| 陈豪杰,张嘉男,郝定均,等.脊柱机器人置钉错误的多因素分析.骨科,2020,11(6): 523-528. |
| 脊柱机器人置钉错误的多因素分析 |
| Multi-factor analysis of robot assisted pedicle screw dislocation |
| 投稿时间：2020-05-30 |
| DOI：10.3969/j.issn.1674-8573.2020.06.011 |
| 中文关键词: 脊柱机器人 椎弓根螺钉 骨质疏松 肥胖 危险因素 |
| 英文关键词: Spinal robot Pedicle screw Osteoporosis Obesity Risk factors |
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| 中文摘要: |
| 目的 探讨Renaissance机器人系统辅助椎弓根螺钉置入错误的危险因素。方法 回顾性分析2017年6月至2019年12月在西安交通大学医学院附属红会医院脊柱病医院使用Renaissance机器人系统辅助椎弓根螺钉置入的162例（1 023枚螺钉）的临床资料。根据术后CT平扫结果对螺钉进行Gertzbein Robbins评级，被评估为A级和B级的螺钉纳入满意组，被评估为C级、D级、E级、术中调整螺钉及非技术原因导致的无法注册的螺钉纳入不满意组。计算置钉成功率和准确率。将年龄、性别、身体质量指数（body mass index, BMI）、骨密度以及疾病类型、椎体旋转程度和螺钉置入类型（经皮植入或开放植入）进行单因素分析筛选危险因素，再采用多因素Logistic回归分析确定机器人置钉错误的独立危险因素。结果 有37枚螺钉注册失败，术后共评估986枚螺钉；满意组897枚，不满意组126枚，置钉成功率为87.67%（897/1 023），置钉准确率为90.97%（897/986）。经二元Logistic回归分析，机器人辅助置钉错误的独立危险因素为肥胖、骨质疏松、椎体重度旋转和先天性脊柱侧凸。结论 肥胖、骨质疏松、椎体重度旋转和先天性脊柱侧凸是导致机器人辅助置钉错误的危险因素；建议避免病例存在单个或多个危险因素，以确保手术的安全性。 |
| 英文摘要: |
| Objective To investigate the risk factors of incorrect pedicle screw placement assisted by Renaissance robot system. Methods The clinical data of 162 patients (1 023 screws) undergoing Renaissance robot system assisted pedicle screw placement in the Spine Disease Hospital of Honghui Hospital Affiliated to Medicine College of Xi'an Jiaotong University from June 2017 to December 2019 were retrospectively analyzed. According to postoperative CT plain scan, the Gertzbein Robbins scores of screws were evaluated. The grade A and B grade screws were included in the satisfactory group. The screws of grade C, D and E, the adjusted screws during operation and unregistered screws due to non-technical reasons were included in the unsatisfactory group. The success rate and accuracy rate were calculated. Age, gender, body mass index (BMI) and bone mineral density (BMD), disease type, vertebral rotation degree and screw placement type (percutaneous or open implantation) were analyzed by univariate analysis to screen the risk factors, and then multivariate logistic regression analysis was used to determine the main independent risk factors of robot screw placement errors. Results Total of 37 screws failed to register and 986 screws were evaluated postoperatively; 897 screws were satisfactory and 126 screws were dissatisfied. The success rate of screw placement was 87.67% (897/1 023) and the accuracy rate of screw placement was 90.97% (897/986). By binary Logistic regression analysis, the independent risk factors of robot assisted screw placement errors were obesity, osteoporosis, severe vertebral rotation and congenital scoliosis. Conclusion Obesity, osteoporosis, severe rotation of vertebral body and congenital scoliosis are the risk factors of robot assisted screw placement errors. It is suggested to avoid single risk factors or multiple risk factors in cases, so as to ensure the safety of surgery and help to enhance the confidence of surgical doctors. |
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