Analysis of therapeutic effect of robot-assisted percutaneous screw in the treatment of thoracolumbar fractur_West China Medical Journal

Authors：

XIE Bin , XU Hongda , DENG Haitao , LI Mingfan , ZHAO Shengxin , ZHANG Lei , WANG Tieheng ,  QING Peidong

Department of Spine Surgery, Mianyang Orthopedic Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

QING Peidong, Email: 1466427665@qq.com

Keywords：

Robot; free hand; thoracolumbar fracture; percutaneous; pedicle screws

DOI：

10.7507/1002-0179.202408051

Video：

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Objective To explore the clinical effect of PSIS-A robot-assisted percutaneous screw in the treatment of thoracolumbar fracture. Methods Patients with thoracolumbar fracture who were hospitalized in Mianyang Orthopedic Hospital between August 2022 and January 2024 and required percutaneous pedicle screw f ixation were selected. Patients were divided into robot group and free hand group by random number table. Operative time, intraoperative bleeding, intraoperative radiation dose and time, implant accuracy rate, small joint invasion rate, Visual Analogue Scale score for pain and other indexes were compared between the two groups. Results A total of 60 patients were included. Among them, there were 28 cases in the robot group and 32 cases in the free hand group. On the third day after surgery, the Visual Analogue Scale score of the robot group was better than that of the free hand group (P=0.003). Except for intraoperative bleeding and radiation frequency (P>0.05), the surgical time, average nail implantation time, and intraoperative radiation dose in the robot group were all lower than those in the free hand group (P<0.05). The accuracy and excellence rate of nail planting in the robot group were higher than those in the free hand group (94.6% vs. 84.9%; χ²=7.806, P=0.005). There was no statistically significant difference in the acceptable accuracy rate (96.4% vs. 91.1%; χ²=3.240, P=0.072) and the incidence of screw facet joint invasion (7.2% vs.14.1%; χ²=3.608, P=0.058) between the two groups. Conclusion The application of PSIS-A type robot assisted percutaneous minimally invasive pedicle screw fixation in the treatment of thoracolumbar fr actures is promising.

Citation： XIE Bin, XU Hongda, DENG Haitao, LI Mingfan, ZHAO Shengxin, ZHANG Lei, WANG Tieheng, QING Peidong. Analysis of therapeutic effect of robot-assisted percutaneous screw in the treatment of thoracolumbar fractur. West China Medical Journal, 2024, 39(10): 1537-1542. doi: 10.7507/1002-0179.202408051 Copy

