Mazor脊柱机器人辅助改良经皮椎体成形术治疗腰椎骨质疏松性骨折的疗效分析

Effectiveness of Mazor spine robot-assisted percutaneous vertebroplasty with modified approach in treating lumbar osteoporotic vertebral compression fractures

中文关键词:  腰椎骨质疏松性压缩骨折  经皮椎体成形术  改良入路  机器人辅助  临床疗效

英文关键词:Lumbar osteoporotic vertebral compression fractures  Percutaneous vertebroplasty  Modified approach  Robot-assisted  Clinical effectiveness

中文摘要:

  【摘要】 目的：探讨Mazor脊柱机器人辅助改良经皮椎体成形术（percutaneous vertebroplasty，PVP）手术治疗腰椎骨质疏松性压缩骨折（osteoporotic vertebral compression fracture，OVCF）的疗效。方法：回顾性分析2020年7月～2020年12月在本院接受PVP治疗的腰椎OVCF患者50例，其中A组（Mazor脊柱机器人辅助改良腰椎PVP手术组）23例，B组（徒手椎弓根入路PVP手术组）27例；记录两组手术时间、透视次数、辐射暴露剂量、住院时间、骨水泥弥散情况；测量治疗前、治疗后3d、3个月时的椎体高度恢复值、腰痛VAS评分、生活质量ODI评分。结果：A组平均手术时间为40.61±3.85min，明显大于B组（30.70±3.26min），其中A组包含机器人配对与注册时间（TA1）为23.43±2.97min，穿刺至切口关闭时间（TA2）为16.74±5.13min。A组术中平均透视次数为6.96±1.80次，辐射暴露平均剂量为0.55±0.07mSv，其中配对与注册透视次数为2.12±0.35次，辐射暴露平均剂量为0.15±0.03mSv；B组术中平均透视次数为17.70±3.98次，辐射暴露平均剂量为1.25±0.12mSv；A组术中平均透视次数及辐射暴露平均剂量明显小于B组（P＜0.05）。A组骨水泥弥散形式全部属于Ⅱ型，B组骨水泥以单侧弥散为主，仅有14.87%（4/27）属于Ⅱ型弥散，两组间差异显著（P＜0.05）。两组术后3d、3个月腰痛VAS评分均较术前明显降低，差异均有显著性意义（P＜0.05），组间比较两组术后VAS评分无差异（P＞0.05）；两组术后3d、3个月随访时ODI评分均较术前明显降低，术后各时间点随访与术前相比差异均有显著性意义（P＜0.05），组间比较两组术后ODI评分无差异（P＞0.05）。结论：Mazor脊柱机器人辅助改良入路经皮椎体成形术治疗腰椎骨质疏松性骨折安全、有效，并可缩短术中穿刺手术时间、减少术中透视辐次数。

英文摘要:

  【Abstract】 Objectives: To explore the effectiveness of Mazor spine robot-assisted percutaneous vertebroplasty(PVP) with the modified approach to treat lumbar osteoporotic vertebral compression fractures(OVCF). Methods: A retrospective analysis on 50 patients with lumbar OVCF who underwent PVP surgery were performed in our hospital from July 2020 to December 2020. 23 cases were included in group A(Mazor spine robot-assisted lumbar modified PVP group), while 27 cases were included in group B(free-hand lumbar transpedicular PVP). In both groups, the operation time, number of fluoroscopy, radiation exposure dose, hospital stay time and bone cement diffusion were recorded. The preoperative, postoperative day 3, and postoperative month 3 vertebral body height recovery, low back pain visual analogue scale(VAS) scores, and quality of life ODI scores were also recorded. Results: The average operation time of group A was 40.61±3.85 minutes, which was significantly longer than that of group B(30.70±3.26 minutes). In group A, the time of robot matching and registration was TA1(23.43±2.97 minutes), and the time from puncture to incision closure was TA2(16.74±5.13 minutes). In group A, the average number of intraoperative fluoroscopy was 6.96±1.80 times with 0.55±0.07mSv radiation exposure, among which robot matching and registration accounts for 2.12±0.35 times with 0.15±0.03mSv radiation exposure. In group B, the average number of intraoperative fluoroscopy was 17.70±3.98 times with 1.25±0.12mSv radiation exposure. The average number of intraoperative fluoroscopy and dose of radiation exposure in group A were significantly lower than those in group B(P＜0.05). In group A, bone cement was diffused into the center of the vertebral body(type Ⅱ), while in group B bone cement was mainly unilaterally diffused except for 14.87%(4/27) towards into center(type Ⅱ)(P＜0.05). The VAS scores of back pain on the third day and third month after surgery were significantly lower than those before surgery(P＜0.05). There was no difference in VAS scores between the two groups after surgery(P＞0.05). The ODI scores of the two groups on the third day and third month after surgery were significantly lower than those before surgery(P＜0.05). There was no difference in the postoperative ODI scores between the two groups(P＞0.05). Conclusions: Mazor spine robot assisted PVP with the lumbar modified approach for treating lumbar osteoporotic fractures is a safe and effective surgery to quickly relieve the pain caused by fractures with the reduced intraoperative radiation and surgeon workload.