| Objective Through the non-shield orthopedic surgical robot-assisted assisted percutaneous minimally invasive pedicle screw fixation in patients with doublesegment thoracolumbar vertebral fractures,and compared with free-hand operation,the efficacy of orthopedic surgical robot-assisted percutaneous minimally invasive pedicle screw fixation was analyzed and compared,and the accuracy and safety of robotassisted screw placement were evaluated.Methods The clinical data of patients with double-segment thoracolumbar fractures undergoing percutaneous minimally invasive pedicle screw fixation in our hospital from January 2019 to December 2020 were retrospectively analyzed.Twenty-four patients undergoing percutaneous minimally invasive pedicle screw fixation were selected and divided into two groups according to different surgical methods,namely,robot-assisted surgery(referred to as the robot group)and the manual operation under traditional fluoroscopy(referred to as the free-hand group),of which 12 were in the robot group and the free-hand group.There were 8 males and 4 females in the robot group,with an age range of 35-74 years,and an average age of 52.3±11.7 years.Vertebral fractures were classified according to AO classification: 7 cases were A1 type,9 cases were A2 type,and 8 cases were A3 type.The cause of injury in the robot group:traffic accident injury in 6 cases,fall injury in 3 cases,and fall injury in 3 cases.There were 7 males and 5 females in the freehand group,with an age range of 36-69 years,and an average age of 51.4±9.6 years.According to AO classification,8 cases of vertebral fractures were A1 type,6 cases were A2 type,and 10 cases were A3 type.Causes of injury in the free-hand group: 5 cases of traffic accidents,4 cases of falling from heights,and 3 cases of falls.All patients in the robotic group underwent percutaneous minimally invasive pedicle screw internal fixation with the help of orthopedic surgical robots,while in the free-hand group,physicians performed percutaneous minimally invasive pedicle screw internal fixation with bare hands.The operation conditions and postoperative recovery of the robotic group and the manual group were recorded,and the operation conditions of the two groups of patients were compared by intraoperative evaluation indicators(operation time,fluoroscopy times,fluoroscopy time,intraoperative blood loss,and intraoperative guide needle adjustment times),the robot group needs to record the path planning time during the intraoperative process.Postoperative CT was performed to evaluate the accuracy of screw placement in both groups.Visual analogue scale(VAS),sagittal cobb angle,and percentage of anterior vertebral height of the injured vertebra were used to analyze and compare the postoperative recovery of the two groups of patients.The preoperative records were recorded respectively 3d after operation and at the last follow-up.Results In general,there was no statistically significant difference in gender,age,body mass index(BMI),cause of injury,time from injury to surgery,fracture segment and AO classification of fracture between the robot group and the unarmed group(P >0.05).There was no statistically significant difference in preoperative VAS score,cobb angle of sagittal plane and percentage of anterior vertebral height between the robot group and the free-hand group(P > 0.05).The baseline data of the two groups were consistent and could be compared and analyzed.Compared with the manual group,the robotic group had shorter operation time(129.2±10.5 vs.153.8±18.1 min),fewer fluoroscopy times(8.5±2.1 vs.39.8±5.1 times),and shorter fluoroscopy time(9.8±1.9vs.43.9±4.8s),fewer guide needle adjustments(2.3±1.4 vs.18.6±2.6 times),and less intraoperative blood loss(65.3±9.8 vs.96.8±10.9m L),with significant differences between groups Significance(P <0.05).The path planning time of the robot group was35.0±4.3 min.Postoperative CT scans were used to evaluate the accuracy of screws with reference to the NEO method.A total of 128 screws were implanted in 12 patients in the robot group,92 screws were located in the middle line of the pedicle without deviation(level 0),and 36 screws were deviated from the middle line of the pedicle with different degrees of deviation(level I 28,level II 8)In the free-hand group,126 screws were implanted in 12 patients,69 screws were located in the middle of the pedicle,and there was no deviation(level 0).57 screws were deviated from the middle of the pedicle,and there were different degrees of deviation(level I 38,level II 19).In the acceptable number of screws,there were 120 screws in the robot group and 107 screws in the free-hand group.The robot group was more accurate than the free-hand group(93.75 % vs.84.92 %),and the difference between the two groups was statistically significant(P < 0.05).The screws in both groups did not enter the spinal canal and penetrate the cortical bone,and there was no nerve injury after operation.During the follow-up period,no screw loosening occurred in the robot group and the free-hand group,and no secondary operation was performed in all patients.In the comparison between groups,the VAS score,cobb angle in sagittal position and the percentage of anterior vertebral height of the injured vertebra in the robot group were similar to those in the free-hand group before operation,3 d after operation and at the last follow-up,and the difference between groups was not statistically significant(P >0.05).In the intra-group comparison,the VAS score,sagittal cobb angle and the percentage of anterior vertebral height of the injured vertebra in the robot group and the free-hand group were significantly different at the three time points before operation,3d after operation and the last follow-up(P < 0.05).However,the VAS score and sagittal cobb angle of the two groups at 3 d and the last follow-up were significantly lower than those before operation.The percentage of anterior vertebral height of the injured vertebra at 3 d and the last follow-up was significantly higher than that before operation,and the difference was statistically significant(P < 0.05).Conclusion Robot-assisted percutaneous pedicle fixation can achieve satisfactory clinical results in the treatment of double-segment thoracolumbar fractures.Compared with traditional manual surgery,the postoperative efficacy of robot-assisted surgery is the same in the two groups,but the precision of robot-assisted screw placement is higher,less intraoperative blood loss,lower radiation exposure,and shorter operation time,which can meet the needs of clinical treatment. |
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