Comparison of clinical efficacies between cortical bone trajectory screw and pedicle screw fixation techniques under robot-assisted technology in posterior lumbar short-segment decompression and fu-sion
10.3969/j.issn.1004-406X.2023.12.06
- VernacularTitle:腰椎后路短节段减压融合术中应用机器人辅助下皮质骨螺钉与椎弓根螺钉固定的临床疗效比较
- Author:
Jipeng SONG
1
;
Wancheng LIN
;
Siyuan YAO
Author Information
1. 首都医科大学附属北京世纪坛医院脊柱外科 100038北京市
- Keywords:
Robot-assisted cortical bone trajectory screw placement;
Robot-assisted pedicle screw place-ment;
Lumbar spinal stenosis;
Single segment;
Decompression and fusion
- From:
Chinese Journal of Spine and Spinal Cord
2023;33(12):1098-1106
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To compare the clinical efficacy between robot-assisted cortical bone trajectory screw(RCBTS)and robot-assisted pedicle screw(RPS)for patients with lumbar spinal stenosis(LSS)undergoing sin-gle-level decompression and fusion.Methods:In this retrospective cohort study,LSS patients who underwent robot-assisted single-level decompression and fusion in Beijing Shijitan Hospital between June 2020 and June 2022 were reviewed.A total of 99 patients were included and divided into RCBTS group of 41 patients and RPS group of 58 patients.There were 59 males and 40 females,with an average age of 67.07±4.65 years old.The incision length,operative time,intraoperative blood loss,24h postoperative drainage,and postopera-tive hospital stay were compared between groups.The Japanese Orthopaedic Association(JOA)score and visual analogue scale(VAS)of low back pain were compared at 3d,3 months and 6 months after operation,and the fixed effects of JOA score and VAS score changes were tested.The screw positions were graded according to the Gertzbein-Robbins method.The accuracy of screw placement of the two surgical methods was evaluated by reviewing the postoperative imaging data.The perioperative and postoperative 3 months of complications were compared between the two groups.Results:There were no significant differences in baseline data be-tween the two groups(P＜0.05).Comparing with the RPS group,the RCBTS group was shorter in operative time(134.39±22.23min vs 152.93±19.10min,P＜0.001),smaller in incision length(64.93±3.71mm vs 78.84±3.82mm,P＜0.001),less in intraoperative blood loss(155.61±37.15mL vs 172.41±43.22mL,P=0.001)and postoperative drainage within 24h(83.66±21.54mL vs 101.21±29.80mL,P=0.002),and shorter in postoperative hospital stay(4.90±1.26d vs 6.26±1.66d,P＜0.001),with statistical significance.There was no significant difference in JOA score and VAS score changes between the two groups at each time point(P＞0.05).The fixed effect test showed that time was a fixed effect of JOA and VAS score changes(P＜0.001).The RCBTS group was no sig-nificantly different from the RPS group in the accuracy of screw placement(grade A:152/164 vs 211/232,P=0.538;grade B:9/164 vs 15/232,P=0.688;grade C:3/164 vs 6/232,P=0.619),the rate of clinically accept-able screw placement(161/164 vs 226/232,P=0.619),the rate of bad screw placement(3/164 vs 6/232,P=0.619),and the incidence of postoperative complications(only 1 patient in the RCBTS group developed delayed wound healing)(P＞0.05).Conclusions:Compared with RPS,RCBTS has significant advantages in operative time,incision length,intraoperative blood loss,volume of postoperative drainage,and postoperative hospital stay.However,there is no significant difference between the two groups in terms of postoperative functional recovery and alleviation in low back pain.
