摘要
目的比较脊柱机器人辅助和传统透视辅助下微创经皮椎弓根螺钉复位内固定术治疗单节段无神经症状胸腰椎骨折的临床疗效及植钉准确性。方法回顾分析2016年12月-2018年1月收治的58例单节段无神经症状的胸腰椎骨折患者临床资料,根据手术方式不同分为A组(脊柱机器人辅助经皮复位内固定组,28例)和B组(传统透视辅助经皮复位内固定组,30例)。两组患者均无神经症状,不合并其他骨折和脏器损伤。两组患者年龄、性别、骨折部位、骨折AO分型、受伤至手术时间及术前椎体前缘高度百分比、矢状面Cobb角、疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)等一般资料比较差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者植钉时间、手术时间、术中出血量、术中透视次数、住院时间、手术费用、术后并发症,以及术前、术后3 d、术后6个月及末次随访时的VAS评分、ODI评分、椎体前缘高度百分比、矢状面Cobb角。参考Neo等的方法评估植入椎弓根螺钉的精确性。结果A组植钉时间、手术时间、术中透视次数均显著少于B组,手术费用高于B组(P<0.05);但两组术中出血量、住院时间比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间12~18个月,平均15.2个月。A、B组术后精确植钉百分率分别为93.75%(150/160)和84.71%(144/170),比较差异有统计学意义(χ^2=5.820,P=0.008)。除A组发生术后切口浅部感染1例,经换药后切口愈合外,两组均未出现神经血管损伤、螺钉松动断裂等并发症,两组并发症发生率比较差异无统计学意义(χ^2=0.625,P=0.547)。两组术后各时间点椎体前缘高度百分比、矢状面Cobb角、VAS评分、ODI评分均较术前显著改善(P<0.05);术后各时间点两组间比较差异均无统计学意义(P>0.05)。结论脊柱机器人和传统透视辅助下经皮复位内固定术治疗单节段无神经症状胸腰椎骨折均可获得满意的临床效果,但前者植钉准确性更高,术中透视次数更少,植钉时间更短,对术者技术要求较低,具有广泛的应用潜力。
Objective To compare the effectiveness and screw planting accuracy of percutaneous reduction and internal fixation with robot and traditional fluoroscopy-assisted in the treatment of single-level thoracolumbar fractures without neurological symptoms. Methods The clinical data of 58 patients with single-level thoracolumbar fractures without neurological symptoms between December 2016 and January 2018 were retrospectively analysed. According to different surgical methods, the patients were divided into group A(28 cases underwent robot-assisted percutaneous reduction and internal fixation) and group B(30 cases underwent fluoroscopy-assisted percutaneous reduction and internal fixation). There was no neurological symptoms, other fractures or organ injuries in the two groups. There was no significant difference in general data of age, gender, fracture location, AO classification, time from injury to surgery, and preoperative vertebral anterior height ratio, sagittal Cobb angle, visual analogue scale(VAS) score, and Oswestry disability index(ODI) score between the two groups(P>0.05). The screw placement time, operation time, intraoperative blood loss,intraoperative fluoroscopy frequency, hospitalization time, operation cost, postoperative complications, VAS score, ODI score, anterior vertebral height ratio, and sagittal Cobb angle before operation, at 3 days, 6 months after operation, and at last follow-up were recorded and compared between the two groups. The accuracy of the pedicle screw placement was evaluated by Neo’s criteria. Results The screw placement time, operation time, and intraoperative fluoroscopy frequency of group A were significantly less than those of group B, and the operation cost was significantly higher than that of group B(P<0.05). But there was no significant difference in intraoperative blood loss and hospitalization time between the two groups(P>0.05). Both groups were followed up 12-24 months, with an average of 15.2 months. The accuracy rate of screw placement in groups A and B was 93.75%(150/160) and 84.71%(144/170), respectively, and the difference was significant(χ^2=5.820, P=0.008). Except for 1 case of postoperative superficial infection in group A and wound healing after dressing change, there was no complication such as neurovascular injury, screw loosening and fracture in both groups, and there was no significant difference in the incidence of complications between the two groups(χ^2=0.625, P=0.547). The anterior vertebral height ratio, sagittal Cobb angle, VAS score, and ODI score of the two groups were significantly improved(P<0.05);there was no significant difference between the two groups at all time points after operation(P>0.05).Conclusion The spinal robot and traditional fluoroscopy-assisted percutaneous reduction and internal fixation can both achieve satisfactory effectiveness in the treatment of single-level thoracolumbar fractures without neurological symptoms.However, the former has higher accuracy, fewer fluoroscopy times, shorter time of screw placement, and lower technical requirements for the operator. It has wide application potential.
作者
田野
张嘉男
陈浩
丁柯元
刘团江
黄大耿
郝定均
TIAN Ye;ZHANG Jianan;CHEN Hao;DING Keyuan;LIU Tuanjiang;HUANG Dageng;HAO Dingjun(Xi’an Medical University,Xi’an Shaanxi,710068,P.R.China;Department of Spinal Surgery,Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University,Xi’an Shaanxi,710054,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第1期69-75,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81772357、81830077)~~
关键词
脊柱机器人
透视
经皮复位内固定
胸腰椎骨折
植钉
准确性
Spinal robot
fluoroscopy
percutaneous reduction and internal fixation
thoracolumbar fracture
screw placement
accuracy
