Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate.
Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate.
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DOI：
10.1186/s12893-022-01814-6
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发表时间：
2022-10-22
期刊：
影响因子：
1.9
通讯作者：
Zhou, Xiao-zhong
中科院分区：
文献类型：
--
作者：
Du, Sheng-yang;Dai, Jun;Zhou, Zhen-tao;Shan, Bing-chen;Jiang, Feng-xian;Yang, Jing-yan;Cao, Lei;Zhou, Xiao-zhong
机器人技术在经皮椎弓根螺钉置入准确性方面的发展不断增加。然而，目前还不清楚机器人是否真的优化了螺钉尺寸的选择并增强了螺钉的稳定性。本研究的目的是比较使用机器人辅助与传统透视入路治疗胸腰椎骨折的椎弓根螺钉的尺寸（直径和长度）、放置准确性和松动率。进行了一项回顾性队列研究，以评价70例连续患者[34例机器人辅助经皮椎弓根螺钉固定（RAF）和36例传统透视引导经皮椎弓根螺钉固定（FGF）]。记录人口统计学、临床特征和放射学特征。评估椎弓根螺钉长度、直径和椎弓根螺钉放置准确性。通过术后1年的影像学数据评估患者的矢状面后凸Cobb角（KCA）、前路椎体高度比（VHA）和螺钉松动率。两组之间的平均计算机断层扫描（CT）Hounsfield单位（HU）值、手术持续时间或住院时间无显著差异。与FGF组相比，RAF组的透视频率较低[14（12 - 18）vs. 21（16 - 25），P <0.001]，"A + B级"椎弓根螺钉置入率较高（96.5% vs. 89.4%，P <0.05）。螺钉直径RAF组为6.04 ± 0.55 mm，FGF组为5.78 ± 0.50 mm（P <0.001）。螺钉长度RAF组为50.45 ± 4.37 mm，FGF组为48.63 ± 3.86 mm（P <0.001）。1年随访时，RAF组KCA和VHR的矫正丢失小于FGT组[（3.8 ± 1.8 ° vs. 4.9 ± 4.2 °）和（5.5 ± 4.9% vs. 6.4 ± 5.7%）]，34例患者中有2例发生螺钉松动RAF组36例患者中有6例（5.9%）发生了肿瘤坏死，而FGF组36例患者中有6例（16.7%）发生了肿瘤坏死，但两组间差异无统计学意义（P> 0.05）。与透视引导技术相比，机器人辅助脊柱手术减少了辐射暴露，并优化了术中螺钉轨迹和尺寸。尽管无统计学意义，但RAF组的松动率低于FGT组。
There has been increased development of robotic technologies for the accuracy of percutaneous pedicle screw placement. However, it remains unclear whether the robot really optimize the selection of screw sizes and enhance screw stability. The purpose of this study is to compare the sizes (diameter and length), placement accuracy and the loosening rate of pedicle screws using robotic-assisted versus conventional fluoroscopy approaches for thoracolumbar fractures. A retrospective cohort study was conducted to evaluate 70 consecutive patients [34 cases of robot-assisted percutaneous pedicle screw fixation (RAF) and 36 of conventional fluoroscopy-guided percutaneous pedicle screw fixation (FGF)]. Demographics, clinical characteristics, and radiological features were recorded. Pedicle screw length, diameter, and pedicle screw placement accuracy were assessed. The patients’ sagittal kyphosis Cobb angles (KCA), anterior vertebral height ratios (VHA), and screw loosening rate were evaluated by radiographic data 1 year after surgery. There was no significant difference in the mean computed tomography (CT) Hounsfield unit (HU) values, operation duration, or length of hospital stay between the groups. Compared with the FGF group, the RAF group had a lower fluoroscopy frequency [14 (12–18) vs. 21 (16–25), P < 0.001] and a higher “grade A + B” pedicle screw placement rate (96.5% vs. 89.4%, P < 0.05). The mean screw diameter was 6.04 ± 0.55 mm in the RAF group and 5.78 ± 0.50 mm in the FGF group (P < 0.001). The mean screw length was 50.45 ± 4.37 mm in the RAF group and 48.63 ± 3.86 mm in the FGF group (P < 0.001). The correction loss of the KCA and VHR of the RAF group was less than that of the FGT group at the 1-year follow-up [(3.8 ± 1.8° vs. 4.9 ± 4.2°) and (5.5 ± 4.9% vs. 6.4 ± 5.7%)], and screw loosening occurred in 2 out of 34 patients (5.9%) in the RAF group, and 6 out of 36 patients (16.7%) in the FGF group, but there were no significant differences (P > 0.05). Compared with the fluoroscopy-guided technique, robotic-assisted spine surgery decreased radiation exposure and optimizes screw trajectories and dimensions intraoperatively. Although not statistically significant, the loosening rate of the RAF group was lower that of than the FGT group.
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影响因子：
4.6
作者：
Chang HK;Ku J;Ku J;Kuo YH;Chang CC;Wu CL;Lirng JF;Wu JC;Huang WC;Cheng H;Hsu SM
通讯作者：
Hsu SM
影响因子：
1.9
作者：
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影响因子：
4.1
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通讯作者：
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影响因子：
3
作者：
Siebenga, Jan;Leferink, Vincent J. M.;Patka, Peter
通讯作者：
Patka, Peter
影响因子：
3
作者：
Hyun, Seung-Jae;Kim, Ki-Jeong;Kim, Hyun-Jib
通讯作者：
Kim, Hyun-Jib