Liu Peng, Hu Jiang, Zhang Wei, Lin Shu, Yu Yang, Tang Liuyi, Wang Fei
Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China.
Sci Rep. 2025 Jul 2;15(1):23175. doi: 10.1038/s41598-025-05081-2.
The optimal treatment for neurologically intact thoracolumbar fractures remains controversial. Percutaneous pedicle screw fixation (PPSF) has been proposed for certain type AO/A3 fractures without neurological deficits; however, achieving satisfactory reduction remains challenging. This study applied robot-assisted PPSF and compared it with free-hand techniques to enhance treatment outcomes. We retrospectively analyzed the medical records of 182 consecutive patients with thoracolumbar burst fractures treated with PPSF, with (n = 88) and without (n = 94) robotic assistance, at our hospital between April 2017 and June 2019. We evaluated surgical time, intraoperative bleeding, radiation dosage, accuracy of screw placement, fractured vertebral height, Cobb's angle, surgery efficacy (pain relief and limb function), and implant failure to assess the potential advantages of robot-assisted PPSF. Significant differences were observed in surgical time (P < 0.001), intraoperative bleeding (P = 0.017), pedicle screw violation (P < 0.001), fractured vertebral height and Cobb's angle at one week postoperatively (P = 0.001, P = 0.024) and at twelve months postoperatively (P = 0.001, P = 0.002). However, implant failure (P = 0.587), analgesic effect, and function recovery at one week postoperatively (P = 0.725, P = 0.093) and at twelve months postoperatively (P = 0.232, P = 0.259) were similar in both groups. Robot-assisted PPSF for thoracolumbar burst fractures reduces surgery time, intraoperative bleeding, and improves screw placement accuracy, achieving better reduction compared to the free-hand technique. It also effectively prevents endplate collapse and kyphosis recurrence post-surgery, though short-term functional recovery is similar between both methods. However, due to the limitations of retrospective studies and cohort heterogeneity, further long-term follow-up and prospective studies are needed to validate these findings.
神经功能完好的胸腰椎骨折的最佳治疗方法仍存在争议。对于某些无神经功能缺损的AO/A3型骨折，已有人提出采用经皮椎弓根螺钉固定术（PPSF）；然而，实现满意的复位仍然具有挑战性。本研究应用机器人辅助PPSF，并将其与徒手技术进行比较，以提高治疗效果。我们回顾性分析了2017年4月至2019年6月期间在我院接受PPSF治疗的182例连续性胸腰椎爆裂骨折患者的病历，其中88例接受了机器人辅助，94例未接受机器人辅助。我们评估了手术时间、术中出血、辐射剂量、螺钉置入准确性、骨折椎体高度、Cobb角、手术疗效（疼痛缓解和肢体功能）以及植入物失败情况，以评估机器人辅助PPSF的潜在优势。在手术时间（P < 0.001）、术中出血（P = 0.017）、椎弓根螺钉穿破（P < 0.001）、术后1周（P = 0.001，P = 0.024）和术后12个月（P = 0.001，P = 0.002）的骨折椎体高度和Cobb角方面观察到显著差异。然而，两组的植入物失败情况（P = 0.587）、术后1周（P = 0.725，P = 0.093）和术后12个月（P = 0.232，P = 0.259）的镇痛效果和功能恢复情况相似。机器人辅助PPSF治疗胸腰椎爆裂骨折可缩短手术时间、减少术中出血，并提高螺钉置入准确性，与徒手技术相比能实现更好的复位。它还能有效防止术后终板塌陷和后凸畸形复发，尽管两种方法的短期功能恢复相似。然而，由于回顾性研究的局限性和队列异质性，需要进一步的长期随访和前瞻性研究来验证这些发现。
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