机器人辅助技术与传统徒手技术在脊柱手术中的比较：一项荟萃分析。

Robot-assisted technique vs conventional freehand technique in spine surgery: A meta-analysis.

机构信息

Department of Spinal Surgery, the 215 Hospital of shaanxi nuclear industry, Xianyang, China.

Department of Spinal Surgery, Affiliated Chenzhou Hospital, The First School of Clinical Medicine, Southern Medical University (The First People's Hospital of Chenzhou), Chenzhou, Hunan, 423000, China.

出版信息

Int J Clin Pract. 2021 May;75(5):e13964. doi: 10.1111/ijcp.13964. Epub 2021 Jan 7.

DOI:10.1111/ijcp.13964

PMID:33370470

Abstract

BACKGROUND

The impact of robot-assisted techniques versus conventional freehand techniques in terms of the accuracy of pedicle screw placement remains conflicting. This meta-analysis was performed to evaluate this relationship.

METHODS

A systematic literature search up to July 2020 was performed and 15 studies were detected with 6041 pedicle screw placements with 2748 of them were using robot-assisted techniques and 3293 were conventional freehand techniques. They reported relationships between robot-assisted techniques and conventional freehand techniques in pedicle screw placement. Odds ratio (OR) or Mean differences (MD) with 95% confidence intervals (CIs) was calculated comparing the robot-assisted techniques to conventional freehand techniques in pedicle screw placement risks using the dichotomous and continuous method with a random or fixed-effect model.

RESULTS

Robot-assisted techniques had a significantly higher screw position grade A in Gertzbein-Robbins classification of the screw placement accuracy (OR, 2.43; 95% CI, 1.66-3.54, P < .001); shorter postoperative stay (MD, -0.67; 95% CI, -1.16 to -0.19, P < .001); lower intraoperative blood loss (MD, -91.64; 95% CI, -152.44 to -30.83, P = .003); fewer intraoperative radiation dose (MD, -23.52; 95% CI, -40.12 to -6.0.93, P = .005); and low proximal facet violations (MD, 0.08; 95% CI, 0.03-0.20, P < .001) compared with conventional freehand techniques. However, no significant difference was found between robot-assisted techniques and conventional freehand techniques in surgical time (OR, 11.71; 95% CI, 03.27-26.70, P = .13); visual analogue scale scores (MD, -0.15; 95% CI, -0.54 to 0.23, P = .44); and Oswestry disability index scores (MD, 0.21; 95% CI, -5.09-5.51, P = .94).

CONCLUSIONS

The extent of the improvement with robot-assisted techniques in screw position grade A in Gertzbein-Robbins classification of the screw placement accuracy, postoperative stay, intraoperative blood loss, intraoperative radiation dose, and proximal facet violations was significantly better than conventional freehand techniques. This relationship forces us to recommend robot-assisted techniques for pedicle screw placement to avoid any possible negative postoperative results.

摘要

背景

机器人辅助技术与传统徒手技术在椎弓根螺钉放置准确性方面的影响仍存在争议。本荟萃分析旨在评估这种关系。

方法

系统检索截至 2020 年 7 月的文献，共发现 15 项研究，共涉及 6041 例椎弓根螺钉置入术，其中 2748 例采用机器人辅助技术，3293 例采用传统徒手技术。他们报告了机器人辅助技术与传统徒手技术在椎弓根螺钉放置风险方面的关系。使用二项和连续方法，采用随机或固定效应模型，比较机器人辅助技术与传统徒手技术在椎弓根螺钉放置风险方面的关系，计算比值比（OR）或均数差值（MD）及其 95%置信区间（CI）。

结果

机器人辅助技术在螺钉放置准确性的 Gertzbein-Robbins 分类中螺钉位置等级 A 显著更高（OR，2.43；95%CI，1.66-3.54，P<.001）；术后住院时间更短（MD，-0.67；95%CI，-1.16 至-0.19，P<.001）；术中出血量更少（MD，-91.64；95%CI，-152.44 至-30.83，P=.003）；术中辐射剂量更低（MD，-23.52；95%CI，-40.12 至-6.09，P=.005）；近端小关节面侵犯更少（MD，0.08；95%CI，0.03-0.20，P<.001），与传统徒手技术相比。然而，在手术时间（OR，11.71；95%CI，03.27-26.70，P=.13）、视觉模拟评分（MD，-0.15；95%CI，-0.54 至 0.23，P=.44）和 Oswestry 残疾指数评分（MD，0.21；95%CI，-5.09-5.51，P=.94）方面，机器人辅助技术与传统徒手技术之间无显著差异。