Yu Lingjia, Chen Xi, Margalit Adam, Peng Huiming, Qiu Guixing, Qian Wenwei
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China.
Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Int J Med Robot. 2018 Jun;14(3):e1892. doi: 10.1002/rcs.1892. Epub 2018 Feb 19.
Medical robotics has progressively become more compelling in modern orthopaedic surgery. Several studies comparing robot-assisted (RA) and freehand (FH) conventional techniques for pedicle screw fixation have been published, but the results are unclear. Here, we assessed current evidence regarding the efficiency, safety and accuracy of RA compared with FH techniques.
A literature search of PubMed, Embase, the Cochrane Library and Web of Science was performed to compare the differences between RA and FH in spine surgery. Two reviewers independently reviewed included studies, conducted a risk of bias assessment, and extracted data.
Three randomized controlled trials (RCTs) and six retrospective comparative studies included a total of 750 patients (3625 pedicle screws). No significant differences were noted between RA and FH in pedicle screw accuracy (95.5% compared with 92.9%; odds ratio: 1.35; 95% confidence interval [CI], 0.55 to 3.30; P=0.51), overall complication rate (1.33% compared with 3.45%; odds ratio: 0.46; 95% CI, 0.15 to 1.43; P=0.18) and radiation exposure time (weighted mean difference [WMD]:8.49; 95% CI, -15.43 to 32.40; P=0.49). While RA was associated with a longer operative time (WMD: 39.63; 95% CI, 5.27 to 73.99; P= 0.02), percutaneous or minimal robot-assisted pedicle screw fixation (M-RA) had a shorter radiation exposure time than FH (WMD: -33.10; 95% CI, -38.18 to -28.02; P=0.00) CONCLUSIONS: The current literature did not prove that RA supersedes FH, although several studies are more optimistic about this procedure. Future well-designed RCTs assessing RA and FH are needed to confirm and update the findings of this analysis.
在现代骨科手术中，医疗机器人技术的吸引力日益增强。已有多项比较机器人辅助（RA）和徒手（FH）两种传统椎弓根螺钉固定技术的研究发表，但结果尚不清楚。在此，我们评估了与FH技术相比，RA在效率、安全性和准确性方面的现有证据。
对PubMed、Embase、Cochrane图书馆和Web of Science进行文献检索，以比较RA和FH在脊柱手术中的差异。两名 reviewers 独立审查纳入的研究，进行偏倚风险评估并提取数据。
三项随机对照试验（RCT）和六项回顾性比较研究共纳入750例患者（3625枚椎弓根螺钉）。RA和FH在椎弓根螺钉置入准确性（95.5% 对比 92.9%；优势比：1.35；95% 置信区间 [CI]，0.55至3.30；P = 0.51）、总体并发症发生率（1.33% 对比 3.45%；优势比：0.46；95% CI，0.15至1.43；P = 0.18）和辐射暴露时间（加权平均差 [WMD]：8.49；95% CI，-15.43至32.40；P = 0.49）方面无显著差异。虽然RA与手术时间较长相关（WMD：39.63；95% CI，5.27至73.99；P = 0.02），但经皮或微创机器人辅助椎弓根螺钉固定（M-RA）的辐射暴露时间比FH短（WMD：-33.10；95% CI，-38.18至-28.02；P = 0.00）。结论：尽管有几项研究对该手术更为乐观，但目前的文献并未证明RA优于FH。需要未来设计良好的RCT来评估RA和FH，以证实和更新本分析的结果。
