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韩国机器人辅助脊柱手术的单中心经验：螺钉准确性分析、螺钉位置不当的潜在风险因素及学习曲线

A Single-Center Experience of Robotic-Assisted Spine Surgery in Korea : Analysis of Screw Accuracy, Potential Risk Factor of Screw Malposition and Learning Curve.

作者信息

Oh Bu Kwang, Son Dong Wuk, Lee Jun Seok, Lee Su Hun, Kim Young Ha, Sung Soon Ki, Lee Sang Weon, Song Geun Sung, Yi Seong

机构信息

Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea.

Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea.

出版信息

J Korean Neurosurg Soc. 2024 Jan;67(1):60-72. doi: 10.3340/jkns.2023.0128. Epub 2023 Oct 27.

DOI:10.3340/jkns.2023.0128
PMID:38224963
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10788558/
Abstract

OBJECTIVE: Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF. METHODS: This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation. RESULTS: The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend. CONCLUSION: In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.

摘要

目的：近年来，机器人辅助脊柱手术（RASS）被认为是一种微创且相对精确的方法。在14个月的时间里，共对100例患者尝试了495例机器人辅助椎弓根螺钉固定（RAPSF）手术。本研究旨在分析RAPSF的准确性、潜在风险因素和学习曲线。 方法：本回顾性研究采用Gertzbein和Robbins量表（GRS）评估RAPSF的位置。使用临床可接受组（GRS A级和B级）、不满意组（GRS C级、D级和E级）的比例以及手术评估助手程序分析准确性。将RAPSF分为未突破组（GRS A级）和突破组（GRS B级、C级、D级和E级），并评估RAPSF的潜在风险因素。根据病例积累情况，通过每颗螺钉的机器人使用时间变化以及突破和失败螺钉的发生趋势分析学习曲线。 结果：RAPSF的临床可接受组为98.12%。在使用手术评估助手程序的分析中，尖端偏移为2.37±1.89mm，尾部偏移为3.09±1.90mm，角度偏移为3.72°±2.72°。在潜在风险因素分析中，未突破组和突破组之间的螺钉固定水平差异（p=0.009）以及追踪器与植入水平之间的节段距离差异（p=0.001）具有统计学意义，但其他因素无统计学意义。未突破组和突破组之间在椎弓根宽度（p<0.001）和尾部偏移（p=0.042）方面的平均差异具有统计学意义。在学习曲线分析中，突破和失败螺钉的发生率以及每颗螺钉的机器人使用时间呈显著下降趋势。 结论：在本研究中，RAPSF具有较高的准确性，且未发现特定的潜在风险因素。然而，推测椎弓根宽度与螺钉突破有关。同时，随着学习曲线的推进，每颗螺钉的机器人使用时间以及突破和失败螺钉的发生率降低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6d33/10788558/1cf9656c716c/jkns-2023-0128f9.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6d33/10788558/9e46a389820c/jkns-2023-0128f8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6d33/10788558/1cf9656c716c/jkns-2023-0128f9.jpg

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引用本文的文献

[1]
[Robotically assisted and minimally invasive pedicle screw placement at the lumbar spine].

Unfallchirurgie (Heidelb). 2025-6-26

[2]
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[3]
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[4]
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Neurospine. 2024-3

本文引用的文献

[1]
Factors Affecting the Accuracy of Pedicle Screw Placement in Robot-Assisted Surgery: A Multicenter Study.

Spine (Phila Pa 1976). 2022-12-1

[2]
Robotics in spine surgery: systematic review of literature.

Int Orthop. 2023-2

[3]
Risk Factors of Unsatisfactory Robot-Assisted Pedicle Screw Placement: A Case-Control Study.

Neurospine. 2021-12

[4]
Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula.

Neurosurg Focus. 2022-1

[5]
Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes.

J Spine Surg. 2021-6

[6]
The current state of navigation in robotic spine surgery.

Ann Transl Med. 2021-1

[7]
Initiation of a Robotic Program in Spinal Surgery: Experience at a Three-Site Medical Center.

Mayo Clin Proc. 2021-5

[8]
Impact of the Fourth Industrial Revolution on the Health Sector: A Qualitative Study.

Healthc Inform Res. 2020-10

[9]
Robotic-Assisted Pedicle Screw Placement During Spine Surgery.

JBJS Essent Surg Tech. 2020-5-21

[10]
Accuracy of robot-assisted versus conventional freehand pedicle screw placement in spine surgery: a systematic review and meta-analysis of randomized controlled trials.

Ann Transl Med. 2020-7

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