背景:作为机器人辅助(RA)手术中的新兴技术,目前的证据缺乏对其应用于经椎间孔腰椎椎间融合术(TLIF)的潜在益处的充分支持.
目的:我们旨在研究RATLIF在治疗腰椎退行性疾病方面是否优于FGTLIF。
方法:我们通过搜索PubMed,系统回顾了截至2022年7月比较RA与FGTLIF治疗腰椎退行性疾病的研究,Embase,WebofScience,CINAHL(EBSCO),中国国家知识基础设施(CNKI),万方,VIP,还有Cochrane图书馆,以及已发表评论文章的参考文献。纳入队列研究(CSs)和随机对照试验(RCTs)。评价标准包括经皮椎弓根螺钉置入的准确性,近端小关节侵犯(FJV),辐射暴露,手术持续时间,估计失血量(EBL),和手术翻修。使用Cochrane偏倚风险和ROBINS-I工具评估方法学质量。使用随机效应模型,并采用标准化平均差(SMD)作为效应测量。我们根据手术类型进行了亚组分析,使用的特定机器人系统,和研究设计。两名研究者独立筛选摘要和全文文章,证据的确定性使用等级(建议评估的等级,开发和评估)方法。
结果:我们的搜索发现了539篇文章,其中21人符合定量分析的纳入标准。荟萃分析显示,RA的“临床可接受”准确性比FG高1.03倍(RR:1.0382,95%CI:1.0273-1.0493)。RA的“完美”准确率比FG组高1.12倍(RR:1.1167,95%CI:1.0726-1.1626)。在近端FJV的情况下,我们的结果表明,与FG组相比,RA椎弓根螺钉置入患者的发生率降低了74%(RR:0.2606,95CI:0.2063-0.3293).17个CS和2个RCT报告了持续时间。CSs结果表明RA和FG组之间没有显着差异(SMD:0.1111,95CI:-0.391-0.6131),但RCT结果表明,接受RA-TLIF的患者比FG需要更多的手术时间(SMD:3.7213,95CI:3.0756-4.3669).16个CSs和2个RCT报告了EBL。结果表明,接受RA椎弓根螺钉置入的患者的EBL少于FG组(CSs:SMD:-1.9151,95CI:-3.1265-0.7036,RCTs:SMD:-5.9010,95CI:-8.7238-3.0782)。对于辐射暴露,CSs的结果表明,RA和FG组之间的辐射时间没有显着差异(SMD:-0.5256,95CI:-1.4357-0.3845),但接受RA椎弓根螺钉置入的患者的辐射剂量低于FG组(SMD:-2.2682,95CI:-3.1953-1.3411).四个CSs和一个RCT报告了修订病例数。CSs结果提示RA组与FG组的翻修例数差异无统计学意义(RR:0.4087,95%CI0.1592-1.0495)。我们的发现受到纳入研究的残余异质性的限制,这可能会限制对结果的解释。
结论:在TLIF中,与FG方法相比,RA技术在椎弓根螺钉放置方面显示出更高的精度。这种准确性有助于诸如保护相邻小关节以及减少术中辐射剂量和失血的优点。然而,与RA手术相关的术前准备时间越长,手术时间和放射时间与FG技术相当.目前,FG螺钉的放置仍然是主要的方法,临床外科医生对其应用有更高的熟练程度。因此,将RA纳入TLIF手术可能不是最佳选择.
背景:PROSPEROCRD42023441600.
BACKGROUND: As an emerging technology in robot-assisted (RA) surgery, the potential benefits of its application in transforaminal lumbar interbody fusion (TLIF) lack substantial support from current evidence.
OBJECTIVE: We aimed to investigate whether the RA TLIF is superior to FG TLIF in the treatment of lumbar degenerative disease.
METHODS: We systematically reviewed studies comparing RA versus FG TLIF for lumbar degenerative diseases through July 2022 by searching PubMed, Embase, Web of Science, CINAHL (EBSCO), Chinese National Knowledge Infrastructure (CNKI), WanFang, VIP, and the Cochrane Library, as well as the references of published review articles. Both cohort studies (CSs) and randomized controlled trials (RCTs) were included. Evaluation criteria included the accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL), and surgical revision. Methodological quality was assessed using the Cochrane risk of bias and ROBINS-I Tool. Random-effects models were used, and the standardized mean difference (SMD) was employed as the effect measure. We conducted subgroup analyses based on surgical type, the specific robot system used, and the study design. Two investigators independently screened abstracts and full-text articles, and the certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.
RESULTS: Our search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher \"clinically acceptable\" accuracy than FG (RR: 1.0382, 95% CI: 1.0273-1.0493). And RA had 1.12-folds higher \"perfect\" accuracy than FG group (RR: 1.1167, 95% CI: 1.0726-1.1626). In the case of proximal FJV, our results indicate a 74% reduction in occurrences for patients undergoing RA pedicle screw placement compared to those in the FG group (RR: 0.2606, 95%CI: 0.2063- 0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391-0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756-4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265-0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238-3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357-0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953-1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592-1.0495). Our findings are limited by the residual heterogeneity of the included studies, which may limit the interpretation of the results.
CONCLUSIONS: In TLIF, RA technology exhibits enhanced precision in pedicle screw placement when compared to FG methods. This accuracy contributes to advantages such as the protection of adjacent facet joints and reductions in intraoperative radiation dosage and blood loss. However, the longer preoperative preparation time associated with RA procedures results in comparable surgical duration and radiation time to FG techniques. Presently, FG screw placement remains the predominant approach, with clinical surgeons possessing greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be considered the optimal choice.
BACKGROUND: PROSPERO CRD42023441600.