Lin Shu, Hu Jiang, Wan Lun, Tang Liuyi, Wang Yue, Yu Yang, Zhang Wei
Department of Orthopedics, Sichuan Academy of Medical Science·Sichuan Provincal People's Hospital, Chengdu Sichuan, 610072, P.R.China.
Department of Orthopedics, Sichuan Academy of Medical Science·Sichuan Provincal People's Hospital, Chengdu Sichuan, 610072,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Jan 15;34(1):76-82. doi: 10.7507/1002-1892.201906105.
To compare short-term effectiveness between robot-guided percutaneous minimally invasive pedicle screw internal fixation and traditional open internal fixation in the treatment of thoracolumbar fractures.
The clinical data of 52 cases of thoracolumbar fracture without neurological injury symptoms admitted between January 2018 and May 2018 were retrospectively analyzed. According to the different surgical methods, they were divided into minimally invasive group (24 cases, treated with robot-assisted percutaneous minimally invasive pedicle screw internal fixation) and open group (28 cases, treated with traditional open internal fixation). There was no significant difference between the two groups in the general data such as gender, age, cause of injury, fracture segment, thoracolumbar injury classification and severity score (TLICS), preoperative back pain visual analogue scale (VAS) score, Oswestry disability index (ODI) score, fixed segment height, and fixed segment kyphosis Cobb angle ( >0.05). The operation time, intraoperative blood loss, and hospitalization time of the two groups were recorded and compared; as well as the VAS score, ODI score, fixed segment height, and fixed segment kyphosis Cobb angle of the two groups before operation and at 3 days, 1 month, 6 months, and 10 months after operation. CT scan was reexamined at 1-3 days after operation, and the pedicle screw insertion accuracy rate was determined and calculated according to Gertzbein-Robbins classification standard.
The operation time of the minimally invasive group was significantly longer than that of the open group, but the intraoperative blood loss and hospitalization time were significantly shorter than those of the open group ( <0.05). There were 132 pedicle screws and 158 pedicle screws implanted in the minimally invasive group and the open group respectively. According to the Gertzbein-Robbins classification standard, the accuracy of pedicle screws was 97.7% (129/132) and 96.8% (153/158), respectively, showing no significant difference between the two groups ( =0.505, =0.777). The patients in both groups were followed up 10 months, and there was no rejection or internal fixation fracture. In the minimally invasive group, the internal fixator was removed at 10 months after operation, but not in the open group. The VAS score, ODI score, fixed segment heigh, and fixed segment kyphotic Cobb angle of the two groups were improved in different degrees when compared with preoperative ones ( <0.05). Except that the VAS score and ODI score of the minimally invasive group were significantly better than those of the open group at 3 days after operation ( <0.05), there was no significant difference between the two groups at other time points ( >0.05).
Robot-assisted percutaneous minimally invasive pedicle screw internal fixation for thoracolumbar fractures has significant advantages in intraoperative blood loss, hospitalization time, and early postoperative effectiveness and other aspects, and the effect of fracture reduction is good.
比较机器人引导下经皮微创椎弓根螺钉内固定与传统切开内固定治疗胸腰椎骨折的短期疗效。
回顾性分析2018年1月至2018年5月收治的52例无神经损伤症状的胸腰椎骨折患者的临床资料。根据手术方式不同，分为微创组（24例，采用机器人辅助经皮微创椎弓根螺钉内固定治疗）和切开组（28例，采用传统切开内固定治疗）。两组患者在性别、年龄、受伤原因、骨折节段、胸腰椎损伤分类及严重程度评分（TLICS）、术前腰背痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评分、固定节段高度、固定节段后凸Cobb角等一般资料方面比较，差异无统计学意义（>0.05）。记录并比较两组患者的手术时间、术中出血量及住院时间；以及两组患者术前、术后3天、1个月、6个月及10个月的VAS评分、ODI评分、固定节段高度、固定节段后凸Cobb角。术后1 - 3天复查CT扫描，根据Gertzbein - Robbins分类标准确定并计算椎弓根螺钉置入准确率。
微创组手术时间显著长于切开组，但术中出血量及住院时间显著短于切开组（<0.05）。微创组和切开组分别植入椎弓根螺钉132枚和158枚。根据Gertzbein - Robbins分类标准，椎弓根螺钉置入准确率分别为97.7%（129/132）和96.8%（153/158），两组比较差异无统计学意义（=0.505，=0.777）。两组患者均随访10个月，均未出现排斥反应及内固定断裂情况。微创组于术后10个月取出内固定器，切开组未取出。与术前比较，两组患者的VAS评分、ODI评分、固定节段高度、固定节段后凸Cobb角均有不同程度改善（<0.05）。除术后3天时微创组VAS评分、ODI评分显著优于切开组外（<0.05），其他时间点两组比较差异无统计学意义（>0.05）。
机器人辅助经皮微创椎弓根螺钉内固定治疗胸腰椎骨折在术中出血量、住院时间及术后早期疗效等方面具有显著优势，骨折复位效果良好。
