机器人联合三维“C”型臂辅助置钉在44例脊柱侧弯矫形术中的应用价值

目的 分析评价骨科手术机器人联合三维“C”型臂导航辅助下椎弓根螺钉置入在脊柱侧弯矫形手术中的准确性和安全性,并与徒手置钉进行对比。 方法 回顾性分析2016年9月至2022年4月收治的96例脊柱侧弯患者临床资料。44例采用机器人联合三维“C”型臂导航辅助下椎弓根螺钉置入术(机器人组);52例采用徒手透视辅助下椎弓根螺钉置入术(徒手组)。记录手术时间、术中出血量、术中辐射剂量、术后住院时间和术后并发症。通过X线和计算机断层扫描(CT)评估治疗前后脊柱冠状位和矢状位参数变化、顶椎旋转角、术后旋转分级以及椎弓根螺钉置入准确率。 结果 机器人组和徒手组患者术后Cobb角、SVA及顶椎旋转角均较术前改善(P<0.05),且两组术后顶椎旋转改善率及旋转分级差异无统计学意义(P>0.05)。机器人组置钉准确率高于徒手组(96.5% vs 88.6%, P<0.05)。机器人组患者的术中辐射剂量高于徒手组［(4.85±0.44)μSv vs(15.97±2.35)×10^-5μSv; P<0.05)］。机器人组外科医生术中辐射剂量低于徒手组［(2.96×±0.75)×10^-5μSv vs(6.35×±0.93)×10^-5μSv; P<0.05)］。机器人组手术时间多于徒手组［(7.1±2.2)h vs(5.5±1.6 )h; P<0.05］。机器人组和徒手组出血量及术后住院日差异无统计学意义(P>0.05)。 结论 骨科手术机器人联合三维“C”型臂导航有效地提高了脊柱矫形术中椎弓根螺钉置入的准确性和安全性。

Clinical application of robotic-assisted navigation based on 3D C-arm in 44 cases of scoliosis surgery

Objective To evaluate the accuracy and safety of robotic-assisted navigation with three-dimensional(3D)C-arm-assisted pedicle screw insertion for scoliosis surgery and compare it with freehand technique. Methods Clinical data od 96 scoliosis patients were involved, including 44 undergoing robotic-assisted technique(robot group), and 52 patients undergoing freehand technique(freehand group). Operation time, intraoperative blood loss, intraoperative radiation dose, postoperative hospital stay and complications were recorded. Changes in coronal and sagittal position parameters, apex rotation angle, postoperative rotation grade, and pedicle screw placement accuracy were evaluated with X-ray and computed tomography(CT)before and after treatment. Results Cobb angle, SVA and apex rotation angle were improved in both groups(P<0.05), but there was no differences between the two groups in the improvement rate of apex rotation and rotation grade(P>0.05). Compared with the freehand group, the robot group had higher accuracy in pedicle screw placement(96.5% vs 88.6%, P<0.05), higher radiation exposure on patients ［(4.85±0.44)μSv vs(15.97×10^-5±2.35×10^-5)μSv, P<0.05］, lower radiation exposure on surgeons ［(2.96×10^-5±0.75×10^-5)μSv vs(6.35×10^-5±0.93×10^-5)μSv, P<0.05)］, and longer operation time ［(7.1±2.2)h vs(5.5±1.6)h, P<0.05］. There were no significant differences in blood loss and postoperative stay between the two groups. Conclusion Robotic-assisted navigation based on 3D C-arm effectively increases the accuracy and safety of pedicle screw insertion in scoliosis surgery.