Department of Orthopedics & Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China.
Pain Physician. 2022 Jan;25(1):E133-E140.
Despite percutaneous kyphoplasty (PKP) being widely used to treat osteoporotic vertebral compression fractures (OVCFs), the details of puncture are still controversial. With the development of surgical robots in spine surgery, robotic-assisted PKP surgery will become a promising treatment strategy.
To evaluate the efficacy and safety of establishing an optimal working path through a unilateral pedicle approach to improve bone cement distribution under the assistance of a surgical robot in percutaneous kyphoplasty.
Experimental and prospective study.
PKP surgery under the assistance of the TINAVI robot was performed on 78 patients with osteoporotic vertebral compression fractures (OVCFs) from May 2018 to January 2020 in a single spine center. During the operation, the optimal path of the working channel made through unilateral pedicle puncture was designed according to the details of the fractured vertebral body under the guidance of the TINAVI surgical robot. Visual analog scale (VAS) scores of back pain, intraoperative blood loss, surgical time, and complications were recorded and evaluated. Postoperative fluoroscopy and 3D-CT were used to evaluate the distribution of bone cement.
We have successfully performed 78 PKP surgeries under the assistance of the TINAVI robot. The mean procedure time was 13.9 ± 2.6 minutes from the beginning of C-arm scan to finish the injection of bone cement, and the intraoperative blood loss was 5.4 ± 2.8 mL. Pain of all cases was relieved immediately and significantly after PKP surgery; the VAS score was 7.5 ± 2.3 before surgery and 1.4 ± 0.8 post-surgery. The mean volume of bone cement was 4.7 ± 1.9 mL, and bone cement leakage occurred at the anterior edge of the fractured vertebral body in 2 patients, with no neurological and vascular injury in any of the cases. Postoperative fluoroscopy and 3D-CT showed that a good bone cement distribution evenly through unilateral pedicle puncture in the fractured vertebral body in all cases except the bone cement leakage in 2 patients.
More cases are needed to evaluate the efficacy and stability of robot-assisted PKP surgery. A control group of PKP performed freehand should be included in this study.
Robotic-assisted PKP surgery through the unilateral approach to establishing an optimal working channel is a safe and available procedure for treating OVCFs in terms of better distribution of bone cement, high accuracy, good repeatability, and less surgical trauma.
尽管经皮椎体后凸成形术（PKP）广泛用于治疗骨质疏松性椎体压缩性骨折（OVCFs），但穿刺细节仍存在争议。随着脊柱外科手术机器人的发展，机器人辅助 PKP 手术将成为一种有前途的治疗策略。
评估在手术机器人辅助下通过单侧椎弓根入路建立最佳工作通道，以改善经皮椎体后凸成形术中骨水泥在骨折椎体下的分布的疗效和安全性。
实验性和前瞻性研究。
2018 年 5 月至 2020 年 1 月，在一家脊柱中心对 78 例骨质疏松性椎体压缩性骨折（OVCFs）患者进行了 TINAVI 机器人辅助下的 PKP 手术。在手术过程中，根据 TINAVI 手术机器人引导下骨折椎体的详细情况，设计单侧椎弓根穿刺的最佳工作通道。记录并评估视觉模拟评分（VAS）评分（腰痛、术中出血量、手术时间和并发症）。术后行透视和 3D-CT 检查评估骨水泥分布情况。
我们成功完成了 78 例 TINAVI 机器人辅助下的 PKP 手术。从 C 臂扫描开始到完成骨水泥注射的平均手术时间为 13.9±2.6 分钟，术中出血量为 5.4±2.8ml。所有患者术后疼痛均立即明显缓解，PKP 术前 VAS 评分为 7.5±2.3，术后为 1.4±0.8。平均骨水泥用量为 4.7±1.9ml，2 例患者出现骨折椎体前缘骨水泥渗漏，无神经血管损伤。术后透视和 3D-CT 显示，除 2 例患者骨水泥渗漏外，所有患者均通过单侧椎弓根穿刺在骨折椎体中获得良好的骨水泥分布。
需要更多病例来评估机器人辅助 PKP 手术的疗效和稳定性。本研究应包括徒手 PKP 手术的对照组。
通过单侧入路建立最佳工作通道的机器人辅助 PKP 手术在治疗 OVCFs 方面是一种安全可行的方法，在骨水泥分布、高精度、良好的可重复性和较小的手术创伤方面具有优势。
