文章简介

出版社:Eur Spine J.

作   者:Lonjon N, Chan-Seng E, Costalat V, Bonnafoux B, Vassal M, Boetto J

编   号:10.1007/s00586-015-3758-8

年   份:2015年    点击量:797

文章摘要 全文翻译

Purpose

        While image guidance and neuronavigation have enabled a more accurate placement of pedicle implants, they can inconvenience the surgeon. Robot- assisted placement of pedicle screws appears to overcome these disadvantages. However, recent data concerning the superiority of currently available robots in assisting spinal surgeons are conflicting. The aim of our study was to evaluate the percentage of accurately placed pedicle screws, inserted using a new robotic-guidance system.

目的

        虽然图像引导和神经导航已使椎弓根植入物的位置更精确,但这些技术使得外科医生感到操作不便。机器人辅助下置入椎弓根螺钉技术似乎可以克服这些缺点。然而,目前关于脊柱外科机器人优势的数据相互矛盾,本研究旨在评估使用新型机器人引导系统精确放置和插入椎弓根螺钉的比例。

Method

        20 Patients were operated on successively by the same surgeon using robotic assistance (ROSA TM , Med- tech) (Rosa group 10 patients, n = 40 screws) or by the freehand conventional technique (Freehand group 10 patients, n = 50 screws). Patient characteristics as well as the duration of the operation and of exposure to X rays were recorded.

方法

        由同一名外科医生使用机器人辅助系统(ROSA TM , Med- tech) (Rosa组 10例患者, n = 40枚螺钉)或传统技术(Freehand组 10例患者, n = 50枚螺钉)先后对20例患者进行手术。我们记录了患者特征、手术持续时间和暴露在X射线的持续时间。

Results

        The mean age of patients in each group (RG and FHG) was 63 years. Mean BMI and operating time among the RG and FHG were, respectively, 26 and 27 kg/m2 , and 187 and 119 min. Accurate placement of the implant (score A and B of the Gertzbein Robbins classification) was achieved in 97.3 % of patients in the RG (n = 36) and in 92 % of those in the FHG (n = 50). Four implants in the RG were placed manually following failed robotic assistance.

结果

        每组患者(RG and FHG)的平均年龄为63岁。RG和FHG组的平均体重指数分别为26 kg/m2和 27 kg/m2,手术时间分别为187分钟和119分钟。RG组(n = 36)有97.3 %的患者实现了植入物精确置入,FHG组(n = 50)有92 %的患者实现了植入物精确置入。机器人辅助失败后,RG组的4个内植物改为手动放置。

Conclusion

        We report a higher rate of precision with robotic as compared to the FH technique. Providing assistance by permanently monitoring the patient’s movements, this image-guided tool helps more accurately pinpoint the pedicle entry point and control the trajectory. Limitations of the study include its small sized and non- randomized sample. Nevertheless, these preliminary results are encouraging for the development of new robotic techniques for spinal surgery.

结论

        与FH技术相比,机器人辅助系统具有更高的精度。在持续运动监测帮助下,该影像引导工具有助于更准确地定位椎弓根入口点和控制轨迹。本研究的局限性在于病例较少且非随机抽样。然而,对于脊柱手术中应用这种新机器人技术的发展,这些初步结果令人鼓舞。