摘要
目的 比较机器人与导航技术辅助椎弓根螺钉内固定的准确性和疗效.方法 回顾性分析2017年6月至2023年4月在西安交通大学附属红会医院脊柱外科行内固定治疗的腰椎疾患患者764例,根据辅助置钉为机器人或导航技术分为文艺复兴组(使用Renaissance®机器人,212例)、天玑组(使用天玑®骨科机器人,301例)和S8导航组(使用StealthStation™ S8外科导航系统,251例).比较三组患者的手术时间、透视时间、X线辐射剂量、术中失血量、螺钉置入的准确率、螺钉翻修率、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及术后感染率.结果 文艺复兴组置入922枚螺钉、天玑组1 260枚螺钉、S8导航组1044枚螺钉.三组临床可接受椎弓根螺钉置入的准确率分别为92.08％(849/922)、99.68％(1 256/1 260)、99.43％(1 038/1 044),文艺复兴组小于天玑组和S8组(x2=90.334,P＜0.001;x2=68.446,P＜0.001),天玑组与S8组比较差异无统计学意义(x2=0.380,P=0.537).三组手术时间分别为(173.64±62.23)min、(177.11±60.85)min、(176.02±60.93)min,术中失血量分别为(118.16±58.26)ml、(121.84±55.91)ml、(123.62±59.84)ml,组间差异均无统计学意义(P＞0.05).三组透视时间分别为(8.73±2.92)s、(10.67±2.85)s、(11.31±2.89)s,X线辐射剂量分别为(18.83±7.41)μSv、(20.40±7.60)μSv和(22.88±7.47)μSv,组间及两两比较的差异均有统计学意义(P＜0.05).所有患者均获得随访,随访时间3～30个月.术后文艺复兴组3例因螺钉穿透椎弓根皮质刺激神经根而行螺钉翻修术,其他两组均无一例行螺钉翻修术.术后文艺复兴组1例、天玑组1例发生浅表感染,经延长抗生素使用时间后痊愈.术后3个月,文艺复兴组、天玑组、S8导航组腿痛VAS评分分别为(3.52±1.14)分、(3.59±1.12)分、(3.39±1.16)分,背痛 VAS 评分分别为(3.54±1.14)分、(3.57±1.12)分、(3.51±1.15)分,ODI 评分分别为 12.48％±4.53％、12.01％±4.57％、12.28％±4.60％,组间差异均无统计学意义(P＞0.05).结论 天玑®骨科机器人辅助置入螺钉的准确率与Stealth-StationTM S8外科导航系统相当,两者均优于Renaissance®机器人;而Renaissance®机器人的透视时间和X线辐射剂量均小于天玑®骨科机器人,而天玑®骨科机器人小于StealthStation™ S8外科导航系统.机器人与导航技术辅助椎弓根螺钉内固定治疗腰椎疾患的早期疗效相近.
Abstract
Objective To compare the accuracy and efficacy of robot assisted and navigation assisted pedicle screw fixa-tion.Methods Retrospective analysis of 764 patients with lumbar spine disorders who underwent internal fixation treatment at the Department of Spine Surgery,Honghui Hospital,Xi'an Jiaotong University,from June 2017 to April 2023 were performed.They were divided into the Renaissance group(212 cases),the Tinavi group(301 cases),and the S8 navigation group(251 cases),according to the method of assisted placement of pedicle screws.The operation time,fluoroscopy time,X-ray radiation dose,intra-operative blood loss,accuracy of screw placement,screw revision rate,pain visual analogue scale(VAS),Oswestry disability index(ODI)and postoperative infection rate were compared among the three groups.Results 922 screws were placed in the Renais-sance group,1,260 screws in the Tinavi group,and 1,044 screws in the S8 navigation group.The accuracy of clinically acceptable pedicle screw placement was 92.08％(849/922),99.68％(1,256/1,260),and 99.43％(1,038/1,044)in the three groups,respective-ly,with the Renaissance group being smaller than the Tinavi group and the S8 group(x2=90.334,P＜0.001;x2=68.446,P＜0.001),and the Tinavi group and the S8 group had no statistically significant difference(x2=0.380,P=0.537).The operation time of the three groups was 173.64±62.23 min,177.11±60.85 min,176.02±60.93 min,and the intraoperative blood loss was 118.16±58.26 ml,121.84±55.91 ml,123.62±59.84 ml,respectively,and the differences between the groups were not statistically significant(P＞0.05).The fluoroscopy time of the three groups was 8.73±2.92 s,10.67±2.85 s,and 11.31±2.89 s,and the X-ray radiation doses were 18.83±7.41 μSv,20.40±7.60 μSv,and 22.88±7.47 μSv,respectively,with statistically significant differences between the groups and the two comparisons(P＜0.05).All patients were given follow-up for 3-30 months.Three cases in the postoperative Re-naissance group underwent screw revision for nerve root irritation due to screw penetration of the pedicle cortex,and none of the other two groups underwent screw revision.Postoperatively,one case in the Renaissance group and one case in the Tinavi group had superficial infections,which were cured after prolonged antibiotic use.At 3 months postoperatively,the VAS scores for leg pain in the Renaissance group,the Tinavi group,and the S8 navigation group were 3.52±1.14,3.59±1.12,and 3.39±1.16,and the VAS scores for back pain were 3.54±1.14,3.57±1.12,and 3.51±1.15,respectively;the ODI scores were 12.48％±4.53％,12.01％±4.57％,and 12.28％±4.60％,and none of the differences between the groups were statistically significant(P＞0.05).Conclusion The accuracy of screw placement by the Tinavi robot was comparable to that of the S8 navigation,and both were superior to that of the Renaissance robot;the fluoroscopy time and radiation dose of the Renaissance robot were smaller than those of the Tinavi ro-bot,which was smaller than that of the S8 navigation.The early efficacy of robotics and navigation-assisted pedicle screw internal fixation for lumbar spine disorders is similar.
基金项目
国家"十四五"重点研发计划(2022YFC2407503)
维普
万方数据