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

English Keywords:Orthopedic surgical robot  Pedicle screw  Percutaneous needle puncture technique  Learning curve

English Abstract:

  【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.