Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, 230022, Anhui, China.
BMC Surg. 2022 Feb 11;22(1):52. doi: 10.1186/s12893-022-01502-5.
Robot-assisted (RA) technique has been increasingly applied in clinical practice, providing promising outcomes of inserting accuracy and cranial facet joint protection. However, studies comparing this novel method with other assisted methods are rare, and the controversy of the superiority between the insertion techniques remains. Thus, we compare the rates and risk factors of intrapedicular accuracy and cranial facet joint violation (FJV) of RA, fluoroscopy-guided percutaneous (FP), and freehand (FH) techniques in the treatment of thoracolumbar fractures.
A total of 74 patients with thoracolumbar fractures requiring pedicle screw instruments were retrospectively included and divided into RA, FP, and FH groups from June 2016 to May 2020. The primary outcomes were the intrapedicular accuracy and cranial FJV. The factors that affected the intrapedicular accuracy and cranial FJV were assessed using multivariate analyses.
The optimal intrapedicular accuracy of pedicle screw placement (Grade A) in the RA, FP, and FH groups was 94.3%, 78.2%, and 88.7%, respectively. This finding indicates no significant differences of RA over FH technique (P = 0.062) and FP technique (P = 0.025), but significantly higher accuracies of RA over FP (P < 0.001). In addition, the rates of proximal FJV in RA, FP, and FH groups were 13.9%, 30.8%, and 22.7%, respectively. RA had a significantly greater proportion of intact facet joints than the FP (P = 0.002). However, FP and FH (P = 0.157), as well as RA and FH (P = 0.035) showed significantly similar outcomes with respect to the proximal FJV. The logistic regression analysis showed that FP technique (OR = 3.056) was independently associated with insertion accuracy. Meanwhile, the age (OR = 0.974), pedicle angle (OR = 0.921), moderate facet joint osteoarthritis (OR = 5.584), and severe facet joint osteoarthritis (OR = 11.956) were independently associated with cranial FJV.
RA technique showed a higher rate of intrapedicular accuracy and a lower rate of cranial FJV than FP technique, and similar outcomes to FH technique in terms of intrapedicular accuracy and cranial FJV. RA technique might be a safe method for pedicle screw placement in thoracolumbar surgery.
机器人辅助（RA）技术已越来越多地应用于临床实践，在提高置钉准确性和保护颅面关节方面具有良好的效果。然而，比较这种新方法与其他辅助方法的研究很少，并且插入技术的优越性仍存在争议。因此，我们比较 RA、透视引导经皮（FP）和徒手（FH）技术在胸腰椎骨折治疗中的椎弓根内准确性和颅面关节侵犯（FJV）的发生率和风险因素。
回顾性纳入 2016 年 6 月至 2020 年 5 月因胸腰椎骨折需行椎弓根螺钉固定的 74 例患者，分为 RA、FP 和 FH 组。主要结局为椎弓根内准确性和颅面 FJV。采用多因素分析评估影响椎弓根内准确性和颅面 FJV 的因素。
RA、FP 和 FH 组椎弓根螺钉置入的最佳椎弓根内准确性（Grade A）分别为 94.3%、78.2%和 88.7%。这表明 RA 技术与 FH 技术（P=0.062）和 FP 技术（P=0.025）相比无显著差异，但 RA 技术明显优于 FP 技术（P<0.001）。此外，RA、FP 和 FH 组的近端 FJV 发生率分别为 13.9%、30.8%和 22.7%。RA 组的关节突关节完整率明显高于 FP 组（P=0.002）。然而，FP 和 FH（P=0.157）以及 RA 和 FH（P=0.035）在近端 FJV 方面的结果无显著差异。Logistic 回归分析显示，FP 技术（OR=3.056）与插入准确性独立相关。同时，年龄（OR=0.974）、椎弓根角度（OR=0.921）、中度关节突关节炎（OR=5.584）和重度关节突关节炎（OR=11.956）与颅面 FJV 独立相关。
与 FP 技术相比，RA 技术具有更高的椎弓根内准确性和更低的颅面 FJV 发生率，在椎弓根内准确性和颅面 FJV 方面与 FH 技术的结果相似。RA 技术可能是胸腰椎手术中椎弓根螺钉置入的一种安全方法。
3 级。
