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Title: [Study on robot-assisted pedicle screw implantation in adolescent idiopathic scoliosis surgery].
Author: Chen H, Zhu X, Dong L, Liu T.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Nov 15; 35(11):1457-1462. PubMed ID: 34779173.
Abstract:
OBJECTIVE: To investigate the safety and accuracy of robot-assisted pedicle screw implantation in the adolescent idiopathic scoliosis (AIS) surgery. METHODS: The clinical data of 46 patients with AIS who were treated with orthopedics, bone graft fusion, and internal fixation via posterior approach between June 2018 and December 2019 were analyzed retrospectively. Among them, 22 cases were treated with robot-assisted pedicle screw implantation (robot group) and 24 cases with manual pedicle screw implantation without robot assistance (control group). There was no significant difference in gender, age, body mass index, Lenke classification, and preoperative Cobb angle of the main curve, pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score between the two groups ( P>0.05). The intraoperative blood loss, pedicle screw implantation time, intraoperative pedicle screw adjustment times, and VAS and JOA scores after operation were recorded. The Cobb angle of the main curve was measured on X-ray film and the spinal correction rate was calculated. The screw position and the accuracy of screw implantation were evaluated on CT images. RESULTS: The operation completed successfully in the two groups. The intraoperative blood loss, pedicle screw implantation time, and pedicle screw adjustment times in the robot group were significantly less than those in the control group ( P<0.05). There was 1 case of poor wound healing in the robot group and 2 cases of mild nerve root injury and 2 cases of poor incision healing in the control group, and there was no significant difference in the incidence of complications between the two groups ( P=0.667). All patients in the two groups were followed up 3-9 months (mean, 6.4 months). The VAS and JOA scores at last follow-up in the two groups were superior to those before operation ( P<0.05), but there was no significant difference in the difference of pre- and post-operative scores between the two groups ( P>0.05). The imaging review showed that 343 screws were implanted in the robot group and 374 screws in the control group. There were significant differences in pedicle screw implantation classification and accuracy between the two groups (89.5% vs 79.1%)( Z=-3.964, P=0.000; χ ²=14.361, P=0.000). At last follow-up, the Cobb angles of the main curve in the two groups were significantly lower than those before operation ( P<0.05), and there was significant difference in the difference of pre- and post-operative Cobb angles between the two groups ( t=0.999, P=0.323). The spinal correction rateswere 79.82%±5.33% in the robot group and 79.62%±5.58% in the control group, showing no significant difference ( t=0.120, P=0.905). CONCLUSION: Compared with manual pedicle screw implantation, robot-assisted pedicle screw implantation in AIS surgery is safer, less invasive, and more accurate. 目的: 探讨青少年特发性脊柱侧弯（adolescent idiopathic scoliosis，AIS）矫形术中机器人辅助植钉的安全性及准确性。. 方法: 回顾分析 2018 年 6 月—2019 年 12 月采用后路矫形植骨融合内固定术治疗且符合选择标准的 46 例 AIS 患者临床资料。其中，22 例术中采用机器人辅助植钉（机器人组），24 例徒手植钉（徒手组）。两组患者性别、年龄、身体质量指数、Lenke 分型以及术前主弯 Cobb 角、疼痛视觉模拟评分（VAS）、日本骨科协会（JOA）评分等一般资料比较，差异均无统计学意义（ P>0.05），具有可比性。记录术中出血量、植钉时间、术中调钉次数以及术后 VAS 评分、JOA 评分，X 线片测量主弯 Cobb 角及计算脊柱矫正率，CT 评估螺钉位置并计算植钉准确率。. 结果: 两组手术均顺利完成；机器人组术中出血量、植钉时间以及术中调钉次数均少于徒手组（ P<0.05）。术后机器人组 1 例切口愈合不良，徒手组 2 例轻度神经根损伤、2 例切口愈合不良，两组并发症发生率比较差异无统计学意义（ P=0.667）。两组患者术后均获随访，随访时间 3～9 个月，平均 6.4 个月。两组末次随访时 VAS 评分、JOA 评分均优于术前（ P<0.05）；VAS 评分、JOA 评分手术前后差值组间比较，差异均无统计学意义（ P>0.05）。影像学复查示，术中机器人组植入 343 枚螺钉、徒手组 374 枚螺钉，两组植钉位置分级及植钉准确率（89.5% vs 79.1%）比较，差异均有统计学意义（ Z=−3.964， P=0.000； χ ²=14.361， P=0.000）。两组末次随访时主弯 Cobb 角均较术前减小，差异有统计学意义（ P<0.05）；手术前后差值组间比较差异有统计学意义（ t=0.999， P=0.323）。机器人组脊柱矫正率为 79.82%±5.33%，徒手组为 79.62%±5.58%，差异无统计学意义（ t=0.120， P=0.905）。. 结论: 与徒手植钉相比，AIS 矫形术中采用机器人辅助植钉安全、微创，而且准确性更高。.

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