机器人辅助经皮椎弓根钉固定术治疗胸腰椎骨折的疗效及预后分析

doi:10.3969/j.issn.1006-5725.2024.12.014

Abstract

Abstract:

Objective To explore the efficacy and prognosis of robot-assisted percutaneous pedicle screw （PPS） in the treatment of thoracic and lumbar spine fracture. Methods A total of 84 patients with thoracolumbar fracture were selected from Xuzhou Renci Hospital from November 2018 to November 2022， and divided into study group （42 cases with robot-assisted PPS） and control group （42 cases with free-hand PPS） according to random number rank method. Perioperative indexes， nail placement accuracy， prognostic indexes （VAS score， Cobb Angle， relative height of anterior vertebra） and incidence of postoperative complications were compared between the two groups. Results Less intraoperative blood loss， shorter fluoroscopy time， fluoroscopy times， operative time， single nail placement time and radiation exposure time， and higher nail placement accuracy were observed in the study group （P < 0.05）. VAS score and Cobb Angle of the injured vertebrae were lower in the postoperative 3 d and the last follow-up， and the relative height of the injured vertebrae was higher than that before surgery in the two groups （P < 0.05）. Conclusion Robot-assisted PPS in the treatment of thoracolumbar fracture has a good application effect， which can shorten the operation time， reduce the intraoperative fluoroscopy times， improve the accuracy of nail placement， and have good safety.

Key words: thoracolumbar fracture, robots, percutaneous pedicle screw, efficacy, prognosis

CLC Number:

R683

Lei MENG,Jun SHANG,Yulong SUN,Yuxiang ZHANG,Meng HAN. Effect and prognosis of robot assisted percutaneous pedicle screw for thoracolumbar fracture[J]. The Journal of Practical Medicine, 2024, 40(12): 1696-1700.

Figures/Tables 6

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References 26

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组别	性别（男/女，例）	年龄（x ± s，岁）	BMI （x ± s，kg/m²）	损伤至手术时间（d）	损伤部位（例）
组别	性别（男/女，例）	年龄（x ± s，岁）	BMI （x ± s，kg/m²）	损伤至手术时间（d）	T₁₁	T₁₂	L₁	L₂	L₃	L₄
观察组（n = 42）	23/19	48.58 ± 3.21	21.98 ± 2.21	3.22 ± 1.12	6	8	11	8	5	4
对照组（n = 42）	22/20	49.84 ± 3.1	20.12 ± 2.25	3.45 ± 1.16	7	9	10	6	6	4
t/χ ² 值	0.048	1.615	3.404	0.826	0.091	0.074	0.063	0.343	0.105	0.00
P值	0.827	0.111	0.001	0.412	0.763	0.786	0.801	0.558	0.746	1.000

组别	术中出血量（mL）	透视时间（s）	透视次数（次）	手术时间（min）	单钉置入时间（min）	射线曝光时间（s）	下地行走时间（d）	住院时间（d）
观察组（n = 42）	45.27 ± 6.22	9.88 ± 1.94	8.53 ± 2.19	76.27 ± 12.37	3.31 ± 2.21	12.27 ± 2.11	14.03 ± 1.09	21.08 ± 1.07
对照组（n = 42）	56.18 ± 4.25	43.94 ± 4.84	29.84 ± 5.17	95.42 ± 15.5	6.53 ± 1.83	72.53 ± 6.57	14.04 ± 1.11	21.03 ± 1.27
t值	7.87	43.143	24.918	5.774	6.265	58.851	0.037	0.178
P值	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	0.971	0.859

组别	置钉数（枚）	0级	1级	2级	3级	置钉准确率（%）
观察组（n = 42）	219	215	4	0	0	98.17
对照组（n = 42）	221	190	14	11	7	85.97
Z/χ ²值		19.175				22.363
P值		< 0.001				< 0.001

指标	组别	术前	术后3 d	末次随访	F值	P值
VAS评分（分）	观察组（n = 42）	7.78 ± 1.41	2.16 ± 0.87^*	1.77 ± 0.67^*	F_时点= 1 839.395 F_组间= 0.235 F_交互= 0.724	P_时点 < 0.001 P_组间 = 0.629 P_交互= 0.397
	对照组（n = 42）	7.65 ± 1.42	2.18 ± 0.69^*	1.86 ± 0.77^*
	t值	0.421	1.634	1.206
	P值	0.675	0.106	0.231
伤椎前缘相对高度（%）	观察组（n = 42）	44.88 ± 4.31	91.22 ± 3.32^*	90.27 ± 3.15^*	F_时点 = 14 490.872 F_组间= 0.064 F_交互= 0.365	P_时点 < 0.001 P_组间 = 0.801 P_交互= 0.548
	对照组（n = 42）	45.31 ± 4.13	91.49 ± 3.46^*	90.16 ± 3.19^*
	t值	0.467	0.365	0.159
	P值	0.642	0.716	0.874
伤椎Cobb角（°）	观察组（n = 42）	20.1 ± 2.29	9.42 ± 3.28^*	9.04 ± 2.16^*	F_时点= 1 615.231 F_组间 = 0.126 F_交互=0.030	P_时点 < 0.001 P_组间 = 0.723 P_交互 = 0.862
	对照组（n = 42）	19.85 ± 2.17	8.98 ± 3.24^*	8.96 ± 2.50^*
	t值	0.514	0.618	0.157
	P值	0.609	0.538	0.876

组别	腰痛	泌尿系统感染	脑脊液漏	坐骨神经痛	螺钉松动	总发生率
观察组（n = 42）	1	1	0	1	0	3/42
对照组（n = 42）	1	0	1	1	1	4/42
χ ² 值	-					0.156
P值	-					0.693

Effect and prognosis of robot assisted percutaneous pedicle screw for thoracolumbar fracture

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