目的:机器人在脊柱手术中的作用仍然存在争议,尤其是脊柱侧弯矫正手术。本研究旨在通过将机器人辅助(RA)手术与导航系统(NS)和常规徒手技术(CF)进行比较,来评估其安全性和有效性。
方法:根据系统评价和荟萃分析(PRISMA)指南的首选报告项目,通过对以下数据库的电子搜索进行了系统评价和荟萃分析:MEDLINE,EMBASE,和Cochrane中央控制试验登记册(CENTRAL)。包括所有将RA与NS或CF比较的脊柱侧凸后路脊柱融合术的论文。基于异质性分析,采用固定效应和随机效应分析模型。
结果:共纳入10项观察性研究。RA与NS(OR=2.02,CI=1.52-2.67,p<0.00001)和CF(OR=3.06,CI=1.79-5.23,p<0.00001)相比,椎弓根螺钉准确放置的几率明显更高。RA的缺点是相对于NS(MD=10.74,CI=3.52-17.97,p=0.004)和CF(MD=40.27,CI=20.90,p<0.0001),手术持续时间明显更长。围手术期结果包括估计的失血量,辐射暴露,住院时间,cobb角校正率,术后SRS评分,VAS疼痛评分,JOA得分,以及神经损伤和翻修手术的发生率,组间比较(p>0.05)。
结论:与NS和CF相比,RA提供了更高的椎弓根螺钉放置精度,然而,手术可能需要更长时间。就围手术期结果而言,这三种技术都具有可比性。
OBJECTIVE: The role of robotics in spine surgery remains controversial, especially for scoliosis correction surgery. This study aims to assess the safety and efficacy of robotic-assisted (RA) surgery specifically for scoliosis surgery by comparing RA to both
navigation systems (NS) and conventional freehand techniques (CF).
METHODS: As per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic
review and meta-analysis were conducted via an electronic search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). All papers comparing RA to either NS or CF for posterior spinal fusion in scoliosis were included. Fixed and random effects models of analysis were utilised based on analysis heterogeneity.
RESULTS: 10 observational studies were included in total. RA had significantly greater odds of accurate pedicle screw placement relative to both NS (OR = 2.02, CI = 1.52-2.67, p < 0.00001) and CF (OR = 3.06, CI = 1.79-5.23, p < 0.00001). The downside of RA was the significantly greater operation duration relative to NS (MD = 10.74, CI = 3.52-17.97, p = 0.004) and CF (MD = 40.27, CI = 20.90, p < 0.0001). Perioperative outcomes including estimated blood loss, radiation exposure, length of hospital stay, cobb angle correction rate, postoperative SRS score, VAS pain score, JOA score, as well as rates of neurological injury and revision surgery, were comparable between the groups (p > 0.05).
CONCLUSIONS: RA offers significantly greater pedicle screw placement accuracy relative to NS and CF, however, surgery can take longer. In terms of perioperative outcomes, all three techniques are comparable.