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| LIANG Lichua,LIU Liehua,ZHAO Chen.Robot-assisted navigation vs. C-arm fluoroscopy in percutaneous pedicle screw fixation for treating thoracolumbar burst fractures: a comparative study of efficacy[J].Chinese Journal of Spine and Spinal Cord,2025,(3):236-242. |
| Robot-assisted navigation vs. C-arm fluoroscopy in percutaneous pedicle screw fixation for treating thoracolumbar burst fractures: a comparative study of efficacy |
| Received:June 21, 2024 Revised:December 14, 2024 |
| English Keywords:Thoracolumbar fracture Robot-assisted Percutaneous reduction and internal fixation Pedicle screw |
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| English Abstract: |
| 【Abstract】 Objectives: To evaluate the clinical efficacies of robot-assisted versus C-arm fluoroscopy-guided percutaneous pedicle screw fixation for thoracolumbar burst fractures. Methods: A retrospective analysis was conducted on 46 patients(26 males, 20 females; age 27-69 years) with thoracolumbar burst fractures treated between January 2022 and December 2023. The patients were divided into the observation group of 21 cases(12 males, 9 females; 52.1±8.8 years) receiving robot-assisted navigation, and the control group of 25 cases(14 males, 11 females; 50.9±13.2 years) undergoing conventional C-arm fluoroscopy guidance. No significant differences were observed in baseline characteristics (case number, sex ratio, BMI; P>0.05). Both groups of patients underwent percutaneous pedicle screw internal fixation of the injured vertebra. Intraoperative parameters(fluoroscopy frequency, operative time, blood loss), postoperative CT scans on 3d(assessed by Gertzbein-Robbins scale for screw placement accuracy), pre- and postoperative pain VAS scores(thoracolumbar back pain before surgery and at 1d, 3d, and 1 month after surgery), and radiographic parameters(Cobb angle, anterior vertebral body height ratio at preoperation, and postoperative 3d, 1 month, and 6 months) were recorded and compared using t-tests and Mann-Whitney U tests. Results: The observation group demonstrated significantly shorter operative time(90.71±9.52min vs 117.62±16.63min, P<0.05), reduced blood loss(67.14±18.75mL vs 139.52±28.01mL, P<0.05), and fewer fluoroscopy exposures(9.14±2.27 vs 18.86±2.86, P<0.05) than the control group. No complications occurred during follow-up in both groups. The observation group exhibited superior screw placement accuracy(98.4% vs 90.7%, P<0.05) with 124/126 screws graded as excellent/good versus 136/150 in controls. Postoperative pain VAS scores were lower in the observation group on 1d(2.67±0.57 vs 4.00±0.70, P<0.05) and 3d (1.19±0.68 vs 1.95±0.59, P<0.05), but comparable at 1 month(0.76±0.43 vs 1.10±0.53, P>0.05). The postoperative 3d, 1 month and 6 months′ Cobb angles(6.08°±1.49° vs 6.09°±1.05°, 6.26°±1.46° vs 6.28°±1.14°, 6.78°±1.38° vs 6.91°±1.31°) and anterior vertebral height ratios[(90.14±1.56)% vs (90.06±1.69)%, (89.62±1.56)% vs (89.44±2.12)%, (88.87±1.72)% vs (88.92±1.88)%] showed no significant intergroup differences at different time points(P>0.05). Conclusions: Robot-assisted percutaneous pedicle screw fixation for the treatment of thoracolumbar burst fractures has significant advantages in improving surgical accuracy, reducing intraoperative blood loss, shortening operative time, and decreasing the number of fluoroscopic exposures. |
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