1.	福嘉欣, 肖联平, 王树森, 等. 经肌间隙入路结合伤椎置钉短节段内固定与传统 AF 钉棒系统治疗胸腰段骨折的效果比较. 中国组织工程研究, 2019, 23(8): 1177-1181.
2.	陈磊, 荆珏华, 钱军, 等. 经皮与开放椎弓根钉棒跨伤椎内固定治疗胸腰椎骨折. 实用骨科杂志, 2018, 24(3): 201-204,247.
3.	Korovessis P, Mpountogianni E, Syrimpeis V. Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. Eur Spine J, 2017, 26(5): 1492-1498.
4.	邹守平, 卢道云, 叶力. 微创经皮伤椎置钉治疗胸腰椎骨折: 6 个月随访脊柱生物力学变化. 中国组织工程研究, 2021, 25(24): 3865-3869.
5.	张双伟, 王朝君, 刘永强, 等. 快速康复外科在 Wiltse 入路行胸腰椎骨折术后内固定取出中的应用效果. 颈腰痛杂志, 2021, 42(5): 676-678.
6.	Schulze M, Gehweiler D, Riesenbeck O, et al. Biomechanical characteristics of pedicle screws in osteoporotic vertebrae-comparing a new cadaver corpectomy model and pure pull-out testing. J Orthop Res, 2017, 35(1): 167-174.
7.	Pourdanesh F, Esmaeelinejad M, Aghdashi F. Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review. Br J Oral Maxillofac Surg, 2017, 55(10): 999-1007.
8.	郭振国, 年利伟, 赵建民, 等. 胸腰椎骨折的治疗进展. 内蒙古医科大学学报, 2019, 41(1): 108-111.
9.	Parker SL, McGirt MJ, Farber SH, et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery, 2011, 68(1): 170-178.
10.	Katonis P, Christoforakis J, Kontakis G, et al. Complications and problems related to pedicle screw fixation of the spine. Clin Orthop Relat Res, 2003(411): 86-94.
11.	Fan Y, Du JP, Liu JJ, et al. Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: an updated meta-analysis. Medicine (Baltimore), 2018, 97(22): e10970.
12.	Zhang RJ, Zhou LP, Zhang HQ, et al. Rates and risk factors of intrapedicular accuracy and cranial facet joint violation among robot-assisted, fluoroscopy-guided percutaneous, and freehand techniques in pedicle screw fixation of thoracolumbar fractures: a comparative cohort study. BMC Surg, 2022, 22(1): 52.
13.	Du SY, Dai J, Zhou ZT, et al. Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate. BMC Surg, 2022, 22(1): 365.
14.	Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
15.	Babu R, Park JG, Mehta AI, et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurg, 2012, 71(5): 962-970.
16.	祝乃强, 侯静怡, 马桂云, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折. 中国矫形外科杂志, 2019, 27(18): 1663-1668.
17.	谭章勇, 汪建良, 许科峰, 等. 短节段钉棒固定联合伤椎置钉治疗胸腰椎骨折的疗效分析. 中国医刊, 2021, 56(8): 881-884.
18.	胡鸣, 毕大鹏, 俞胜宝. 开放与经皮椎弓根螺钉内固定治疗单纯胸腰椎椎体骨折的对比研究. 实用骨科杂志, 2022, 28(5): 412-415, 435.
19.	Court C, Vincent C. Percutaneous fixation of thoracolumbar fractures: current concepts. Orthop Traumatol Surg Res, 2012, 98(8): 900-909.
20.	Charles YP, Ntilikina Y, Collinet A, et al. Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine. Surg Radiol Anat, 2021, 43(6): 843-853.
21.	Du X, Ou YS, Zhu Y, et al. Oblique lateral interbody fusion combined percutaneous pedicle screw fixation in the surgical treatment of single-segment lumbar tuberculosis: a single-center retrospective comparative study. Int J Surg, 2020, 83: 39-46.
22.	吴中桓, 田素魁, 房晓彬, 等. 微创经皮椎弓根螺钉联合伤椎置钉治疗胸腰段椎体骨折的临床疗效观察. 中国骨与关节杂志, 2019, 8(6): 449-453.
23.	Patel RD, Graziano G, Vanderhave KL, et al. Facet violation with the placement of percutaneous pedicle screws. Spine (Phila Pa 1976), 2011, 36(26): E1749-E1752.
24.	赵钇伟. 经皮椎弓根螺钉上位关节突关节侵扰危险因素及临床疗效分析. 济南: 山东大学, 2021.
25.	Hou C, Yang H, Chen Y, et al. Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: a retrospective study. Front Surg, 2023, 9: 1085580.
26.	Fayed I, Tai A, Triano MJ, et al. Lateral versus prone robot-assisted percutaneous pedicle screw placement: a CT-based comparative assessment of accuracy. J Neurosurg Spine, 2022, 37(1): 112-120.
27.	Volk VL, Steele KA, Cinello-Smith M, et al. Pedicle screw placement accuracy in robot-assisted spinal fusion in a multicenter study. Ann Biomed Eng, 2023, 51(11): 2518-2527.
28.	俞阳, 胡豇, 唐六一, 等. 机器人辅助手术治疗胸腰椎骨折. 脊柱外科杂志, 2020, 18(4): 222-226.
29.	Li HM, Zhang RJ, Shen CL. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Spine (Phila Pa 1976), 2020, 45(2): E111-E119.
30.	Fan Y, Du J, Zhang J, et al. Comparison of accuracy of pedicle screw insertion among 4 guided technologies in spine surgery. Med Sci Monit, 2017, 23: 5960-5968.
31.	Du W, Zou Dx, Zhang Jf, et al. Guide wire displacement in robot-assisted spinal pedicle screw implantation. Wideochir Inne Tech Maloinwazyjne, 2021, 16(3): 526-535.

