方法:系统综述和荟萃分析。
背景:脊柱侧凸患者的人体解剖结构的复杂性和椎体结构的变异性对脊柱畸形矫正手术中椎弓根螺钉的放置提出了挑战。通过技术进步,机器人已被引入脊柱手术,以协助椎弓根螺钉的放置。
方法:使用PubMed进行了系统搜索,科克伦,Embase,包括CNKI数据库和比较研究,评估使用机器人辅助或徒手技术在脊柱侧凸患者中放置椎弓根螺钉的准确性和术后疗效。分析评估了螺钉放置的准确性,手术持续时间,术中失血,术后住院时间,和并发症。
结果:包含584名患者的七项研究被纳入荟萃分析,机器人辅助组282例(48.3%),徒手组320例(51.7%)。与徒手放置相比,机器人辅助放置显示出临床可接受的螺钉放置结果明显更好(比值比[OR]:2.61,95%置信区间[CI]:1.75-3.91,P<0.0001)。然而,两组在实现"完美"螺钉放置方面无统计学差异(OR:1.52,95%CI:0.95-2.46,P=0.08).与徒手组相比,机器人辅助组的手术时间更长(平均偏差[MD]:43.64,95%CI:22.25-64.74,P<0.0001),但术后住院时间更短(MD:-1.12,95%CI:-2.15至-0.08,P=0.03)。两组患者总并发症发生率及术中失血量差异无统计学意义。两组手术前后Cobb角比较差异无统计学意义。
结论:在脊柱侧凸手术中,机器人辅助椎弓根螺钉的放置比徒手放置具有更高的准确性和更短的住院时间;尽管机器人方法与更长的手术持续时间相关,相似的并发症发生率和术中失血。
METHODS: A systematic review and meta-analysis.
BACKGROUND: The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement.
METHODS: A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications.
RESULTS: Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75-3.91, P < 0.0001). However, there were no statistically significant differences in achieving \"perfect\" screw placement between the two groups (OR: 1.52, 95% CI: 0.95-2.46, P = 0.08). The robot-assisted group had longer operation durations (mean deviation [MD]: 43.64, 95% CI: 22.25-64.74, P < 0.0001) but shorter postoperative hospital stays (MD: - 1.12, 95% CI: - 2.15 to - 0.08, P = 0.03) than the freehand group. There were no significant differences in overall complication rates or intraoperative blood loss between the two groups. There was no significant difference in Cobb Angle between the two groups before and after operation.
CONCLUSIONS: Robot-assisted pedicle screw placement offers higher accuracy and shorter hospital stay than freehand placement in scoliosis surgery; although the robotics approach is associated with longer operative durations, similar complication rates and intraoperative blood loss.