Peng Yu-Ning, Tsai Li-Cheng, Hsu Horng-Chaung, Kao Chia-Hung
Department of Medicine, China Medical University Hospital, Taichung.
Department of Orthopedic Surgery, China Medical University Hospital, Taichung.
Ann Transl Med. 2020 Jul;8(13):824. doi: 10.21037/atm-20-1106.
This systematic review and meta-analysis investigated differences in accuracy, operation time, and radiation exposure time between robot-assisted and freehand techniques for pedicle screw insertion. Two investigators independently searched for articles on randomized controlled trials (RCTs) published from 2012 to 2019. The final meta-analysis included seven RCTs. We compared the accuracy of pedicle screw placement, operation time, and radiation exposure time between robot-assisted and conventional freehand groups. Seven RCTs included 540 patients and placement of 2,476 pedicle screws, of which 1,220 were inserted using the robot-assisted technique and 1,256 were inserted using the conventional freehand technique. The pedicle screw positions were classified using the Gertzbein and Robbins classification (grade A-E). The combined results of Grade A [odds ratio (OR) =1.68; 95% confidence intervals (CI): 0.82-3.44; P=0.16), Grade A+B (OR =1.70; 95% CI: 0.47-6.13; P=0.42), and Grade C+D+E (OR =0.59; 95% CI: 0.16-2.12; P=0.42) for the accuracy rate revealed no significant difference between the two groups. Subgroup analysis results revealed that the TiRobot-assisted technique presented a significantly improved pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. The SpineAssist-assisted technique presented an inferior pedicle screw insertion accuracy rate compared with that of the conventional freehand technique, based on Grade A, Grade A+B, and Grade C+D+E classifications. No difference between the Renaissance-assisted and conventional freehand techniques was noted for pedicle screw insertion accuracy rates, based on both Grade A (OR =1.58; 95% CI: 0.85-2.96; P=0.15), Grade A+B (OR =2.20; 95% CI: 0.39-12.43; P=0.37), and Grade C+D+E (OR =0.45; 95% CI: 0.08-2.56; P=0.37) classifications. Regarding operation time, robot-assisted surgery had significantly longer operation time than conventional freehand surgery. The robot-assisted group had significantly shorter radiation exposure time. Regarding the pedicle screw insertion accuracy rate, the TiRobot-assisted technique was superior, the SpineAssist-assisted technique was inferior, and Renaissance was similar to the conventional freehand technique.
本系统评价和荟萃分析研究了机器人辅助与徒手椎弓根螺钉置入技术在准确性、手术时间和辐射暴露时间方面的差异。两名研究者独立检索了2012年至2019年发表的关于随机对照试验（RCT）的文章。最终的荟萃分析纳入了7项RCT。我们比较了机器人辅助组和传统徒手组之间椎弓根螺钉置入的准确性、手术时间和辐射暴露时间。7项RCT纳入了540例患者，共置入2476枚椎弓根螺钉，其中1220枚采用机器人辅助技术置入，1256枚采用传统徒手技术置入。椎弓根螺钉位置采用Gertzbein和Robbins分类法（A-E级）进行分类。A级（优势比（OR）=1.68；95%置信区间（CI）：0.82-3.44；P=0.16）、A级+B级（OR =1.70；95%CI：0.47-6.13；P=0.42）以及C级+D级+E级（OR =0.59；95%CI：0.16-2.12；P=0.42）准确率的合并结果显示两组之间无显著差异。亚组分析结果显示，基于A级、A级+B级和C级+D级+E级分类，TiRobot辅助技术的椎弓根螺钉置入准确率显著高于传统徒手技术。基于A级、A级+B级和C级+D级+E级分类，SpineAssist辅助技术的椎弓根螺钉置入准确率低于传统徒手技术。基于A级（OR =1.58；95%CI：0.85-2.96；P=0.15）、A级+B级（OR =2.20；95%CI：0.39-12.43；P=0.37）以及C级+D级+E级（OR =0.45；95%CI：0.08-2.56；P=0.37）分类，Renaissance辅助技术与传统徒手技术在椎弓根螺钉置入准确率方面无差异。在手术时间方面，机器人辅助手术的手术时间明显长于传统徒手手术。机器人辅助组的辐射暴露时间明显更短。在椎弓根螺钉置入准确率方面，TiRobot辅助技术更优，SpineAssist辅助技术较差，Renaissance与传统徒手技术相似。
Zotero 插件