Zhang Chunlin, Wang Zheng, Zhang Changsheng, Chen Fuan, Zhang Hua, Yan Xu
Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.
J Spinal Disord Tech. 2012 Oct;25(7):E191-8. doi: 10.1097/BSD.0b013e31825ef937.
Prospective.
To explore the feasibility and accuracy of thoracic and lumbar pedicle guidewire placement using a newly developed Spine Bull's-Eye Robot with the pedicle standard axis view (PSAV).
Placement of pedicle screws in the thoracic spine is considered to be particularly risky surgery and is associated with a relatively high rate of screw misplacement. Use of robot-assisted surgery may improve the accuracy of pedicle screw placement.
The study included 204 pedicles (T1-L5) from 6 human vertebrae and 5 pedicles from 3 patients. Computed tomographic reconstruction of target vertebrae was performed for surgical planning. Using the PSAV, a guidewire (1.2 mm diameter, 13.5 cm length) was inserted into the "bull's-eye" (the center of the pedicle circular projection) using the remotely operated Spine Bull's-Eye Robot. After surgery, vertebral body axial and lateral radiographs, and computed tomographic scans were used to assess the guidewire trajectory. Planned and actual (postoperative) measures for transverse section angle, sagittal section angle, and the superior/inferior and medial/lateral vertical distances from the entry point were compared.
The PSAV was acquired clearly in 203 of 209 (97.1%) pedicles; the guidewire was successfully inserted in each of these pedicles. There were no significant differences between any of the planned and actual (postoperative) measures. All of the pedicles for which guidewire placement was abandoned (because of lack of bull's-eye resolution in the PSAV) were small upper thoracic specimens, exhibiting evidence of decalcification, presumably because of preservation procedures. None of the patients experienced complications associated with guidewire placement.
Use of the Spine Bull's-Eye Robot with PSAV seems be an accurate and feasible approach for guidewire (and thus pedicle screw) placement in the thoracic and lumbar spine.
前瞻性研究。
探讨使用新开发的带有椎弓根标准轴位视图（PSAV）的脊柱靶心机器人进行胸腰椎椎弓根导丝置入的可行性和准确性。
胸椎椎弓根螺钉置入被认为是一项风险特别高的手术，且螺钉误置率相对较高。使用机器人辅助手术可能会提高椎弓根螺钉置入的准确性。
本研究包括来自6个人体椎体的204个椎弓根（T1-L5）和来自3名患者的5个椎弓根。对目标椎体进行计算机断层扫描重建以进行手术规划。使用PSAV，通过遥控操作的脊柱靶心机器人将一根导丝（直径1.2毫米，长度13.5厘米）插入“靶心”（椎弓根圆形投影的中心）。手术后，使用椎体前后位和侧位X线片以及计算机断层扫描来评估导丝轨迹。比较计划的和实际（术后）的横截面积角度、矢状面角度以及从进针点的上下和内外垂直距离的测量值。
209个椎弓根中的203个（97.1%）清晰获得了PSAV；在这些椎弓根中每个都成功插入了导丝。任何计划的和实际（术后）的测量值之间均无显著差异。所有因PSAV中缺乏靶心分辨率而放弃导丝置入的椎弓根均为上胸椎小标本，显示出脱钙迹象，可能是由于保存程序所致。没有患者出现与导丝置入相关的并发症。
使用带有PSAV的脊柱靶心机器人似乎是胸腰椎导丝（进而椎弓根螺钉）置入的一种准确且可行的方法。
