机器人辅助与C型臂X线机透视经皮椎弓根螺钉内固定术治疗胸腰椎爆裂骨折的疗效对比

Robot-assisted navigation vs. C-arm fluoroscopy in percutaneous pedicle screw fixation for treating thoracolumbar burst fractures: a comparative study of efficacy

中文关键词:  胸腰椎骨折  机器人辅助  经皮复位内固定  椎弓根螺钉

英文关键词:Thoracolumbar fracture  Robot-assisted  Percutaneous reduction and internal fixation  Pedicle screw

中文摘要:

  【摘要】 目的：评估机器人辅助与C型臂X线机透视下经皮椎弓根螺钉内固定术治疗胸腰椎爆裂骨折的临床效果。方法：回顾性分析2022年1月~2023年12月期间在我院收治的46例胸腰椎爆裂骨折患者，其中男26例，女20例，年龄27~69岁。根据术中是否使用机器人辅助，分为机器人辅助引导的观察组的和传统C型臂X线机透视引导的对照组。观察组21例，男12例，女9例，年龄27~69岁（52.1±8.8岁）；对照组25例，男14例，女11例，年龄27~69岁（50.9±13.2岁）。两组患者的病例数及男女比例、BMI无统计学差异（P＞0.05）。两组患者均行伤椎经皮椎弓根内固定手术，记录术中透视次数、手术持续时间和术中出血量。记录术后3d的CT资料，根据Gertzbein-Robbins评分，评价置钉的优良率。记录术前及术后1d、3d、1个月的胸腰背部疼痛VAS评分。测量术前及术后3d、1个月、6个月的Cobb角及椎体前缘相对高度，使用t检验和Mann-Whitney U检验对比术前及术后数据。结果：观察组的手术时间（90.71±9.52min vs 117.62±16.63min，P＜0.05）、术中出血量（67.14±18.75mL vs 139.52±28.01mL，P＜0.05）和透视次数（9.14±2.27次 vs 18.86±2.86次，P＜0.05）均显著低于对照组。两组随访期间均未出现并发症。对照组共置入150枚螺钉，其中136枚位置优良；观察组共置入126枚螺钉，其中124枚位置优良，观察组螺钉置入优良率更高（98.4% vs 90.7%，P＜0.05）。两组术后1d（2.67±0.57分 vs 4.00±0.70分，P＜0.05）、术后3d疼痛VAS评分（1.19±0.68分 vs 1.95±0.59分，P＜0.05）有统计学差异；术后1个月VAS疼痛评分（0.76±0.43 vs 1.10±0.53，P＞0.05）无统计学差异。两组术后3d、1个月及6个月的Cobb角（6.08°±1.49° vs 6.09°±1.05°；6.26°±1.46° vs 6.28°±1.14°；6.78°±1.38° vs 6.91°±1.31°）与椎体前缘相对高度[（90.14±1.56）% vs （90.06±1.69）%；（89.62±1.56）% vs （89.44±2.12）%；（88.87±1.72）% vs （88.92±1.88）%]在各时间点比较均无统计学差异（P＞0.05）。结论：机器人辅助经皮椎弓根螺钉内固定术治疗胸腰椎爆裂性骨折在提高手术精确度、减少术中出血、缩短手术时间和减少透视次数方面具有显著优势。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacies of robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar burst fractures. Methods: A retrospective analysis was conducted on 46 patients(26 males, 20 females; age 27-69 years) with thoracolumbar burst fractures treated between January 2022 and December 2023. The patients were divided into the observation group of 21 cases(12 males, 9 females; 52.1±8.8 years) receiving robot-assisted navigation, and the control group of 25 cases(14 males, 11 females; 50.9±13.2 years) undergoing conventional C-arm fluoroscopy guidance. No significant differences were observed in baseline characteristics (case number, sex ratio, BMI; P>0.05). Both groups of patients underwent percutaneous pedicle screw internal fixation of the injured vertebra. Intraoperative parameters(fluoroscopy frequency, operative time, blood loss), postoperative CT scans on 3d(assessed by Gertzbein-Robbins scale for screw placement accuracy), pre- and postoperative pain VAS scores(thoracolumbar back pain before surgery and at 1d, 3d, and 1 month after surgery), and radiographic parameters(Cobb angle, anterior vertebral body height ratio at preoperation, and postoperative 3d, 1 month, and 6 months) were recorded and compared using t-tests and Mann-Whitney U tests. Results: The observation group demonstrated significantly shorter operative time(90.71±9.52min vs 117.62±16.63min, P<0.05), reduced blood loss(67.14±18.75mL vs 139.52±28.01mL, P<0.05), and fewer fluoroscopy exposures(9.14±2.27 vs 18.86±2.86, P<0.05) than the control group. No complications occurred during follow-up in both groups. The observation group exhibited superior screw placement accuracy(98.4% vs 90.7%, P<0.05) with 124/126 screws graded as excellent/good versus 136/150 in controls. Postoperative pain VAS scores were lower in the observation group on 1d(2.67±0.57 vs 4.00±0.70, P<0.05) and 3d (1.19±0.68 vs 1.95±0.59, P<0.05), but comparable at 1 month(0.76±0.43 vs 1.10±0.53, P>0.05). The postoperative 3d, 1 month and 6 months′ Cobb angles(6.08°±1.49° vs 6.09°±1.05°, 6.26°±1.46° vs 6.28°±1.14°, 6.78°±1.38° vs 6.91°±1.31°) and anterior vertebral height ratios[(90.14±1.56)% vs (90.06±1.69)%, (89.62±1.56)% vs (89.44±2.12)%, (88.87±1.72)% vs (88.92±1.88)%] showed no significant intergroup differences at different time points(P>0.05). Conclusions: Robot-assisted percutaneous pedicle screw fixation for the treatment of thoracolumbar burst fractures has significant advantages in improving surgical accuracy, reducing intraoperative blood loss, shortening operative time, and decreasing the number of fluoroscopic exposures.