摘要
目的探讨机器人辅助颈椎后路椎弓根螺钉置入手术治疗颈椎病患者的置钉精确度与临床效果。方法纳入2018年4月至12月上海交通大学医学院仁济医院脊柱外科采取手术治疗的颈椎病患者18例。其中男11例,女7例,年龄(60.7±5.41)岁。依照手术方式将患者分为机器人辅助椎弓根螺钉置入(RA)组(8例)和传统徒手椎弓根螺钉置入(CF)组(10例)。比较2组患者的手术时间、术中出血量、透视次数、累计透视时间和辐射剂量以及住院时间;采用Rampersaud分类标准评价螺钉置钉的准确性;采用颈椎日本骨科协会评分(JOA)和颈椎功能障碍指数(NDI)评估术后患者神经功能恢复情况;采用Odom's评分评估末次随访时患者满意度。结果2组患者的基线特征、术中出血量、住院时间等差异无统计学意义(均P>0.05)。RA组与CF组“绝对安全区”(A级)椎弓根螺钉置入率分别为91.8%和49.2%,“相对安全区”(A+B级)椎弓根螺钉置入率分别为98.0%和83.6%,“可疑安全区”(C+D级)椎弓根螺钉置入率分别为2.0%和16.4%。RA组和CF组手术时间分别为(326.3±78.55)min和(242.0±26.99)min,术中透视次数分别为(14.9±2.53)次和(18.2±1.48)次,累计术中透视时间分别为(2.3±0.94)min和(3.5±0.50)min,患者所暴露辐射剂量分别为(45.3±17.60)Gy和(62.2±6.03)Gy,差异均有统计学意义(P=0.006,0.003,0.003,0.039)。2组随访时间内JOA评分、NDI评分和患者满意度差异均无统计学意义(均P>0.05)。结论骨科机器人辅助与传统徒手颈椎后路椎弓根螺钉置入手术治疗颈椎病均可取得相似满意疗效;骨科机器人辅助技术可以提高颈椎后路椎弓根螺钉置入的精确度,同时可以显著减少患者和术者X线暴露。
Objective To evaluate the accuracy and clinical effec of posterior cervical surgery with robot-assisted pedicle screw insertion in treatment of cervical spondylosis.Methods Eighteen patients with cervical spondylosis admitted to the Department of Spinal Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University from April to December 2018 including 11 males and 7 females with an age of(60.7±5.41)years were involved.All patients were assigned either in robot-assisted group(RA,8 patients)or in conventional freehand group(CF,10 patients).Perioperative data such as operation time,intraoperative blood loss,the number of intraoperative fluoroscopy,cumulative fluoroscopy time and radiation dose and hospitalization time were compared between the 2 groups.The screw placement accuracy was evaluated according to the Rampersaud classification.The JOA score and NDI score were used to assess the recovery of neurological function in the patients.Odom's score was used to assess patients'satisfaction at the last follow-up.Results There was no significant difference in baseline characteristics,intraoperative blood loss and hospitalization time between the 2 groups(all P>0.05).The rates that pedicle screws placed in"absolute safe zone"(grade A)in RA group and CF group were 91.8%and 49.2%,respectively;the incidences that pedicle screws inserted in"relative safe zone"(grade A+B)were 98.0%and 83.6%,respectively;the probabilities that pedicle screws posed in"questionable safe zone"(grade C+D)were 2.0%and 16.4%,respectively.The operation time of RA and CF group was(326.3±78.55)min and(242.0±26.99)min,respectively;the number of fluoroscopy was 14.9±2.53 and 18.2±1.48,respectively;the cumulative fluoroscopy time was(2.3±0.94)min and(3.5±0.50)min,respectively;the radiation doses exposed to the patients were(45.3±17.60)Gy and(62.2±6.03)Gy,respectively,and all the differences were statistically significant(P=0.006,0.003,0.003,0.039,respectively).There was no significant difference in JOA and NDI scores between the 2 groups during the follow-up period(all P>0.05).There was no significant difference in patients satisfaction rate between the 2 groups at the last follow-up(P>0.05).Conclusion Both robot-assisted and conventional freehand posterior pedical screw insertion techniques showed favorable clinical outcomes for the treatment of cervical spondylosis.Orthopedic robot-assisted technology significantly improves the accuracy of posterior pedicle screw placement via the posterior approach.In addition,it could significantly reduce the radiation dose suffered by the patients and surgeons.
作者
吕振东
陈智
韩应超
劳立峰
李全
张煜辉
沈洪兴
Lyu Zhendong;Chen Zhi;Han Yingchao;Lao Lifeng;Li Quan;Zhang Yuhui;Shen Hongxing(Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China)
出处
《骨科临床与研究杂志》
2020年第3期131-137,共7页
Journal Of Clinical Orthopedics And Research
基金
国家自然科学基金(81802139)
上海申康医院发展中心新兴前沿技术联合研究项目(SHDC12015103)
上海市科委上海市优秀学术带头人计划(18XD1402300)
上海交通大学医工交叉基金(YG2017QN51)。
关键词
机器人手术
颈椎
椎弓根钉
椎关节强硬
治疗结果
Robotic surgical procedures
Cervical vertebrae
Pedicle screws
Spondylosis
Treatment outcome
