Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Nanshao gate, Xi'an, 710054, Shaan'xi Province, China.
Sci Rep. 2019 Feb 28;9(1):3025. doi: 10.1038/s41598-019-40057-z.
The accuracy of robot-assisted pedicle screw placement is unstable and remains controversial. The purpose of this study was to determine the risk factors for unsatisfactory Renaissance robot-assisted pedicle screw placement. This was a retrospective study of prospective data. From January 2017 to March 2018, 136 robot-assisted pedicle screw placements were performed in our department for spinal diseases, and a total of 874 screws were evaluated. All screws were assessed by the Gertzbein and Robbins classification. A and B were defined as satisfactory. C, D, and E were defined as unsatisfactory. Intraoperative registration failures due to nontechnical reasons or intraoperative adjustment were also defined as unsatisfactory. According to the evaluated results, the screws were divided into the satisfactory group (Group A) and the unsatisfactory group (Group B). The satisfactory rate was defined as satisfactory screws (the screws in Group A)/total screws, and the accurate rate was defined as accuracy screws (the screws in Group A)/the screws implanted by the robot (total screws - failed registration screws - screws adjusted during the operation). The age, sex, BMI, and BMD as well as the type of disease, the degree of vertebral rotation and the type of screw placement (percutaneous implantation or open implantation) were compared between the two groups, with the assessment of potential risk factors for unsatisfactory robot-assisted screw placement using logistic regression. A total of 874 screws were evaluated; there were 759 screws in Group A and 115 screws in Group B. The satisfactory rate was 86.8% (759/874), and the accuracy rate of the robot-placed screws was 94.4% (759/804). After logistic regression analysis, the independent risk factors were identified as obesity (OR 5.357 [95% CI 2.897-9.906], p < 0.01), osteoporosis, vertebral rotation and the presence of congenital scoliosis (OR 9.835 [95% CI 4.279-22.604], p < 0.01), particularly for severe osteoporosis (T < -3.5) and severe vertebral rotation (III-IV). According to the results of this study, obesity, osteoporosis and congenital scoliosis are risk factors for unsatisfactory robot-assisted screw placement. Furthermore, for surgeons in the initial stage of using a robot, we suggest avoiding cases in which a single risk factor or multiple risk factors exist to ensure the safety of the operation and to help augment the confidence of the surgeons.
机器人辅助椎弓根螺钉置钉的准确性不稳定，仍存在争议。本研究旨在确定影响 Renaissance 机器人辅助椎弓根螺钉置钉效果不佳的相关因素。这是一项前瞻性数据的回顾性研究。2017 年 1 月至 2018 年 3 月，我科对脊柱疾病患者共行 136 例机器人辅助椎弓根螺钉置钉术，共置入 874 枚螺钉。所有螺钉均采用 Gertzbein 和 Robbins 分级评估，A 和 B 级定义为满意，C、D 和 E 级定义为不满意。因非技术原因或术中调整导致的术中注册失败也被定义为不满意。根据评估结果，将螺钉分为满意组（A 组）和不满意组（B 组）。满意率定义为满意螺钉（A 组螺钉）/总螺钉数，准确率定义为准确螺钉（A 组螺钉）/机器人植入螺钉（总螺钉数-注册失败螺钉数-术中调整螺钉数）。比较两组患者的年龄、性别、BMI 和 BMD 以及疾病类型、椎体旋转程度和螺钉置钉类型（经皮植入或开放植入），采用 logistic 回归分析机器人辅助螺钉置入不满意的潜在危险因素。共评估了 874 枚螺钉，其中 A 组 759 枚，B 组 115 枚。满意率为 86.8%（759/874），机器人置钉准确率为 94.4%（759/804）。经 logistic 回归分析，肥胖（OR 5.357[95%CI 2.897-9.906]，p<0.01）、骨质疏松症、椎体旋转和先天性脊柱侧凸（OR 9.835[95%CI 4.279-22.604]，p<0.01）是机器人辅助螺钉置入不满意的独立危险因素，尤其是严重骨质疏松症（T<-3.5）和严重椎体旋转（III-IV）。根据本研究结果，肥胖、骨质疏松症和先天性脊柱侧凸是机器人辅助螺钉置钉效果不佳的危险因素。此外，对于刚开始使用机器人的外科医生，我们建议避免单一或多种危险因素的存在，以确保手术安全，并帮助增强外科医生的信心。
