Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
World Neurosurg. 2019 May;125:e1057-e1062. doi: 10.1016/j.wneu.2019.01.243. Epub 2019 Feb 18.
We sought to compare clinical outcomes of robot-assisted versus conventional freehand fluoroscopy-assisted lumbar pedicle screw insertion in patients with osteoporosis.
This study included 80 patients with osteoporosis and lumbar disease treated with pedicle screw internal fixation in the Department of Spine Surgery, Beijing Jishuitan Hospital between June 2016 and July 2018. Patients were randomly assigned to receive either robot-assisted pedicle screw insertion (experimental group) or freehand fluoroscopy-assisted pedicle screw insertion (control group). The accuracy of screw placement was assessed with postoperative computed tomography. Operative time, pedicle screw placement time, radiation exposure to the medical team, and intraoperative blood loss were recorded.
A total of 427 pedicle screws were inserted in 80 patients; 202 pedicle screws were placed in the experimental group, and 225 pedicle screws were placed in the control group. The accuracy of screw placement was significantly higher with robot-assisted pedicle screw insertion (98.5% [199/202]) compared with that achieved with the freehand technique (91.6% [206/225]) (P < 0.05). Robot-assisted pedicle screw insertion was associated with reductions in the mean total pedicle screw placement time (27.60 ± 8.58 vs. 32.26 ± 10.48 minutes), radiation exposure to the medical team (2.23 ± 0.62 vs. 3.35 ± 0.80 fluoroscopic images), and intraoperative blood loss (254.75 ± 115.34 vs. 356.25 ± 141.00 mL; P < 0.05). The mean operative time did not differ significantly between the groups.
Robot-assisted pedicle screw insertion is a more effective surgical option for patients with osteoporosis who present with various spine diseases compared with fluoroscopy-assisted freehand screw placement techniques.
我们旨在比较机器人辅助与传统徒手透视辅助腰椎椎弓根螺钉置入术在骨质疏松症患者中的临床效果。
本研究纳入 2016 年 6 月至 2018 年 7 月在我院脊柱外科接受椎弓根螺钉内固定治疗的 80 例骨质疏松伴腰椎疾病患者。患者随机分为机器人辅助椎弓根螺钉置入组（实验组）和徒手透视辅助椎弓根螺钉置入组（对照组）。术后采用 CT 评估螺钉位置准确性，记录手术时间、椎弓根螺钉置入时间、医护人员射线暴露量和术中出血量。
80 例患者共置入 427 枚椎弓根螺钉，实验组置入 202 枚，对照组置入 225 枚。与徒手技术相比，机器人辅助椎弓根螺钉置入的螺钉位置准确性显著更高（98.5% [199/202] 比 91.6% [206/225]）（P < 0.05）。机器人辅助椎弓根螺钉置入可减少平均总椎弓根螺钉置入时间（27.60 ± 8.58 比 32.26 ± 10.48 分钟）、医护人员射线暴露量（2.23 ± 0.62 比 3.35 ± 0.80 次透视）和术中出血量（254.75 ± 115.34 比 356.25 ± 141.00 mL；P < 0.05），手术时间无显著差异。
与透视辅助徒手螺钉置入技术相比，机器人辅助椎弓根螺钉置入术是治疗骨质疏松伴多种脊柱疾病患者的一种更有效的手术方法。
