| Objective: to compare the safety and accuracy of free-hand and robot-assisted cortical bone trajectory(CBT)screws in the treatment of degenerative diseases of the lumbar spine with osteoporosis.Methods:The clinical data of 62 patients with degenerative diseases of the lumbar spine with osteoporosis treated with CBT screw internal fixation from February 2015 to February 2019 were analyzed retrospectively.Among them,30 cases were implanted with CBT screws assisted by spinal robot(robot group),and 32 cases were implanted with CBT screws with free hand(free-hand group).There was no significant difference in sex,age,body mass index(BMI),type of disease,course of disease,bone mineral density(BMD)and operative segment between the two groups.Visual analog score(VAS)and Oswestry disability index(ODI)were used to evaluate and compare the clinical symptoms of the two groups before and after the last follow-up.The accuracy of nail implantation was evaluated by Kaito’s grading method,and the invasion of CBT screw to the superior articular process was evaluated by Babu’s method.Results: There was no significant difference in VAS score and ODI score of clinical symptoms between the two groups before and after the last follow-up(P > 0.05).The operation time and the amount of intraoperative blood loss in the robot group were significantly less than those in the group B(t=-7.712,P=0.000;t=-8.117,P=0.000).A total of 248 CBT screws were implanted in the two groups,120 in the robot group and 128 in the unarmed group.After pulling out the drainage tube for lumbar surgery segment CT scan,the nail implantation accuracy was evaluated according to Kaito’s grading method:There were 110 nails in grade 0,7 in grade 1,3 in grade 2 in the robot group,and90 in grade 0,15 in grade 1,19 in grade 2 and 4 in grade 3 in the robot group,and there was significant difference between the two groups(Z=-4.664,P=0.000).The robot group was satisfied with 117 nails,the nail placement satisfaction rate was 97.5%,and the bare-handed group was satisfied with 105 nails,and the nail placement satisfaction rate was 82.0%.The difference was statistically significant(2=15.792,P=0.000).After pulling out the drainage tube and performing segmental CT scan of lumbar vertebrae,the invasion of CBT screw to superior articular process was evaluated according to Babu and other methods.Because part of the superior articular process was injured during intraoperative decompression,92 and 96 CBT screws were included in the study.There were 87 in grade0,3 in grade 1,2 in grade 2 and 0 in grade 3 in the robot group,and 72 in grade 0,11 in grade 1,8 in grade 2 and 5 in grade 3 in the free-hand group,the difference is statistically significant(Z=-3.746,P=0.000).Robot group: upper facet joint invasion rate was 2.2%,free-hand group: upper facet joint invasion rate was 13.5%,the difference was statistically significant(?2=8.269,P=0.004).There was no serious spinal cord,nerve and vascular injury caused by nail implantation in both groups.Delayed cerebrospinal fluid leakage occurred in 1 case in the robot group.Blood routine examination on the first day after operation in the free-hand group showed that 2 patients had mild anemia and 1 patient had poor incision healing.Patients in both groups were followed up for 10 to 14 months,with an average of(11.21 ± 1.18)months.The postoperative neurological symptoms were improved well,and no screw loosening or fracture was found during the follow-up period.Conclusion: compared with manual CBT screw implantation,spinal robot-assisted screw implantation has higher accuracy,lower incidence of invasion of superior articular process,so it can be used in the treatment of degenerative diseases of the lumbar spine with osteoporosis. |
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