[1]谭黄圣,赖居易△,冯华龙,等.第三代天玑骨科机器人辅助下经皮置钉在经肌间隙入路腰椎融合内固定术中的应用[J].中国中医骨伤科杂志,2024,32(02):20-24.[doi:10.20085/j.cnki.issn1005-0205.240204]
　TAN Huangsheng LAI Juyi FENG Hualong LAN Zhiming FU Yuanfei SUN Zhitao WANG Jian HE Shenghua.Application of the Third Generation TiRobot-Assisted Percutaneous Screw Placement in Lumbar Fusion and Internal Fixation via Wiltse Approach[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(02):20-24.[doi:10.20085/j.cnki.issn1005-0205.240204]
点击复制

第三代天玑骨科机器人辅助下经皮置钉在经肌间隙入路腰椎融合内固定术中的应用()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年02期
页码:
20-24
栏目:
临床研究
出版日期:
2024-02-15

文章信息/Info

Title:
Application of the Third Generation TiRobot-Assisted Percutaneous Screw Placement in Lumbar Fusion and Internal Fixation via Wiltse Approach
文章编号:
1005-0205(2024)02-0020-05
作者:
谭黄圣1; 2; 赖居易1; 2△; 冯华龙2; 蓝志明2; 付远飞2; 孙志涛2; 王建2; 何升华2△
1广州中医药大学第四临床医学院(广东 深圳,518000); 2深圳市中医院
Author(s):
TAN Huangsheng1; 2 LAI Juyi1; 2△ FENG Hualong2 LAN Zhiming2 FU Yuanfei2 SUN Zhitao2 WANG Jian2 HE Shenghua2△
1Fourth Clinical Medical College,Guangzhou University of Chinese Medicine,Shenzhen 518000,Guangdong China; 2Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518000,Guangdong China.
关键词:
腰椎融合术;  肌间隙入路;  骨科机器人;  内固定;  椎弓根螺钉;  安全性;  并发症
Keywords:
lumbar fusion;  intermuscular approach;  orthopedic rotot;  internal fixation;  pedicle screw;  safety;  complications
分类号:
R681.5
DOI:
10.20085/j.cnki.issn1005-0205.240204
文献标志码:
A
摘要:
目的:探讨第三代天玑骨科机器人辅助下经皮置钉腰椎经肌间隙入路融合内固定术的安全性及临床疗效。方法:选择2021年12月至2022年7月天玑骨科机器人辅助下经Wiltse入路融合内固定术治疗的腰椎患者48例,男28例,女20例; 年龄为32～74岁。48例患者均为单侧神经压迫症状,一侧采用机器人辅助下经皮置入椎弓根螺钉,另一侧采用经Wiltse入路置钉。比较48例患者术前、末次随访视觉模拟量表(VAS)评分和腰椎日本骨科协会(JOA)评分,采用Richter分类标准及螺钉内聚角对比两侧椎弓根螺钉置入准确度,统计分析两侧置钉时间及出血量。结果:患者术后末次随访的VAS评分和JOA评分均较术前明显改善,差异有统计学意义(P<0.05); 术后2 d采用Richter分类标准评价置钉准确度,机器人辅助下共置钉108枚,其中Ⅰ级101枚,Ⅱ级6枚,Ⅲ级1枚。徒手置钉104枚,其中Ⅰ级80枚,Ⅱ级20枚,Ⅲ级4枚。机器人辅助下置钉准确率为93.52%,徒手置钉准确率为76.92%,机器人辅助下置钉准确率显著优于徒手置钉,差异有统计学意义(χ2=7.727,P=0.005)。机器人辅助下置入椎弓根螺钉平均内聚角为25.19°±3.85°,徒手置入椎弓根螺钉平均内聚角为29.19°±4.37°,差异有统计学意义(t=10.24,P=0.03)。机器人辅助下置钉出血量、置钉时间均优于徒手置钉(P<0.05)。结论:机器人辅助经皮置钉相比徒手置钉可进一步提升手术安全性,提高临床疗效。
Abstract:
Objective:To investigate the safety and clinical efficacy of the third generation TiRobot-assisted percutaneous screw placement versus freehand placement of screws in lumbar spine fusion and internal fixation via Wiltse approach.Methods:48 patients with lumbar spine who underwent the third generation TiRobot-assisted fusion and internal fixation via Wiltse approach from December 2021 to July 2022 were selected,including 28 males and 20 females,aged 3274 years old.All 48 patients had symptoms of unilateral nerve compression.Robot-assisted percutaneous pedicle screw placement was used on the side of the lumbar spine,and the lumbar spine on the other side was placed with screws through the Wiltse approach.The preoperative and last follow-up visual analogue scale(VAS)and lumbar Japanese orthopedic association(JOA)scores of 48 patients were compared,and the Richter classification criteria and screw cohesion angle were used to compare the accuracy of pedicle screw placement on the both sides.The time and bleeding volume of bilateral nail placement were statistically analyzed.Results:The VAS score and JOA score of the patients at the last follow-up after operation were significantly improved compared with those before operation(P<0.05).The Richter classification criteria were used to evaluate the accuracy of screw placement 2 d after surgery.There were 108 nails placed on the healthy side,and 101 were grade Ⅰ,6 of grade Ⅱ and 1 of grade Ⅲ.There were 104 nails placed on the affected side,including 80 of grade Ⅰ,20 of grade Ⅱ,and 4 of grade Ⅲ.The accuracy of robot assisted nailing was 93.52%,and that of manual nailing was 76.92%.The accuracy of robot assisted nailing was significantly better than manual nailing,and the difference was statistically significant(χ2=7.727,P=0.005).The average cohesion angle of pedicle screws placed under robotic assistance was 25.19°±3.85°,and the average cohesion angle of pedicle screws placed was 29.19°±4.37°,and the difference was statistically significant(t=10.24,P=0.03).The amount of bleeding and the time of placing nails assisted by robot are better than those of unarmed nails(P<0.05).Conclusion:The results show that the robot-assisted percutaneous nail placement can further improve the safety of surgery and improve the clinical efficacy compared with manual nail placement.

