北京生物医学工程

天玑Ⅱ机器人辅助胸腰椎椎弓根螺钉内固定术的临床应用

Clinical application of 2nd generation TiRobot-assisted thoracolumbar pedicle screw fixation

作者：阎凯张琦刘波何达刘亚军田伟

单位：北京积水潭医院脊柱外科，骨科机器人技术北京市重点实验室（北京 100035） <p>通信作者：田伟。E-mail：tianwei_spine@sina.com</p> <p> </p>

分类号：R318.01

出版年·卷·期（页码）：2022·41·3（297-301）

摘要：

目的分析天玑Ⅱ机器人辅助胸腰椎椎弓根螺钉内固定术的临床效果，为天玑Ⅱ机器人在脊柱外科手术的临床应用提供依据。方法天玑Ⅱ骨科手术机器人优化了主控触屏、机械臂末端和机械臂示踪器。本研究分析2020年12月至2021年5月期间在北京积水潭医院实施天玑Ⅱ机器人辅助胸腰椎椎弓根螺钉内固定术20例患者的病例资料，使用图像融合法测量导针偏差，使用术后影像测量螺钉准确性，同时记录手术时间、术中出血量、术后平均住院时间和并发症情况，评估天玑Ⅱ机器人系统的临床应用效果。结果 20例机器人辅助手术均顺利完成，共置入了92枚椎弓根螺钉。导针的入点偏差为1.44 (0.93, 1.93) mm，止点偏差为1.47 (1.02, 2.22) mm，综合偏差为1.55 (0.96, 1.99) mm。轴位角度偏差为1.90 (1.40, 2.20)°，矢状位角度偏差为1.00 (0.60, 1.20)°。螺钉位置优秀率为90.2%，螺钉位置优良率为100%。手术时间为(206±60)min，术中出血量为200 (113, 200) mL，术后住院时间为5 (4, 6) d，未出现围手术期并发症。结论天玑Ⅱ机器人系统较前一代手术机器人进行了多项升级，有助于更加准确、高效地完成胸腰椎椎弓根螺钉内固定术。

Objective To investigate the clinical outcome of 2nd generation TiRobot-assisted thoracolumbar pedicle screw fixation.，and to provide evidence for the clinical application of 2nd generation TiRobot in spine surgery. Methods The 2nd generation TiRobot optimizes the main control touch screen, the remote end and the tracker of the robotic arm. A total of 20 patients undergone 2nd generation TiRobot-assisted thoracolumbar pedicle screw fixation at Beijing Jishuitan Hospital from December 2020 to May 2021 were analyzed. By measuring the guide-wire deviation (based on image fusion), screw accuracy (based on postoperative image), and perioperative data (operation time, intraoperative blood loss, postoperative hospital stay and complications), the clinical application of the 2nd generation TiRobot system was evaluated. Results All 20 robot-assisted surgeries were completed successfully with a total of 92 pedicle screws inserted. The entry point deviation of the guide-wire was 1.44 (0.93, 1.93) mm, the end point deviation was 1.47 (1.02, 2.22) mm, and the mean deviation for each screw was 1.55 (0.96, 1.99) mm. The axial angular deviation was 1.90 (1.40, 2.20)°, and the sagittal angular deviation was 1.00 (0.60, 1.20)°. The perfect rate of screw position was 90.2%, and the clinically acceptable rate was 100%. The operation time was 206±60 minutes, the intraoperative blood loss was 200 (113, 200) mL, and the postoperative hospital stay was 5 (4, 6) days. There were no perioperative complications. Conclusions The 2nd generation TiRobot system, undergone numerous upgrades compared with its previous generation, helps to complete the thoracolumbar pedicle screw internal fixation more accurately and efficiently.

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