目的:椎弓根螺钉的放置指导在脊柱融合中至关重要,和脊柱手术机器人旨在提高准确性和减少并发症。当前的文献尚未比较可用的机器人系统的相对优点。在这次审查中,作者旨在1)评估脊柱机器人文献的当前状态;2)基于准确性对机器人性能进行荟萃分析,速度,和安全性;3)为机器人系统选择提供建议。
方法:遵循PRISMA指南,作者对PubMed进行了系统的文献综述,Embase,科克伦图书馆,WebofScience,和Scopus截至2022年4月28日,用于研究批准的用于放置腰椎椎弓根螺钉的机器人。三位评审员筛选并提取了与研究特征有关的数据,准确率,术中修正,和再操作。次要性能指标包括手术时间,失血,和辐射暴露。作者使用随机效应模型对机器人的性能进行了统计比较,以说明研究内部和之间的差异。每个机器人还与传统技术的性能基准进行了比较,包括徒手,荧光镜,和CT导航插入。最后,我们进行了Duval和Tweedie修剪和填充检验,以评估是否存在发表偏倚.
结果:作者确定了46项研究,描述了4670名患者和25,054个螺钉,评估了4种不同的机器人系统:MazorX,罗莎,ExcelsiusGPS,和Cirq.Gertzbein-Robbins分类A级或B级螺钉的加权准确率如下:ExcelsiusGPS,98.0%;ROSA,98.0%;Mazor,98.2%;和Cirq,94.2%。没有机器人比其他机器人更准确。然而,ExcelsiusGPS的精度明显高于传统方法,Mazor和ROSA的准确度明显高于透视。术中翻修率为Cirq,0.55%;ROSA,0.91%;马祖,0.98%;和ExcelsiusGPS,1.08%。再次手术率为Cirq,0.28%;ExcelsiusGPS,0.32%;和Mazor,0.76%(ROSA未报告再次手术)。所有机器人的手术时间都相似。ExcelsiusGPS和Mazor的失血量均明显少于ROSA。Cirq的辐射暴露量最低。机器人往往更准确,通常与徒手相比,它们的使用与更少的再次手术和更少的失血有关。荧光镜,或CT导航技术。
结论:基于关键指标,机器人平台的性能相当,准确率高,术中翻修率和再手术率低。脊柱机器人的出版速度将继续加快,选择机器人将取决于实践的背景。
OBJECTIVE: Pedicle screw placement guidance is critical in spinal fusions, and spinal surgery robots aim to improve accuracy and reduce complications. Current literature has yet to compare the relative merits of available robotic systems. In this review, the authors aimed to 1) assess the current state of spinal robotics literature; 2) conduct a meta-analysis of robotic performance based on accuracy, speed, and safety; and 3) offer recommendations for robotic system selection.
METHODS: Following PRISMA guidelines, the authors conducted a systematic literature review across PubMed, Embase, Cochrane Library, Web of Science, and Scopus as of April 28, 2022, for studies on approved robots for placing lumbar pedicle screws. Three reviewers screened and extracted data relating to the study characteristics, accuracy rate, intraoperative revisions, and reoperations. Secondary performance metrics included operative time, blood loss, and radiation exposure. The authors statistically compared the performance of the robots using a random-effects model to account for variation within and between the studies. Each robot was also compared with performance benchmarks of traditional techniques including freehand, fluoroscopic, and CT-navigated insertion. Finally, we performed a Duval and Tweedie trim-and-fill test to assess for the presence of publication bias.
RESULTS: The authors identified 46 studies, describing 4670 patients and 25,054 screws, that evaluated 4 different robotic systems: Mazor X, ROSA, ExcelsiusGPS, and Cirq. The weighted accuracy rates of Gertzbein-Robbins classification grade A or B screws were as follows: ExcelsiusGPS, 98.0%; ROSA, 98.0%; Mazor, 98.2%; and Cirq, 94.2%. No robot was significantly more accurate than the others. However, the accuracy of the ExcelsiusGPS was significantly higher than that of traditional methods, and the accuracies of the Mazor and ROSA were significantly higher than that of fluoroscopy. The intraoperative revision rates were Cirq, 0.55%; ROSA, 0.91%; Mazor, 0.98%; and ExcelsiusGPS, 1.08%. The reoperation rates were Cirq, 0.28%; ExcelsiusGPS, 0.32%; and Mazor, 0.76% (no reoperations were reported for ROSA). Operative times were similar for all robots. Both the ExcelsiusGPS and Mazor were associated with significantly less blood loss than the ROSA. The Cirq had the lowest radiation exposure. Robots tended to be more accurate and generally their use was associated with fewer reoperations and less blood loss than freehand, fluoroscopic, or CT-navigated techniques.
CONCLUSIONS: Robotic platforms perform comparably based on key metrics, with high accuracy rates and low intraoperative revision and reoperation rates. The spinal robotics publication rate will continue to accelerate, and choosing a robot will depend on the context of the practice.