| 钟文杰,廖文鳌,刘希麟,李 亭,胡 豇,王 飞.手术机器人辅助经椎间孔腰椎椎间融合术的置钉准确度及学习曲线分析[J].中国脊柱脊髓杂志,2025,(1):53-60. |
| 手术机器人辅助经椎间孔腰椎椎间融合术的置钉准确度及学习曲线分析 |
| 中文关键词: 机器人 经椎间孔腰椎椎间融合术 腰椎退行性疾病 学习曲线 |
| 中文摘要: |
| 【摘要】 目的：探讨手术机器人辅助经椎间孔腰椎椎间融合术（robot-assisted minimally invasive transforaminal lumbar interbody fusion，RA-MIS-TLIF）的置钉准确度并分析其学习曲线。方法：回顾分析2019年1月~2022年6月于四川省医学科学院·四川省人民医院骨科治疗的160例腰椎退行性疾病患者的临床资料，按手术方式分为机器人组（n=80）和徒手组（n=80），两组患者均根据手术日期的先后进行排序并编号（1~80号），并分别分为4个亚组：1~20号为1组，21~40号为2组，41~60号为3组，61~80号为4组。统计分析两种术式的总手术时间、出血量、规划及置钉时间，比较术前、术后1d以及术后6个月疼痛视觉模拟量表（visual analogue scale，VAS）评分和Oswestry功能障碍指数（Oswestry disability index，ODI），采用ln曲线回归分析方法分析两种术式的总手术时间、出血量随手术例数变化的趋势，并采用Gertzbein-Robbins标准评价术后CT椎弓根螺钉的准确性分级进而评估置钉准确率。结果：患者均顺利完成手术，机器人组总手术时间162.9±5.7min，出血量91.4±9.5mL，规划及置钉时间42.1±1.3min；徒手组总手术时间169.1±6.6min，出血量101.0±9.2mL，规划及置钉时间57.0±6.3min。机器人组共置入320枚螺钉，螺钉置钉准确率为97%（311/320）；徒手组共置入320枚螺钉，螺钉置钉准确率为92%（295/320），且两组均无C、D级螺钉。两组总手术时间均随着手术例数的增加而减少，机器人组：[y=-5.894×ln（x）+183.891，R2=0.576，P＜0.05]，在2、3组间达到相对稳定；徒手组：[y=-4.424×ln（x）+184.221，R2=0.376，P＜0.05]，在3、4组之间达到相对稳定；两组出血量均随着手术例数的增加而减少，机器人组：[y=-9.480×ln（x）+125.361，R2=0.547，P＜0.05 ]，在2、3组之间达到相对稳定；徒手组：[y=-3.868×ln（x）+114.183，R2=0.148，P＜0.05]，在2、3组之间达到相对稳定。VAS评分，机器人组术后1d由术前6.9±1.1分降至2.4±0.9分（P＜0.05），术后6个月降至1.1±0.4分（P＜0.05）；徒手组术后1d由术前7.0±0.9分降至2.4±0.9分（P＜0.05），术后6个月降至1.4±0.6分（P＜0.05）。ODI，机器人组术后1d由术前（59.5±7.1）%降至（20.0±4.1）%（P＜0.05），术后6个月降至（10.8±3.0）%（P＜0.05）；徒手组术后1d由术前（57.7±6.9）%降至（19.6±4.6）%（P＜0.05），术后6个月降至（11.3±3.4）%（P＜0.05）。随访期间160例患者均完成随访，随访期间并未出现严重的并发症。结论：相较于传统徒手置钉MIS-TLIF，RA-MIS-TLIF的螺钉置钉准确率更高，其学习曲线在大约20例时趋于平稳，学习曲线平滑。 |
Accuracy of screw placement and learning curve analysis of robot-assisted minimally invasive transforaminal lumbar interbody fusion |
| 英文关键词:Robot Transforaminal lumbar interbody fusion Degenerative lumbar disease Learning curve |
| 英文摘要: |
| 【Abstract】 Objectives: To investigate the pedicle screw placement accuracy of robot-assisted minimally invasive transforaminal lumbar interbody fusion(RA-MIS-TLIF) and analyze its learning curve. Methods: A retrospective analysis was conducted on the clinical data of 160 patients with degenerative lumbar diseases treated at the Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital between January 2019 and June 2022. The patients were divided into a robot group(n=80) and a manual group(n=80) based on the surgical approach. Each group was further divided into four subgroups(1, 2, 3, 4) of 20 patients each, arranged sequentially according to the order of surgery dates. The total operative time, blood loss, and planning and screw placement time of the two surgical methods were statistically analyzed. Preoperative, postoperative 1d, and six-month postoperative visual analogue scale(VAS) scores for pain and Oswestry disability index(ODI) were compared across the four subgroups. The trends in total operative time and blood loss with increasing surgery cases were analyzed using a logarithmic regression model. Screw placement classification was evaluated using the Gertzbein-Robbins classification based on postoperative CT scans, and then the screw placement accuracy was calculated. Results: All the surgeries were successfully completed. In the robot group, the total operative time was 162.9±5.7min, blood loss was 91.4±9.5mL, and planning and screw placement time was 42.1±1.3min; In the manual group, the total operative time was 169.1±6.6min, blood loss was 101.0±9.2mL, and planning and screw placement time was 57.0±6.3min. A total of 320 screws were placed in each group, with accuracy rates of 97%(311/320) in the robot group and 92%(295/320) in the manual group. Neither group had grade C or D screws. The total operative time decreased with the increase in the number of surgeries in both groups. The robot group achieved relative stability between subgroups 2 and 3[y=-5.894×ln(x)+183.891, R2=0.576, P<0.05], while the manual group achieved relative stability between subgroups 3 and 4[y=-4.424×ln(x)+184.221, R2=0.376, P<0.05]. The blood loss also decreased with the increase in the number of surgeries in both groups, the robot group achieved relative stability between subgroups 2 and 3[y=-9.480×ln(x)+125.361, R2=0.547, P＜0.05], and the manual group achieved relative stability also between subgroups 2 and 3[y=-3.868×ln(x)+114.183, R2=0.148, P＜0.05]. Postoperative VAS scores in the robot group decreased from 6.9±1.1 preoperatively to 2.4±0.9 on postoperative 1d(P<0.05) and to 1.1±0.4 at six months(P<0.05). In the manual group, VAS scores decreased from 7.0±0.9 preoperatively to 2.4±0.9 on postoperative 1d(P<0.05) and to 1.4±0.6 at six months(P<0.05). ODI in the robot group decreased from (59.5±7.1)% preoperatively to (20.0±4.1)% on postoperative 1d(P<0.05) and to (10.8±3.0)% at six months (P<0.05). In the manual group, ODI scores decreased from (57.7±6.9)% preoperatively to (19.6±4.6)% on postoperative 1d(P<0.05) and to (11.3±3.4)% at six months(P<0.05). All the 160 patients completed follow-ups with no severe complications reported during the follow-up period. Conclusions: Comparing with traditional MIS-TLIF with manual pedicle screw placement, RA-MIS-TLIF has a higher accuracy of screw placement and a smoother learning curve, which stabilizes after approximately 20 cases. |
| 投稿时间：2024-01-20 修订日期：2024-11-09 |
| DOI： |
| 基金项目:四川省科技厅三维步态评估系统的研发与骨科临床应用项目（2022YFS0100） |
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