机器人辅助经皮穿刺技术在胸腰椎椎弓根螺钉内固定术中的应用

Application of robot-assisted percutaneous needle puncture technique pedicle screw internal fixation surgery in thoracolumbar spine

中文关键词:  骨科手术机器人  椎弓根螺钉  经皮穿刺技术  学习曲线

英文关键词:Orthopedic surgical robot  Pedicle screw  Percutaneous needle puncture technique  Learning curve

中文摘要:

  【摘要】 目的：比较应用机器人辅助经皮穿刺技术开放置钉手术与常规机器人辅助开放置钉手术的切口暴露时间、置针及置钉准确性，探讨该技术的学习曲线。方法：回顾性分析我院2020年8月~2023年12月行机器人辅助开放椎弓根螺钉内固定术治疗的53例患者，其中21例采用机器人辅助经皮穿刺技术进行椎弓根螺钉置入手术治疗（观察组），32例采用常规机器人辅助开放置钉技术进行椎弓根螺钉置入手术治疗（对照组），两组患者的性别、年龄、疾病类型均无统计学差异（P>0.05）。收集两组患者手术时间、切口暴露时间、出血量、置针及置钉准确率，记录两组患者术后发生的并发症。将观察组患者按照接受手术的先后顺序平均分为A、B、C三组，每组7例，比较三组手术时间、机器人手术时间、置针及置钉准确率、并发症，采用ln曲线回归分析法分析手术时间随手术例数变化的趋势。结果：观察组手术时间265.5±108.8min，对照组为309.2±154.9min，两组间无统计学差异（P＞0.05）；观察组切口暴露时间为189.0±94.7min，对照组手术开始时切口即暴露，切口暴露时间与手术时间相同（309.2±154.9min），观察组切口暴露时间短，有统计学差异（P＜0.05）；观察组置针准确率为94.2%，对照组置针准确率为95.0%，无统计学差异（P＞0.05）；两组置钉准确率均为100%；术中出血量（对照组343.8±207.0mL vs 观察组480.6±392.0mL）无统计学差异（P＞0.05）。观察组切口感染1例，对照组切口感染3例，无统计学差异（P＞0.05）。观察组A组、B组、C组总手术时间分别为350.9±92.8min、263.7±116.2min、181.9±25.8min，机器人手术时间分别为90.1±25.1min、73.9±12.1min、65.4±9.5min，3组间有统计学差异（P＜0.05）。ln对数曲线回归分析结果显示，随着手术病例数的增加，总手术时间[y=-71.324ln（x）+419.603]、机器人手术时间[y=-15.757ln（x）+110.527]显著减少，在第8例达到相对稳定。A组、B组、C组的置针、置钉准确率及并发症发生率比较差异无统计学意义（P＞0.05）。结论：机器人辅助经皮穿刺技术减少了切口暴露时间，具有常规机器人辅助置针及置钉的高精准性；该技术总手术时间、机器人手术时间随着手术病例数的增加而减少，学习曲线很快平稳。

英文摘要:

  【Abstract】 Objectives: To compare the incision exposure time, and accuracy rates of puncture and screw placement of open screw placement with robot-assisted percutaneous needle puncture technique with traditional robot-assisted open screw placement, and to explore the learning curve of such technique. Methods: The clinical data of 53 patients who underwent robot-assisted open pedicle screw fixation surgery between August 2020 and December 2023 were retrospectively analyzed. According to the surgical methods, 21 patients were divided into observation group(treated with robot-assisted pedicle screw placement with percutaneous needle puncture technique), and the other 32 patients were divided into control group(treated with traditional robot-assisted open pedicle screw placement). There were no statistically significant differences in gender, age, and disease type between the two groups of patients(P>0.05). The total operation time, incision exposure time, blood loss, accuracy rate of puncture, and accuracy rate of screw placement, as well as complications, were recorded. The patients in the observation group were divided into three groups(A, B and C) according to the order of operation, with 7 cases in each group, and the total operation time, robot operation time, accuracy rate of puncture, accuracy rate of screw placement, and complications in each group were compared. ln curve regression analysis was used to analyze the trend of operation time with the number of operations. Results: There was no statistical difference between the observation group and control group in the total operation time(265.5±108.8min vs 309.2±154.9min, P＞0.05). The incision exposure time in the observation group(189.00±94.74min) was statistically less than that in the control group(309.2±154.9min)(P<0.05). In the control group, the incision was exposed immediately at the onset of surgery, so the incision exposure time was the same as the total operation time. The accuracy rate of puncture between the observation group and control group showed no statistical difference(94.2% vs 95.0%, P＞0.05). The accuracy rates of screw placement of both groups were 100%. There was no statistical difference in blood loss between the observation group and control group(343.8±207.0mL vs 480.6±392.0mL, P＞0.05). There were 1 cases of incision infection in the observation group and 3 cases in the control group, with no statistical difference(P＞0.05). The total operation time of groups A, B and C was 350.9±92.8min, 263.7±116.2min and, 181.9±25.8min respectively, and the robot operation time was 90.1±25.1min, 73.9±12.1min and, 65.4±9.5min respectively. The differences between the three groups were statistically significant(P＜0.05). The results of the ln curve regression analysis showed that the total operation time[y=-71.324ln(x)+419.603] and the robot operation time [y=-15.757ln(x)+110.527] decreased significantly with the increase of the number of cases and reached a relatively stable level in the 8th case. There was no significant difference in the accuracy rate of puncture, accuracy rate of screw placement and the incidence of complications between groups A, B and C(P＞0.05). Conclusions: Robot-assisted percutaneous needle puncture technique reduces the incision exposure time and maintains a high screw placement accuracy. With the increase of the number of surgical cases, the total operation time and robot operation time decrease, and the learning curve becomes stable fast.