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Abstract：
Eighty consecutive complex spinal robotic cases utilizing intraoperative 3D CT imaging (E3D, Group 2) were compared to 80 age-matched controls using the Excelsius robot alone with C-arm Fluoroscopic registration (Robot Only, Group 1). The demographics between the two groups were similar-severity of deformity, ASA Score for general anesthesia, patient age, gender, number of spinal levels instrumented, number of patients with prior spinal surgery, and amount of neurologic compression. The intraoperative CT scanning added several objective factors improving patient safety. There were significantly fewer complications in the E3D group with only 3 of 80 (4%) patients requiring a return to the operating room compared to 11 of 80 (14%) patients in the Robot Only Group requiring repeat surgery for implant related problems (Chi squared analysis = 5.00, p = 0.025). There was a significant reduction the amount of fluoroscopy time in the E3D Group (36 s, range 4-102 s) compared to Robot only group (51 s, range 15-160 s) (p = 0.0001). There was also shorter mean operative time in the E3D group (257 ± 59.5 min) compared to the robot only group (306 ± 73.8 min) due to much faster registration time (45 s). A longer registration time was required in the Robot only group to register each vertebral level with AP and Lateral fluoroscopy shots. The estimated blood loss was also significantly lower in Group 2 (mean 345 ± 225 ml) vs Group 1 (474 ± 397 ml) (p = 0.012). The mean hospital length of stay was also significantly shorter for Group 2 (3.77 ± 1.86 days) compared to Group 1 (5.16 ± 3.40) (p = 0.022). There was no significant difference in the number of interbody implants nor corrective osteotomies in both groups-Robot only 52 cases vs. 42 cases in E3D group.Level of evidence: IV, Retrospective review.
摘要：
利用术中3DCT成像（E3D，第2组）与使用Excelsius机器人单独进行C臂透视配准（仅机器人，组1)。两组之间的人口统计学特征相似-畸形严重程度，全身麻醉的ASA评分，患者年龄,性别,脊柱水平的数量，先前进行过脊柱手术的患者数量，和神经压迫的程度。术中CT扫描增加了几个提高患者安全性的客观因素。E3D组的并发症明显较少，80例患者中只有3例（4％）需要返回手术室，而仅机器人组的80例患者中有11例（14％）需要重复手术治疗植入物相关问题（卡方分析=5.00，p=0.025）。E3D组的透视时间显着减少（36s，范围4-102s)与仅机器人组(51s，范围15-160秒)(p=0.0001)。与仅机器人组（306±73.8分钟）相比，E3D组的平均手术时间（257±59.5分钟）也更短，因为注册时间（45s）更快。仅在Robot组中需要更长的注册时间，才能将每个椎骨水平与AP和横向透视拍摄进行注册。第2组（平均345±225ml）的估计失血量也显着低于第1组（474±397ml）（p=0.012）。与第1组（5.16±3.40）相比，第2组（3.77±1.86天）的平均住院时间也显着缩短（p=0.022）。两组的椎间植入物数量和矫正截骨术均无显着差异-机器人仅52例与E3D组42例。证据等级:IV,回顾性审查。
