Zhang H P, Hao D J, He B R, Sun H H, Xu Z W, Wang B, Duan Y C, Yang W L, Gao Z L, Kou C J
Department of Spine Surgery, Affiliated Honghui Hospital of Xi'an Jiaotong University, Xi'an 710054, China.
Department of Intraoperative Imaging Examination, Affiliated Honghui Hospital of Xi'an Jiaotong University, Xi'an 710054, China.
Zhonghua Yi Xue Za Zhi. 2024 Oct 8;104(37):3506-3512. doi: 10.3760/cma.j.cn112137-20240329-00722.
To compare the accuracy and safety of robot-assisted and navigation-assisted screw placement in atlantoaxial dislocation surgery. A retrospective analysis was conducted on the clinical data of 49 patients with atlantoaxial dislocation treated consecutively at the Honghui Hospital of Xi'an Jiaotong University from April 2022 to December 2023. Among them, 27 were male and 22 were female, aged (44.2±11.7) years. Based on the date of surgery, 29 patients (from April 2022 to April 2023) received the S8 navigation-assisted screw placement (navigation group), 20 patients (from May to December 2023) received Mazor robot-assisted screw placement (robot group). The accuracy of screw placement, screw placement time, operation time, intraoperative blood loss, and intraoperative complications were recorded and compared between the two groups. The Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) score of pain were adopted to evaluate the recovery of cervical spinal cord function and cervical and shoulder pain at preoperative period and 3-month follow-up, and the occurrence of complications was observed. A total of 196 screws were inserted in 49 patients. In the navigation-assisted group, a total of 116 screws were inserted with an accuracy rate of 93.1% (108/116); in contrast, in the robot-assisted group, a total of 80 screws were inserted with an accuracy rate of 97.5% (78/80) (=0.040). The mean screw placement time, operation time, and blood loss in the navigation-assisted group were all significantly lower than those in the robot-assisted group [(37.8±3.4)min vs (48.4±4.6)min, (127.7±15.3)min vs (165.7±12.1)min and (205.8±13.6)ml vs (290.6±11.2) ml, respectively all <0.01]. One case experienced intraoperative venous plexus injury in the robot-assisted group. Postoperatively, all patients experienced significant relief in neck pain symptoms, and neurological symptoms recovered to varying degrees. The VAS and JOA scores at 3 months post-surgery for both groups showed statistically significant improvements compared to pre-surgery (all <0.01), but there was no statistically significant difference between the two groups (all >0.05). Both robot-assisted and navigation-assisted screw placement show high accuracy and safety in atlantoaxial dislocation surgery. Compared to navigation, robot assistance increases the surgical time and blood loss, but significantly improves the accuracy of screw placement.
比较机器人辅助与导航辅助寰枢椎脱位手术中螺钉置入的准确性和安全性。对2022年4月至2023年12月在西安交通大学附属红会医院连续治疗的49例寰枢椎脱位患者的临床资料进行回顾性分析。其中男性27例，女性22例，年龄（44.2±11.7）岁。根据手术日期，29例患者（2022年4月至2023年4月）接受S8导航辅助螺钉置入（导航组），20例患者（2023年5月至12月）接受Mazor机器人辅助螺钉置入（机器人组）。记录并比较两组螺钉置入的准确性、螺钉置入时间、手术时间、术中出血量及术中并发症。采用日本骨科协会（JOA）评分和视觉模拟量表（VAS）疼痛评分评估术前及术后3个月颈椎脊髓功能恢复情况及颈肩疼痛情况，并观察并发症发生情况。49例患者共置入196枚螺钉。导航辅助组共置入116枚螺钉，准确率为93.1%（108/116）；相比之下，机器人辅助组共置入80枚螺钉，准确率为97.5%（78/80）（P = 0.040）。导航辅助组的平均螺钉置入时间、手术时间和出血量均显著低于机器人辅助组[分别为（37.8±3.4）分钟对（48.4±4.6）分钟、（127.7±15.3）分钟对（165.7±12.1）分钟和（205.8±13.6）毫升对（290.6±11.2）毫升，均P < 0.01]。机器人辅助组有1例术中发生静脉丛损伤。术后所有患者颈部疼痛症状均明显缓解，神经症状均有不同程度恢复。两组术后3个月的VAS和JOA评分与术前相比均有统计学意义的改善（均P < 0.01），但两组之间无统计学意义的差异（均P > 0.05）。机器人辅助和导航辅助螺钉置入在寰枢椎脱位手术中均显示出较高的准确性和安全性。与导航相比，机器人辅助增加了手术时间和出血量，但显著提高了螺钉置入的准确性。
