Tsai Tai-Hsin, Tzou Rong-Dar, Su Yu-Feng, Wu Chieh-Hsin, Tsai Cheng-Yu, Lin Chih-Lung
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Department of Neurosurgery, Kaohsiung Medical University Hospital Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2017 Jan;96(3):e5835. doi: 10.1097/MD.0000000000005835.
This article describes factors affecting the accuracy of transpedicle screw placements performed with the Renaissance robot-guided system and reviews the relevant literature. Between January 2013 and January 2015, Renaissance robot-guided spinal surgery was performed in 125 patients at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan. The surgeries included 662 transpedicle screw implants and 49 Kirschner wire (K-wire) reimplants performed by intraoperative repositioning. The lead author evaluated the accuracy of all K-wire insertions and classified their accuracy into 3 categories relative to the preoperative plan for transpedicle screw placement. For cases in which screws required repositioning after the registration step, factors affecting pedicle screw placement were determined according to the consensus of 3 experienced spinal surgeons. According to the scheme developed by Kuo et al (PLoS One 2016;11:e0153235), the K-wire placement accuracies before and after repositioning were respectively classified as follows: 76.1% and 77.6% in type I; 12.2% and 17.7% in type IIa; 4.3% and 4.5% in type IIb; 6.4% and 0% in type IIIa; and 1% and 1% in type IIIb. The percentage of screws requiring repositioning due to drilling error was 85.7% (42/49). Comparisons of preoperative and postoperative function showed significantly improved accuracy. This study showed that inaccurate pedicle screw placement mainly results from errors in preoperative planning, mounting, registration, drilling, and robot assembly. Pedicle screw placement using a bone-mounted miniature robot system requires meticulous preoperative planning to minimize these errors.
本文描述了影响使用Renaissance机器人引导系统进行椎弓根螺钉置入准确性的因素，并对相关文献进行了综述。2013年1月至2015年1月期间，台湾高雄医学大学附设医院对125例患者实施了Renaissance机器人引导下的脊柱手术。手术包括662枚椎弓根螺钉植入以及术中重新定位后进行的49枚克氏针重新植入。第一作者评估了所有克氏针插入的准确性，并根据椎弓根螺钉置入的术前计划将其准确性分为3类。对于在注册步骤后需要重新定位螺钉的病例，根据3位经验丰富的脊柱外科医生的共识确定影响椎弓根螺钉置入的因素。根据Kuo等人制定的方案（《公共科学图书馆·综合》2016年；11：e0153235），重新定位前后克氏针的置入准确性分别分类如下：I型为76.1%和77.6%；IIa型为12.2%和17.7%；IIb型为4.3%和4.5%；IIIa型为6.4%和0%；IIIb型为1%和1%。因钻孔误差需要重新定位的螺钉比例为85.7%（42/49）。术前和术后功能比较显示准确性有显著提高。本研究表明，椎弓根螺钉置入不准确主要源于术前规划、安装、注册、钻孔和机器人组装方面的误差。使用骨安装微型机器人系统进行椎弓根螺钉置入需要精心的术前规划，以尽量减少这些误差。
