“天玑”骨科手术机器人辅助与徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折的疗效比较

目的比较"天玑"骨科手术机器人辅助和徒手穿刺椎体成形术治疗上胸椎骨质疏松性椎体压缩骨折(OVCF)的疗效。方法回顾性分析西安交通大学医学院附属红会医院脊柱外科自2018年1月至2019年3月使用"天玑"骨科手术机器人辅助下穿刺完成椎体成形术的19例上胸椎OVCF患者(20个椎体)资料(机器人组)和自2016年1月至2017年12月徒手穿刺完成椎体成形术的21例上胸椎OVCF患者(21个椎体)资料(徒手组)。机器人组男5例,女14例;年龄62~88岁;徒手组男6例,女15例;年龄64~83岁。通过比较两组患者的手术时间、骨水泥注入量、术后并发症(骨水泥渗漏、感染和血管栓塞),术后1 d、末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、伤椎椎体前缘高度(AH)和伤椎后凸角(KA)观察疗效。结果机器人组和徒手组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。机器人组中19例患者(20个椎体)和徒手组中21例患者(21个椎体)均顺利完成单侧穿刺入路椎体成形术。40例患者术后随访6~12个月,平均8.3个月。机器人组的手术时间(37.9±8.2)min]、骨水泥注入量(2.3±0.9)mL]、骨水泥渗漏发生率(10.0%,2/20)均少于或低于徒手组(46.2±9.4)min、(4.2±1.3)mL、42.9%(9/21)],差异有统计学意义(P<0.05)。两组患者均无感染和血管栓塞发生。术后1 d、末次随访时两组间VAS评分、ODI、AH和KA比较差异均无统计学意义(P>0.05)。结论相比于传统徒手穿刺椎体成形术,"天玑"骨科手术机器人辅助下穿刺完成椎体成形术治疗上胸椎(T1~T4)OVCF临床疗效满意,可减少手术时间和骨水泥注入量,并降低骨水泥渗漏的发生率。

Puncture assisted by a"TINAVI"orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture of the upper thoracic vertebra

Objective To compare the clinical efficacy between puncture assisted by a"TINAVI"orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture(OVCF)of the upper thoracic vertebra.Methods A retrospective study was conducted of the 19 patients(20 vertebral bodies)with OVCF of the upper thoracic vertebra who had been treated at Department of Spine Surgery,Honghui Hospital from January 2018 to March 2019 by robotic vertebroplasty(robot group)and of another 21 counterpart patients(21 vertebral bodies)who had been treated by conventional vertebroplasty from January 2016 to December 2017(freehand group).Puncture was conducted by a"TINAVI"orthopaedic robot in the robotic vertebroplasty but freehand in the conventional vertebroplasty.The robot group had 5 males and 14 females,aged from 62 to 88 years;the freehand group had 6 males and 15 females,aged from 64 to 83 years.The 2 groups were compared in terms of operation time,bone cement volume,postoperative complications(cement leakage,infection and embolism),visual analogue scale(VAS),Oswestry disability index(ODI),anterior height(AH)and kyphosis angulation(KA)of the injured vertebra at day 1 and last follow-up after surgery.Results The 2 groups were comparable because there were no significant differences between them in the preoperative general data(P>0.05).Vertebroplasty via unilateral puncture approach was completed uneventfully in the 19 patients(20 vertebral bodies)in the robot group and in the 21 patients(21 vertebral bodies)in the freehand group.The 40 patients were followed up for 6 to 12 months(mean,8.3 month).The operation time(37.9±8.2)min],bone cement volume(2.3±0.9)mL]and rate of cement leakage(10.0%,2/20)in the robot group were all significantly less or lower than those in the freehand group(46.2±9.4)min,(4.2±1.3)mL and 42.9%(9/21)](P<0.05).No infection or embolism was observed in either group.There were no significant differences between the 2 groups in VAS,ODI,AH or KA of the injured vertebra at day 1 or last follow-up after surgery(P>0.05).Conclusion In vertebroplaty for OVCF of the upper thoracic vertebra,compared with conventional freehand puncture,puncture assisted by a"TINAVI"orthopaedic robot can lead to satisfactory clinical efficacy because it reduces operation time,volume of bone cement injection,and thus incidence of bone cement leakage.