腰椎后路短节段减压融合术中应用机器人辅助下皮质骨螺钉与椎弓根螺钉固定的临床疗效比较

Comparison of clinical efficacies between cortical bone trajectory screw and pedicle screw fixation techniques under robot-assisted technology in posterior lumbar short-segment decompression and fusion

中文关键词:  机器人辅助皮质骨螺钉置入  机器人辅助椎弓根螺钉置入  腰椎管狭窄症  单节段  减压融合

英文关键词:Robot-assisted cortical bone trajectory screw placement  Robot-assisted pedicle screw placement  Lumbar spinal stenosis  Single segment  Decompression and fusion

中文摘要:

  【摘要】 目的：探讨对于腰椎管狭窄症且行单节段减压融合的患者，机器人辅助下的皮质骨螺钉（robot-assisted cortical bone trajectory screw，RCBTS）固定与机器人辅助下的椎弓根螺钉（robot-assisted pedicle screw，RPS）固定的疗效差异。方法：本研究为回顾性队列研究，回顾了2020年6月～2022年月6月于首都医科大学附属北京世纪坛医院行单节段减压融合且行机器人辅助下置钉的腰椎管狭窄症患者，共纳入99例，其中男性59例，女性40例，平均年龄67.07±4.65岁；应用皮质骨螺钉固定者41例（RCBTS组），应用椎弓根螺钉固定者58例（RPS组）。比较两种不同术式的切口长度、手术时间、术中出血量、术后的24h引流量、术后住院天数；比较术后3d、3个月、6个月的日本骨科协会（Japanese Orthopaedic Association，JOA）评分和腰痛视觉模拟评分（visual analogue scale，VAS），并对JOA评分和VAS评分变化进行了固定效应检验；通过审查术后影像学资料，根据Gertzbein-Robbins方法对螺钉位置进行分级，计算两种术式的置钉准确率；比较两种术式围术期以及术后3个月的并发症发生情况。结果：两组患者基线数据无统计学差异（P>0.05）。RCBTS组患者的手术时长（134.39±22.23min vs 152.93±19.10min，P<0.001）、切口长度（64.93±3.71mm vs 78.84±3.82mm，P<0.001）、术中出血（155.61±37.15mL vs 172.41±43.22mL，P=0.001）、术后24h引流量（83.66±21.54mL vs 101.21±29.80mL，P=0.002）以及术后住院天数（4.90±1.26d vs 6.26±1.66d，P<0.001）均显著小于RPS组患者。两组患者的JOA评分和VAS评分变化在各时间点无显著性差异（P>0.05）。固定效应检验结果表明时间是JOA和VAS评分变化的固定效应（P<0.001）。两组的各级别置钉率（A级：152/164 vs 211/232，P=0.538；B级：9/164 vs 15/232，P=0.688；C级：3/164 vs 6/232，P=0.619）、临床可接受率（161/164 vs 226/232，P=0.619）、置钉不良率（3/164 vs 6/232，P=0.619）以及术后并发症（仅RCBTS组一例患者出现伤口延迟愈合）的发生情况均无显著性差异（P>0.05）。结论：与RPS相比，接受RCBTS的患者在手术时间、切口长度、术中出血量、术后引流量以及术后住院时长方面均具有显著优势；在术后功能恢复和腰痛改善间两组没有显著差异。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy between robot-assisted cortical bone trajectory screw(RCBTS) and robot-assisted pedicle screw(RPS) for patients with lumbar spinal stenosis(LSS) undergoing single-level decompression and fusion. Methods: In this retrospective cohort study, LSS patients who underwent robot-assisted single-level decompression and fusion in Beijing Shijitan Hospital between June 2020 and June 2022 were reviewed. A total of 99 patients were included and divided into RCBTS group of 41 patients and RPS group of 58 patients. There were 59 males and 40 females, with an average age of 67.07±4.65 years old. The incision length, operative time, intraoperative blood loss, 24h postoperative drainage, and postoperative hospital stay were compared between groups. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) of low back pain were compared at 3d, 3 months and 6 months after operation, and the fixed effects of JOA score and VAS score changes were tested. The screw positions were graded according to the Gertzbein-Robbins method. The accuracy of screw placement of the two surgical methods was evaluated by reviewing the postoperative imaging data. The perioperative and postoperative 3 months of complications were compared between the two groups. Results: There were no significant differences in baseline data between the two groups(P<0.05). Comparing with the RPS group, the RCBTS group was shorter in operative time(134.39±22.23min vs 152.93±19.10min, P<0.001), smaller in incision length(64.93±3.71mm vs 78.84±3.82mm, P<0.001), less in intraoperative blood loss(155.61±37.15mL vs 172.41±43.22mL, P=0.001) and postoperative drainage within 24h(83.66±21.54mL vs 101.21±29.80mL, P=0.002), and shorter in postoperative hospital stay(4.90±1.26d vs 6.26±1.66d, P<0.001), with statistical significance. There was no significant difference in JOA score and VAS score changes between the two groups at each time point(P>0.05). The fixed effect test showed that time was a fixed effect of JOA and VAS score changes(P<0.001). The RCBTS group was no significantly different from the RPS group in the accuracy of screw placement(grade A: 152/164 vs 211/232, P=0.538; grade B: 9/164 vs 15/232, P=0.688; grade C: 3/164 vs 6/232, P=0.619), the rate of clinically acceptable screw placement(161/164 vs 226/232, P=0.619), the rate of bad screw placement(3/164 vs 6/232, P=0.619), and the incidence of postoperative complications(only 1 patient in the RCBTS group developed delayed wound healing)(P>0.05). Conclusions: Compared with RPS, RCBTS has significant advantages in operative time, incision length, intraoperative blood loss, volume of postoperative drainage, and postoperative hospital stay. However, there is no significant difference between the two groups in terms of postoperative functional recovery and alleviation in low back pain.