参考文献/References:

[1] 杜盛阳,戴俊,周震涛,等.机器人辅助经皮置钉与徒手Wiltse入路开放置钉治疗脊柱胸腰段骨折的疗效比较[J].中华创伤杂志,2022,38(2):109-115.
[2] 徐子航,龙浩,何祖波,等.机器人辅助皮质骨轨迹螺钉内固定术治疗腰椎退行性疾病的置钉准确率及学习曲线分析[J].中国脊柱脊髓杂志,2022,32(4):305-312.
[3] RICHTER M,MATTES T,CAKIR B.Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine[J].Eur Spine J,2004,13(1):50-59.
[4] 李杨,杜怡斌.机器人辅助与徒手椎弓根螺钉置入在脊柱疾病应用效果的meta分析[J].临床荟萃,2023,38(3):208-215.
[5] TIAN N F,HUANG Q S,ZHOU P,et al.Pedicle screw insertion accuracy with different assisted methods:a systematic review and meta-analysis of comparative studies[J].Eur Spine J,2011,20(6):846-859.
[6] TIAN N F,XU H Z.Image-guided pedicle screw insertion accuracy:a meta-analysis[J].Int Orthop,2009,33(4):895-903.
[7] 杨倩倩,郭大为,王爽,等.“天玑”骨科手术机器人工作原理与质量控制检测[J].中国医学装备,2021,18(5):198-202.
[8] DEVITO D P,KAPLAN L,DIETL R,et al.Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot:retrospective study[J].Spine(Phila Pa 1976),2010,35(24):2109-2115.
[9] MOLLIQAJ G,SCHATLO B,ALAID A,et al.Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery[J].Neurosurg Focus,2017,42(5):E14.
[10] 郭凯,张家豪,黄星,等.框架式并联骨科手术机器人辅助椎弓根螺钉置入[J].中国组织工程研究,2023,27(22):3492-3497.
[11] SIDDIQUI M I,WALLACE D J,SALAZAR L M,et al.Robot-assisted pedicle screw placement:learning curve experience[J].World Neurosurg,2019,130:e417-e422.
[12] KAM J,GAN C,DIMOU S,et al.Learning curve for robot-assisted percutaneous pedicle screw placement inthoracolumbar surgery[J].Asian Spine J,2019,13(6):920-927.
[13] WANG M,LI D,SHANG X,et al.A review of computer-assisted orthopaedic surgery systems[J].Int J Med Robot,2020,16(5):1-28.
[14] 朱振中,郑国焱,张长青.机器人辅助技术在创伤骨科的发展与临床应用[J].中国修复重建外科杂志,2022,36(8):915-922.
[15] 郑山,王博,韩振川,等.“天玑”骨科手术机器人辅助经皮螺钉内固定治疗单纯腰椎峡部裂的疗效观察[J].解放军医学院学报,2022,43(6):617-621.
[16] 范明星,刘亚军,段芳芳,等.机器人辅助胸腰椎椎弓根螺钉内固定术的学习曲线和临床意义[J].骨科临床与研究杂志,2018,3(4):213-217.
[17] 曹旭含,白子兴,孙承颐,等.机器人在骨科手术中应用的可靠性与提升空间[J].中国组织工程研究,2020,24(9):1416-1421.

备注/Memo

备注/Memo:
基金项目:国家自然科学基金面上项目(82174397)
深圳市三名工程项目(SZZYSM202211004)
△通信作者 E-mail:heshenghua99@163.com(何升华)
laijuyi@163.com(赖居易)
更新日期/Last Update: 2024-02-15