机器人辅助脊柱手术中椎弓根螺钉置钉的学习曲线是怎样的？
What is the learning curve for robotic-assisted pedicle screw placement in spine surgery?
机构信息
Scoliosis and Spine Tumor Center, Texas Back Institute, Texas Health Presbyterian Hospital Plano, 6020 West Parker Road, #200a, Plano, TX, 75093, USA.
出版信息
Clin Orthop Relat Res. 2014 Jun;472(6):1839-44. doi: 10.1007/s11999-013-3291-1.
BACKGROUND
Some early studies with robotic-assisted pedicle screw implantation have suggested these systems increase accuracy of screw placement. However, the relationship between the success rate of screw placement and the learning curve of this new technique has not been evaluated.
QUESTIONS/PURPOSES: We determined whether, as a function of surgeon experience, (1) the success rate of robotic-assisted pedicle screw placement improved, (2) the frequency of conversion from robotic to manual screw placement decreased, and (3) the frequency of malpositioned screws decreased.
METHODS
Between June 2010 and August 2012, the senior surgeon (IHL) performed 174 posterior spinal procedures using pedicle screws, 162 of which were attempted with robotic assistance. The use of the robotic system was aborted in 12 of the 162 procedures due to technical issues (registration failure, software crash, etc). The robotic system was successfully used in the remaining 150 procedures. These were the first procedures performed with the robot by the senior surgeon, and in this study, we divided the early learning curve into five groups: Group 1 (Patients 1-30), Group 2 (Patients 31-60), Group 3 (Patients 61-90), Group 4 (Patients 91-120), and Group 5 (Patients 121-150). One hundred twelve patients (75%) had spinal deformity and 80 patients (53%) had previous spine surgery. The accuracy of screw placement in the groups was assessed based on intraoperative biplanar fluoroscopy and postoperative radiographs. The results from these five groups were compared to determine the effect on the learning curve. The numbers of attempted pedicle screw placements were 359, 312, 349, 359, and 320 in Groups 1 to 5, respectively.
RESULTS
The rates of successfully placed screws using robotic guidance were 82%, 93%, 91%, 95%, and 93% in Groups 1 to 5. The rates of screws converted to manual placement were 17%, 7%, 8%, 4%, and 7%. Of the robotically placed screws, the screw malposition rates were 0.8%, 0.3%, 1.4%, 0.8%, and 0%.
CONCLUSIONS
The rate of successfully placed pedicle screws improved with increasing experience. The rate of the screws that were converted to manual placement decreased with increasing experience. The frequency of screw malposition was similar over the learning curve at 0% to 1.4%. Future studies will need to determine whether this finding is generalizable to others.
LEVEL OF EVIDENCE
Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
一些早期的机器人辅助椎弓根螺钉植入研究表明，这些系统提高了螺钉放置的准确性。然而，螺钉放置成功率与新技术学习曲线之间的关系尚未得到评估。
问题/目的：我们确定了随着外科医生经验的增加，（1）机器人辅助椎弓根螺钉放置的成功率是否提高，（2）从机器人转换为手动螺钉放置的频率是否降低，以及（3）螺钉错位的频率是否降低。
方法
2010 年 6 月至 2012 年 8 月，高级外科医生（IHL）使用椎弓根螺钉进行了 174 例脊柱后路手术，其中 162 例尝试使用机器人辅助。由于技术问题（注册失败、软件崩溃等），在 162 例手术中有 12 例手术中止使用机器人系统。在剩下的 150 例手术中，机器人系统成功使用。这些是高级外科医生第一次使用机器人进行的手术，在本研究中，我们将早期学习曲线分为五组：第 1 组（患者 1-30）、第 2 组（患者 31-60）、第 3 组（患者 61-90）、第 4 组（患者 91-120）和第 5 组（患者 121-150）。112 例患者（75%）患有脊柱畸形，80 例患者（53%）有脊柱手术史。根据术中双平面透视和术后 X 线片评估各组螺钉放置的准确性。比较这五组结果，以确定对学习曲线的影响。第 1 至 5 组中尝试的椎弓根螺钉数量分别为 359、312、349、359 和 320。
结果
使用机器人引导的螺钉成功率分别为第 1 至 5 组的 82%、93%、91%、95%和 93%。转换为手动放置螺钉的比例分别为 17%、7%、8%、4%和 7%。在机器人放置的螺钉中，螺钉错位率分别为 0.8%、0.3%、1.4%、0.8%和 0%。
结论
随着经验的增加，成功放置的椎弓根螺钉比例提高。随着经验的增加，转换为手动放置螺钉的比例降低。螺钉错位的频率在学习曲线上相似，为 0%至 1.4%。未来的研究需要确定这一发现是否具有普遍性。
证据水平
III 级，治疗研究。请参阅作者说明，以获取完整的证据水平描述。
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