评估机器人椎弓根螺钉置入与传统方法的比较：系统评价和网络荟萃分析。

Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis.

机构信息

1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.

2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois.

出版信息

Neurosurg Focus. 2022 Jan;52(1):E10. doi: 10.3171/2021.10.FOCUS21509.

DOI:10.3171/2021.10.FOCUS21509

PMID:34973681

Abstract

OBJECTIVE

Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods.

METHODS

A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome.

RESULTS

Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement.

CONCLUSIONS

The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.

摘要

目的

使用椎弓根螺钉（PS）进行脊柱内固定的方法有多种，包括 CT 导航、二维和三维透视、徒手和机器人辅助。机器人辅助 PS 放置存在争议，因为其培训要求、成本和先前不明确的益处。本荟萃分析比较了传统徒手、导航和机器人辅助方法置入 PS 的螺钉放置准确性、手术时间、术中失血量和总体并发症。

方法

对 2000 年 1 月至 2021 年 8 月期间在多个数据库中索引的同行评审文章进行了系统评价，比较了≥2 种 PS 插入方法和≥每治疗臂 10 个螺钉。提取患者结局数据，包括 PS 放置、错位和准确性；手术时间、总体并发症、术中失血量、术后住院时间、术后 Oswestry 残疾指数（ODI）评分和术后背痛视觉模拟量表（VAS）评分。使用纽卡斯尔-渥太华量表和 Cochrane 工具评估偏倚风险。进行网络荟萃分析（NMA）以估计 PS 放置准确性作为主要结局。

结果

总体而言，共纳入 78 项研究，包括 6262 例患者和>31909 个 PS。NMA 结果表明，与徒手（p<0.01 和 p<0.001）、CT 导航（p=0.02 和 p=0.04）和二维透视（p<0.01 和 p<0.01）相比，机器人辅助和 3D 透视 PS 插入具有更高的准确性。累积排序概率曲线（SUCRA）法进一步表明，机器人辅助 PS 插入的准确性更高（S=0.937）。机器人辅助的最佳螺钉放置（S=0.995），而徒手的螺钉放置错误（S=0.069）最大。机器人辅助的方法有利于最小化并发症（S=0.876），而与机器人辅助（OR 2.49，p<0.01）和 CT 导航（OR 2.15，p=0.03）相比，徒手的方法发生并发症的可能性更大。