经皮椎弓根螺钉置入准确性的比较研究：O 臂导航、机器人辅助与徒手技术。

Pedicle Screw Insertion Accuracy Using O-Arm, Robotic Guidance, or Freehand Technique: A Comparative Study.

机构信息

Spine Unit, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Centre d'Imagerie BioMédicale (CIBM), École polytechnique fédérale de Lausanne, Lausanne, Switzerland.

出版信息

Spine (Phila Pa 1976). 2018 Mar 15;43(6):E373-E378. doi: 10.1097/BRS.0000000000002449.

DOI:10.1097/BRS.0000000000002449

PMID:29019807

Abstract

STUDY DESIGN

A retrospective radiological study.

OBJECTIVE

The aim of this study was to evaluate the accuracy of pedicle screw insertion using O-Arm navigation, robotic assistance, or a freehand fluoroscopic technique.

SUMMARY OF BACKGROUND DATA

Pedicle screw insertion using either "O-Arm" navigation or robotic devices is gaining popularity. Although several studies are available evaluating each of those techniques separately, no direct comparison has been attempted.

METHODS

Eighty-four patients undergoing implantation of 569 lumbar and thoracic screws were divided into three groups. Eleven patients (64 screws) had screws inserted using robotic assistance, 25 patients (191 screws) using the O-arm, while 48 patients (314 screws) had screws inserted using lateral fluoroscopy in a freehand technique. A single experienced spine surgeon assisted by a spinal fellow performed all procedures. Screw placement accuracy was assessed by two independent observers on postoperative computed tomography (CTs) according to the A to D Rampersaud criteria.

RESULTS

No statistically significant difference was noted between the three groups. About 70.4% of screws in the freehand group, 69.6% in the O arm group, and 78.8% in the robotic group were placed completely within the pedicle margins (grade A) (P > 0.05). About 6.4% of screws were considered misplaced (grades C&D) in the freehand group, 4.2% in the O-arm group, and 4.7% in the robotic group (P > 0.05). The spinal fellow inserted screws with the same accuracy as the senior surgeon (P > 0.05).

CONCLUSION

The advent of new technologies does not appear to alter accuracy of screw placement in our setting. Under supervision, spinal fellows might perform equally well to experienced surgeons using new tools. The lack of difference in accuracy does not imply that the above-mentioned techniques have no added advantages. Other issues, such as surgeon/patient radiation, fiddle factor, teaching suitability, etc., outside the scope of our present study, need further assessment.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性影像学研究。

目的

本研究旨在评估使用 O 臂导航、机器人辅助或徒手透视技术进行椎弓根螺钉植入的准确性。

背景资料概要

使用“O 臂”导航或机器人设备进行椎弓根螺钉植入术越来越受欢迎。尽管有几项研究分别评估了这些技术，但尚未进行直接比较。

方法

将 84 例接受 569 枚腰椎和胸椎螺钉植入的患者分为三组。11 例患者（64 枚螺钉）采用机器人辅助技术植入螺钉，25 例患者（191 枚螺钉）采用 O 臂，48 例患者（314 枚螺钉）采用徒手透视技术在侧位植入螺钉。由一位经验丰富的脊柱外科医生和一位脊柱研究员协助完成所有手术。术后通过两名独立观察者根据 A 至 D Rampersaud 标准，利用 CT 对螺钉放置的准确性进行评估。

结果

三组之间无统计学差异。在徒手组中，约 70.4%的螺钉、O 臂组中约 69.6%的螺钉和机器人组中约 78.8%的螺钉完全位于椎弓根边缘内（A级）（P＞0.05）。在徒手组中，约 6.4%的螺钉被认为是错位（C 和 D 级），O 臂组中约 4.2%的螺钉和机器人组中约 4.7%的螺钉被认为是错位（P＞0.05）。脊柱研究员使用新工具的螺钉植入准确性与资深外科医生相同（P＞0.05）。