微创医学

目的比较机器人辅助经皮椎弓根螺钉置入与常规开放式椎弓根螺钉置入在腰椎骨折中的应用效果。方法纳入111例接受椎弓根螺钉置入治疗的腰椎骨折患者为研究对象，将其中接受机器人辅助经皮椎弓根螺钉固定术治疗的52例患者设为研究组，将同期接受常规开放式椎弓根螺钉固定术治疗的49例患者设为对照组。比较患者的置钉准确性、手术时间、术中出血量、术后住院时间、视觉模拟量表（VAS）评分、颈椎功能障碍指数（NDI）评分、术后并发症发生情况、伤椎骨折愈合时间、伤椎矢状面Cobb角等指标。结果研究组的置钉准确性高于对照组，术中出血量少于对照组，伤椎骨折愈合时间短于对照组（均P<0.05）。两组患者的手术时间、术后住院时间、并发症发生率差异均无统计学意义（均P>0.05）。术前、术后1周及末次随访时，两组患者的伤椎矢状面Cobb角及伤椎前缘高度百分比差异均无统计学意义（均P>0.05）；随着时间延长，两组患者的伤椎矢状面Cobb角均呈下降趋势，而伤椎前缘高度百分比呈增加趋势（均P<0.05）。术前、术后1个月，两组患者的VAS评分、NDI评分差异均无统计学意义（均P>0.05），而与术前相比，两组患者术后1个月的VAS评分、NDI评分均降低（均P<0.05）。结论在腰椎骨折手术中，机器人辅助经皮椎弓根螺钉置入在置钉准确性、术中出血量和骨折愈合时间方面均优于常规开放式椎弓根螺钉置入，该术式安全、可行。

Objective To compare the application effect of robot-assisted percutaneous pedicle screw placement and conventional open pedicle screw placement in fracture of lumbar vertebrae. Methods A total of 111 patients with fracture of lumbar vertebrae who received pedicle screw placement were included as the study objects. Fifty-two patients who received robot-assisted percutaneous pedicle screw fixation were assigned as study group, and 49 patients who received conventional open pedicle screw fixation at the same time were assigned as control group.The accuracy of screw placement, operation time, intraoperative blood loss, postoperative hospital stay, Visual Analogue Scale (VAS) score, Neck Disability Index(NDI) score, occurrence of postoperative complications, fracture healing time of injured vertebra, Cobb angle of sagittal plane of injured vertebra were compared. Results Compared with the control group, the accuracy of screw placement was higher, the intraoperative blood loss was less, and the fracture healing time of injured vertebra was shorter in the study group (all P<0.05). There was no statistically significant difference in operation time, postoperative hospital stay and complication rate between the two groups (all P>0.05). There was no statistically significant difference in the Cobb angle of sagittal plane of injured vertebra and the percentage of anterior height of injured vertebra between the two groups before operation, 1 week after operation and at the last follow-up (all P>0.05). However, with the prolongation of time, the Cobb angle of sagittal plane of injured vertebra in the two groups showed a downward trend, while the percentage of anterior height of injured vertebra showed an upward trend (all P<0.05). There was no statistically significant difference in VAS score and NDI score between the two groups before operation and 1 month after operation (all P>0.05), but compared with preoperative, the VAS score and NDI score of the two groups decreased 1 month after operation (all P<0.05). Conclusion In operation of fracture of lumbar vertebra, robot-assisted percutaneous pedicle screw placement is superior to the conventional open pedicle screw placement in terms of the accuracy of screw placement, intraoperative blood loss and fracture healing time, which makes the opertion method safe and feasible.