Spine Unit, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Centre d'Imagerie BioMédicale (CIBM), École polytechnique fédérale de Lausanne, Lausanne, Switzerland.
Spine (Phila Pa 1976). 2018 Mar 15;43(6):E373-E378. doi: 10.1097/BRS.0000000000002449.
A retrospective radiological study.
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.
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.
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.
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).
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.
回顾性影像学研究。
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。
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。
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。
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）。
在我们的研究环境中，新技术的出现似乎并没有改变螺钉放置的准确性。在监督下，脊柱研究员可能与经验丰富的外科医生一样出色地使用新工具。准确性没有差异并不意味着上述技术没有额外的优势。在我们目前研究范围之外的其他问题，如外科医生/患者的辐射、 fiddle 因素、教学适用性等，还需要进一步评估。
3 级