1. 福嘉欣, 肖联平, 王树森, 等. 经肌间隙入路结合伤椎置钉短节段内固定与传统 AF 钉棒系统治疗胸腰段骨折的效果比较. 中国组织工程研究, 2019, 23(8): 1177-1181.
2. 陈磊, 荆珏华, 钱军, 等. 经皮与开放椎弓根钉棒跨伤椎内固定治疗胸腰椎骨折. 实用骨科杂志, 2018, 24(3): 201-204,247.
3. Korovessis P, Mpountogianni E, Syrimpeis V. Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. Eur Spine J, 2017, 26(5): 1492-1498.
4. 邹守平, 卢道云, 叶力. 微创经皮伤椎置钉治疗胸腰椎骨折: 6 个月随访脊柱生物力学变化. 中国组织工程研究, 2021, 25(24): 3865-3869.
5. 张双伟, 王朝君, 刘永强, 等. 快速康复外科在 Wiltse 入路行胸腰椎骨折术后内固定取出中的应用效果. 颈腰痛杂志, 2021, 42(5): 676-678.
6. Schulze M, Gehweiler D, Riesenbeck O, et al. Biomechanical characteristics of pedicle screws in osteoporotic vertebrae-comparing a new cadaver corpectomy model and pure pull-out testing. J Orthop Res, 2017, 35(1): 167-174.
7. Pourdanesh F, Esmaeelinejad M, Aghdashi F. Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review. Br J Oral Maxillofac Surg, 2017, 55(10): 999-1007.
8. 郭振国, 年利伟, 赵建民, 等. 胸腰椎骨折的治疗进展. 内蒙古医科大学学报, 2019, 41(1): 108-111.
9. Parker SL, McGirt MJ, Farber SH, et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery, 2011, 68(1): 170-178.
10. Katonis P, Christoforakis J, Kontakis G, et al. Complications and problems related to pedicle screw fixation of the spine. Clin Orthop Relat Res, 2003(411): 86-94.
11. Fan Y, Du JP, Liu JJ, et al. Accuracy of pedicle screw placement comparing robot-assisted technology and the free-hand with fluoroscopy-guided method in spine surgery: an updated meta-analysis. Medicine (Baltimore), 2018, 97(22): e10970.
12. Zhang RJ, Zhou LP, Zhang HQ, et al. Rates and risk factors of intrapedicular accuracy and cranial facet joint violation among robot-assisted, fluoroscopy-guided percutaneous, and freehand techniques in pedicle screw fixation of thoracolumbar fractures: a comparative cohort study. BMC Surg, 2022, 22(1): 52.
13. Du SY, Dai J, Zhou ZT, et al. Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: possible implications for the screw loosening rate. BMC Surg, 2022, 22(1): 365.
14. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976), 1990, 15(1): 11-14.
15. Babu R, Park JG, Mehta AI, et al. Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurg, 2012, 71(5): 962-970.
16. 祝乃强, 侯静怡, 马桂云, 等. 经皮椎弓根螺钉内固定治疗胸腰椎骨折. 中国矫形外科杂志, 2019, 27(18): 1663-1668.
17. 谭章勇, 汪建良, 许科峰, 等. 短节段钉棒固定联合伤椎置钉治疗胸腰椎骨折的疗效分析. 中国医刊, 2021, 56(8): 881-884.
18. 胡鸣, 毕大鹏, 俞胜宝. 开放与经皮椎弓根螺钉内固定治疗单纯胸腰椎椎体骨折的对比研究. 实用骨科杂志, 2022, 28(5): 412-415, 435.
19. Court C, Vincent C. Percutaneous fixation of thoracolumbar fractures: current concepts. Orthop Traumatol Surg Res, 2012, 98(8): 900-909.
20. Charles YP, Ntilikina Y, Collinet A, et al. Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine. Surg Radiol Anat, 2021, 43(6): 843-853.
21. Du X, Ou YS, Zhu Y, et al. Oblique lateral interbody fusion combined percutaneous pedicle screw fixation in the surgical treatment of single-segment lumbar tuberculosis: a single-center retrospective comparative study. Int J Surg, 2020, 83: 39-46.
22. 吴中桓, 田素魁, 房晓彬, 等. 微创经皮椎弓根螺钉联合伤椎置钉治疗胸腰段椎体骨折的临床疗效观察. 中国骨与关节杂志, 2019, 8(6): 449-453.
23. Patel RD, Graziano G, Vanderhave KL, et al. Facet violation with the placement of percutaneous pedicle screws. Spine (Phila Pa 1976), 2011, 36(26): E1749-E1752.
24. 赵钇伟. 经皮椎弓根螺钉上位关节突关节侵扰危险因素及临床疗效分析. 济南: 山东大学, 2021.
25. Hou C, Yang H, Chen Y, et al. Comparison of robot versus fluoroscopy-assisted pedicle screw instrumentation in adolescent idiopathic scoliosis surgery: a retrospective study. Front Surg, 2023, 9: 1085580.
26. Fayed I, Tai A, Triano MJ, et al. Lateral versus prone robot-assisted percutaneous pedicle screw placement: a CT-based comparative assessment of accuracy. J Neurosurg Spine, 2022, 37(1): 112-120.
27. Volk VL, Steele KA, Cinello-Smith M, et al. Pedicle screw placement accuracy in robot-assisted spinal fusion in a multicenter study. Ann Biomed Eng, 2023, 51(11): 2518-2527.
28. 俞阳, 胡豇, 唐六一, 等. 机器人辅助手术治疗胸腰椎骨折. 脊柱外科杂志, 2020, 18(4): 222-226.
29. Li HM, Zhang RJ, Shen CL. Accuracy of pedicle screw placement and clinical outcomes of robot-assisted technique versus conventional freehand technique in spine surgery from nine randomized controlled trials: a meta-analysis. Spine (Phila Pa 1976), 2020, 45(2): E111-E119.
30. Fan Y, Du J, Zhang J, et al. Comparison of accuracy of pedicle screw insertion among 4 guided technologies in spine surgery. Med Sci Monit, 2017, 23: 5960-5968.
31. Du W, Zou Dx, Zhang Jf, et al. Guide wire displacement in robot-assisted spinal pedicle screw implantation. Wideochir Inne Tech Maloinwazyjne, 2021, 16(3): 526-535.

West China Medical Journal

Analysis of therapeutic effect of robot-assisted percutaneous screw in the treatment of thoracolumbar fractur

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