The Accuracy And Safety Analysis Of Spine Robot And Free-hand Technique In The Placement Of Adolescent Idiopathic Scoliosis Pedicle Screws

The accuracy and safety analysis of spine robot and free-hand technique in the placement of adolescent idiopathic scoliosis pedicle screwsAdolescent Idiopathic scoliosis(AIS)is a complex three-dimensional deformity of spine with unknown causes,the incidence rate of adolescent population reached 2%-3%.one or more vertebrae deviate from the midline on the coronal plane,the side convex angle increases gradually,and it is often accompanied by vertebral body rotation,sagittal protrusion or kyphosis,often resulting in thoracic deformity,unequal height of shoulders,"razor back",etc,and queeze the heart and lungs,cause the decline of cardiopulmonary function,and bring physical and psychological damage to the patients,some teenagers have the psychology of autistic inferiority.With the increase of incidence rate and social progress,more and more patients are concerned.According to the progress of the side convex angle and the change of appearance,when the effect of conservative treatment is not good,we use surgical treatment.the orthopedic operation of scoliosis has the name of " Mount Qomolangma ",the shape of vertebral body is changeable,the individual difference is great,the operation is difficult,and the experience of surgeons is highly dependent.and the pedicle screw rod internal fixation system is widely used in the treatment of this disease,combined with multi-level osteotomy technology,AIS posterior three-dimensional orthopedic surgery has achieved good clinical results.It is the key step of orthopedic operation to insert pedicle screw accurately and safely.In order to improve the accuracy of screws and the safety of operation,a variety of intelligent and precise auxiliary equipment for operation are applied,including spine robot system and o-arm navigation system,printing template,neuroelectrophysiological monitoring and so on.The purpose of mazor spine robot is to improve the accuracy of pedicle screw insertion,shorten the operation time,reduce the radiation dose,and improve the safety of operation.Objective:To evaluate the accuracy and clinical safety of mazor spinal robot technique in the pedicle screw placement of adolescent idiopathic scoliosis,and to compare it with the technique of manual screw placement.Methods:A retrospective analysis of 59 cases of adolescent scoliosis admitted to the spinal surgery department of Henan people's Hospital from September 2017 to October 2019.Among them,28 cases of mazor robot assisted nail placement(robot group)and 31 cases of free hand nail placement(free hand group),The time of operation,the average time of single screw insertion,the times of intraoperative fluoroscopy and the amount of intraoperative hemorrhage were recorded.All patients were reexamined with CT after drainage tube was removed,and the accuracy of pedicle screw placement was evaluated according to Rampersaud A D classification.At the same time,the operation related complications of the two groups were recorded,and the data of the two groups were compared and analyzed to evaluate the accuracy and safety of the two methods of pedicle screws placement.Results:1.In this study,59 patients,15 males and 44 females,with an average age of(15.2 ± 2.8)years,were enrolled,in the robot group,588 screws were implanted,in the free hand group,31 screws were implanted,625 screws were implanted,the accuracy of "excellent"(Class A)screws was 90.88%,73.46%,and the accuracy of "clinically acceptable"(Class A + class B)screws was 95.23%,85.12%,respectively.In the comparison of "excellent" and "clinically acceptable" screw placement accuracy,the difference between the robot group and the bare hand group was statistically significant(P < 0.05),the accuracy of screw placement in the group with serious screw misplacement(Class C + class D)was 28(4.77%)and 83(13.28%),respectively.The difference between the two groups was statistically significant(P < 0.05).2.The operation time of robot group was(323.84 ± 31.90)min and free hand group was(324.74 ± 32.06)min,there was no significant difference between the two groups(P>0.05),in robot group,average insertion time of single screw(3.67±0.92)min),Times of perspective(14.92±2.1),Intraoperative blood loss(400.28±50.78)ml,and in free hand group,they are(6.87±1.42)min?(17.88±2.5)min?(486.62±47.21)min,there was significant difference between the two groups(P<0.05),The incidence of adverse reactions in the robot group(3.57%)was lower than that in the freehand group(41.93%).The difference between the two groups was statistically significant(P < 0.05).In the robot group,14 screws(2.38%)were repaired,which was lower than 32 screws(5.12%)in the freehand group.The difference between the two groups was statistically significant(P < 0.05).Conclusion:1.Mazor robot technology in adolescent idiopathic scoliosis has high accuracy of pedicle screw placement and less complications related to surgery.2.Mazor robot technology can reduce the average insertion time of single screw,reduce the radiation amount,and reduce the amount of bleeding,but it does not show an advantage in the operation time.