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目的：探究机器人辅助置入长度更长、直径更大的双螺纹椎弓根螺钉对骨质疏松性腰椎滑脱症患者进行良好固定的可行性。方法：选取2022年8月至2024年6月绵阳市骨科医院收治的80例退行性腰椎滑脱症患者。所有患者均诊断为骨质疏松症，均行后路减压植骨融合、滑脱复位椎弓根螺钉内固定术。80例患者按随机数字表法分为机器人辅助组和骨水泥强化组，每组40例；记录患者手术时间、术中出血量、术中辐射剂量；患者术后常规复查X线片及CT。计算椎弓根螺钉直径与椎弓根宽度(SD/PW)比值；通过Gertzbein-Robbins量表对椎弓根位置进行分级；通过CT影像评估小关节侵犯情况。术前及术后第3日记录疼痛视觉模拟评分(VAS)，术前及术后6个月记录Oswestry功能障碍指数(ODI)以评估功能恢复情况，并采用健康调查简表(SF-36)评估患者生活质量。术后6个月行X线及CT检查观察并发症发生情况。结果：机器人辅助组患者的手术时间短于骨水泥强化组患者，术中辐射剂量低于骨水泥强化组患者(P均<0.001)。机器人辅助组患者的椎弓根螺钉长度长于骨水泥强化组患者，直径及椎弓根螺钉直径与椎弓根宽度(SD/PW)比值均大于骨水泥强化组患者(P均<0.001)。两组患者置钉可接受率差异无统计学意义(χ2=2.513,P=0.113)。机器人辅助组螺钉小关节侵犯率为10.2%(19/186)，低于骨水泥强化组的19.1%(39/204)，两组比较差异有统计学意义(χ2=5.408,P=0.020)。术后第3日机器人辅助组患者VAS评分优于骨水泥强化组(P=0.027)。两组患者术后6个月ODI及SF-36评分均较术前改善(P均<0.001)。无一例患者因椎弓根螺钉松动、退钉、断裂导致固定失效而进行二次翻修手术。结论：骨质疏松性腰椎滑脱症患者使用机器人辅助置入长度更长、直径更大的双螺纹椎弓根螺钉可以获得与骨水泥强化螺钉类似的固定效果，同时手术时间更短、术中辐射剂量更少，并降低后期翻修手术的难度。
Abstract：Objective: To investigate the feasibility of achieving adequate fixation in patients with osteoporotic lumbar spondylolisthesis by using robot-assisted implantation of longer, larger-diameter double-threaded pedicle screws. Methods: A total of 80 patients with degenerative lumbar spondylolisthesis admitted to Mianyang Orthopaedic Hospital from August 2022 to June 2024 were enrolled. All patients were diagnosed with osteoporosis and underwent posterior decompression, instrumented spinal fusion with bone grafting, and reduction of spondylolisthesis using pedicle screw fixation. They were randomly assigned to a robot-assisted group(40 patients) and a cement augmentation group(40 patients). The operation time, intraoperative blood loss, and intraoperative radiation dose were recorded. Postoperative X-rays and CT scans were routinely performed. The ratio of screw diameter to pedicle width(SD/PW) was calculated; the position of the pedicle screws was graded using the Gertzbein-Robbins scale; and facet joint violation was assessed on CT images. The visual analogue scale(VAS) was recorded preoperatively and on postoperative day 3. The Oswestry disability index(ODI) and short form-36(SF-36) survey were assessed preoperatively and at 6 months postoperatively to evaluate functional recovery and quality of life, respectively. Complications were observed through X-ray and CT examinations at 6 months postoperatively. Results: The robot-assisted group had shorter operative time and lower intraoperative radiation dose than the cement augmentation group(both P<0.001). Pedicle screws in the robot-assisted group were longer in length, larger in diameter, and had a higher SD/PW ratio compared to the cement augmentation group(all P<0.001). There was no statistically significant difference in the acceptable rate of screw implantation between the two groups(χ2=2.513, P=0.113). The facet joint violation rate was 10.2%(19/186) in the robot-assisted group, significantly lower than the 19.1%(39/204) in the cement augmentation group(χ2=5.408, P=0.020). On the postoperative day 3, the VAS score in the robot-assisted group was significantly lower than that in the cement augmentation group(P=0.027). Both ODI and SF-36 at 6 months postoperatively were significantly improved compared with those preoperative values in both groups(all P<0.001). No patient required revision surgery due to fixation failure caused by pedicle screw loosening, pullout, or breakage. Conclusions: For patients with osteoporotic lumbar spondylolisthesis, the use of robot-assisted implantation of longer and larger-diameter double-threaded screws can achieve a similar fixation effect to bone cement-augmented screws, with shorter operation time, less radiation exposure, and reduced difficulty in revision surgery.
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基本信息:
中图分类号:R687.3
引用信息:
[1]卿培东,谢彬,胥鸿达,等.机器人辅助双螺纹椎弓根螺钉置入治疗骨质疏松性腰椎滑脱症的疗效分析[J].中华骨与关节外科杂志,2025,18(12):1085-1091.
基金信息:
高端医疗装备推广应用项目（2024TGYY25）