05).No significant difference in the VAS score of low back pain,Cobb angle in the sagittal plane of the injured vertebra,and height ratio of the anterior edge of the injured vertebra was found between the two groups before operation and 7 days and 3 months after surgery(all P values>0.05).Conclusion Thoracolumbar compression fractures without nerve injury can be treated by robot-guided percutaneous pedicle screw fixation and traditional C-arm X-ray machine fluoroscopy.Robotic navigation is better than traditional surgical methods in terms of reducing number of fluoroscopy and radiation dose of medical staff during surgery and shortening screw placement time.
作者
周平辉
马炳旭
叶雨辰
张世辉
傅玉春
张长春
官建中
Zhou Pinghui;Ma Bingxu;Ye Yuchen;Zhang Shihui;Fu Yuchun;Zhang Changchun;Guan Jianzhong(Department of Orthopaedic,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China)
出处
《中华解剖与临床杂志》
2024年第3期166-171,共6页
Chinese Journal of Anatomy and Clinics
基金
安徽省教育厅杰青项目(2022AH020086)
安徽省高校自然科学重点项目(2022AH051487)。
关键词
脊柱骨折
骨折
压缩性
胸椎
腰椎
骨科手术机器人
经皮椎弓根钉内固定
疗效分析
Spinal fractures
Fractures,compression
Thoracic vertebrae
Lumbar vertebrae
Orthopedic surgical robot
Percutaneous pedicle nail fixation
Efficacy analysis
作者简介
通信作者:官建中,Email:guanjianzhong@bbmc.edu.cn。
