Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
Harvard Medical School, Boston, MA 02115, USA.
Sensors (Basel). 2022 Jul 12;22(14):5204. doi: 10.3390/s22145204.
(1) Background: Robotics coupled with navigation (RAN) is a modern surgical platform shown to increase screw placement accuracy during pediatric scoliosis surgery. Our institution uses a technique which combines the RAN platform for apical pedicle screw placement and the freehand (FH) technique for terminal pedicle screw placement during scoliosis surgery (termed hybrid technique). We question if the complementary use of the RAN technology affects intraoperative outcomes, relative to the FH-only approach. (2) Methods: 60 adolescent idiopathic scoliosis (AIS) patients, ages 11−19 at surgery, who were operated on from 2019 through 2020 by a single surgeon, were retrospectively reviewed. Patients were separated by surgery type (hybrid RAN or FH), matched on demographic and surgical factors, and their intraoperative outcomes were compared statistically. (3) Results: Hybrid RAN patients had more screws placed (p = 0.01) and were of a higher BMI percentile (p = 0.005). Controlling for the number of screws placed, BMI%, and initial curve magnitude, there were no statistical differences in estimated blood loss per screw (p = 0.51), curve correction (p = 0.69), complications (p = 0.52), or fluoroscopy time (p = 0.88), between groups. However, operative time was two minutes longer per screw for hybrid RAN patients (p < 0.001). (4) Conclusions: Hybrid RAN surgeries took longer than FH, but yielded comparable effectiveness and safety as the FH technique during the initial RAN adoption phase.
(1) 背景：机器人导航（RAN）技术是一种现代外科手术平台，已被证明可提高儿童脊柱侧凸手术中螺钉的植入精度。我院采用的技术将 RAN 平台用于顶椎椎弓根螺钉植入，而徒手技术（FH）用于脊柱侧凸手术中的末端椎弓根螺钉植入（称为混合技术）。我们想知道相对于 FH 技术，RAN 技术的互补使用是否会影响手术中的结果。(2) 方法：回顾性分析了 2019 年至 2020 年间由同一位外科医生为 60 例青少年特发性脊柱侧凸（AIS）患者（手术时年龄为 11-19 岁）实施的手术。根据手术类型（混合 RAN 或 FH）将患者分组，在人口统计学和手术因素方面进行匹配，并对其术中结果进行统计学比较。(3) 结果：混合 RAN 组患者植入的螺钉数量更多（p = 0.01），BMI 百分位数更高（p = 0.005）。在控制螺钉数量、BMI%和初始曲线幅度的情况下，两组间每个螺钉的估计失血量（p = 0.51）、曲线矫正（p = 0.69）、并发症（p = 0.52）或透视时间（p = 0.88）无统计学差异。然而，混合 RAN 患者的手术时间比 FH 组每螺钉延长了两分钟（p < 0.001）。(4) 结论：混合 RAN 手术比 FH 手术时间长，但在 RAN 技术的初始采用阶段，与 FH 技术一样具有相当的有效性和安全性。
