Fujishiro Takashi, Nakaya Yoshiharu, Fukumoto Shingo, Adachi Shu, Nakano Atsushi, Fujiwara Kenta, Baba Ichiro, Neo Masashi
Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
Spine (Phila Pa 1976). 2015 Dec;40(24):1882-9. doi: 10.1097/BRS.0000000000001099.
A cadaveric study.
To investigate the accuracy of pedicle screw placement using a robotic guidance system (RGS).
RGS is a unique surgery assistance-apparatus. Although several clinical studies have demonstrated that RGS provides accurate pedicle screw placement, very few studies have validated its accuracy.
A total of 216 trajectories performed with the assistance of the RGS in eight cadavers were evaluated. The RGS was used, with different mounting platforms, to drill pilot holes in the thoracic and lumbosacral spine, using 3-mm diameter fiducial wires as trajectory markers. Deviation between the preoperative plan and executed trajectories was measured at the entry points to the vertebrae and at a depth of 30 mm along the wire. Both the deviation from the preoperative plan and the wire position were evaluated in the axial and sagittal planes using computed tomography (CT).
The average deviation from the planned wire placement was 0.64 ± 0.59 mm at the entry point and 0.63 ± 0.57 mm at a depth of 30 mm in the axial plane, and 0.77 ± 0.62 mm and 0.80 ± 0.66 mm, respectively, in the sagittal plane. The magnitude of deviation was not affected by the vertebral level or the platform used. The use of an open approach achieved greater screw placement accuracy at a depth of 30 mm in the sagittal plane, compared with the percutaneous approach. The fiducials were placed completely within the pedicle in 93.9% of trajectories in the axial plane (n = 164 pedicles with a width ≥5 mm) and 98.6% in the sagittal plane (n = 216).
In this cadaveric study, RGS supported execution of accurate trajectories that were equal or slightly superior to reports of CT-based navigation systems.
N/A.
尸体研究。
研究使用机器人引导系统（RGS）进行椎弓根螺钉置入的准确性。
RGS是一种独特的手术辅助设备。尽管多项临床研究表明RGS能实现准确的椎弓根螺钉置入，但很少有研究验证其准确性。
评估了在8具尸体中借助RGS完成的总共216条轨迹。使用不同的安装平台，RGS在胸腰椎和腰骶椎中钻导向孔，使用直径3毫米的基准线作为轨迹标记。在椎骨的入口点以及沿导线30毫米深处测量术前计划与实际执行轨迹之间的偏差。使用计算机断层扫描（CT）在轴向和矢状平面评估与术前计划的偏差以及导线位置。
在轴向平面，入口点处计划导线置入的平均偏差为0.64±0.59毫米，在30毫米深处为0.63±0.57毫米；在矢状平面分别为0.77±0.62毫米和0.80±0.66毫米。偏差大小不受椎体节段或所用平台的影响。与经皮入路相比，开放入路在矢状平面30毫米深处实现了更高的螺钉置入准确性。在轴向平面（n = 164个宽度≥5毫米的椎弓根）93.9%的轨迹以及矢状平面98.6%（n = 216）的轨迹中，基准线完全置于椎弓根内。
在这项尸体研究中，RGS支持执行的准确轨迹与基于CT的导航系统的报告相当或略优。
无。
