Wuhan University of Science and Technology School of Medicine, Wuhan, Hubei, China; Department of Spine Surgery, Wuhan Puren Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, China.
Department of Spine Surgery, Wuhan Puren Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, China.
World Neurosurg. 2024 Jan;181:e163-e176. doi: 10.1016/j.wneu.2023.09.060. Epub 2023 Sep 25.
The purpose of this study was to compare the accuracy and safety of robot-assisted (RA) cervical screw placement with conventional freehand (FH) technique.
Computer-based searches were conducted on various databases including PubMed, Embase, Cochrane Library, Web of Science, the China Biology Medicine, the China National Knowledge Infrastructure, and Wanfang Database. Inclusion criteria were studies reporting the use of RA techniques for cervical screw placement and providing data on safety and accuracy outcomes. Primary outcome indicators focused on the accuracy of screw placement, while secondary outcome indicators included operative time, intraoperative blood loss, length of hospital stay, complication rate, and radiation dose. Data from eligible studies were extracted and synthesized using a forest plot analysis.
A total of 312 patients (1233 screws) from 6 studies were included, with 148 patients (47.4% with 567 screws) in the RA group. Perfect screw accuracy, as categorized by Gertzbein-Robbins grade A, was significantly superior with RA surgery compared to FH technique. RA screw implantation significantly reduced complication rates, intraoperative blood loss, length of hospitalization, and radiation dose compared to the conventional FH group. However, there was no statistically significant difference in surgery time between the RA and FH groups.
RA surgery significantly improves the accuracy of cervical screw insertion and offers potential advantages in terms of reduced complications and blood loss, shorter hospital stays, and decreased radiation exposure. However, the impact on operative time remains uncertain. Further high-quality studies, including large-scale randomized controlled trials, are needed to strengthen the evidence base.
本研究旨在比较机器人辅助（RA）颈椎螺钉固定与传统徒手（FH）技术的准确性和安全性。
计算机检索PubMed、Embase、 Cochrane Library、Web of Science、中国生物医学文献数据库、中国知网和万方数据库，检索时限均为建库至 2022 年 9 月。纳入使用 RA 技术进行颈椎螺钉固定并提供安全性和准确性结果数据的研究。主要结局指标为螺钉放置的准确性，次要结局指标包括手术时间、术中出血量、住院时间、并发症发生率和辐射剂量。提取符合纳入标准的研究资料，并采用森林图进行分析。
共纳入 6 项研究的 312 例患者（1233 枚螺钉），其中 RA 组 148 例患者（47.4%，567 枚螺钉）。RA 手术的 Gertzbein-Robbins 分级 A 级螺钉准确性明显优于 FH 技术。与传统 FH 组相比，RA 螺钉植入术可显著降低并发症发生率、术中出血量、住院时间和辐射剂量，但手术时间两组间无统计学差异。
RA 手术可显著提高颈椎螺钉插入的准确性，并在减少并发症和出血量、缩短住院时间和降低辐射暴露方面具有潜在优势。但对手术时间的影响仍不确定。需要进一步开展高质量研究，包括大规模随机对照试验，以加强证据基础。
