机器人辅助穿刺PVP治疗胸腰段骨质疏松性椎体压缩性骨折的疗效分析

Efficacy analysis of robot-assisted puncture PVP for thoracolumbar osteoporotic vertebral compression fractures

关键词:  压缩性骨折  机器人辅助穿刺  经皮椎体成形术  椎体骨质疏松性压缩骨折  筋膜水肿

Key words:  compression fracture  robot-assisted puncture  percutaneous vertebroplasty  osteoporotic vertebral compression fractures  fascial edema

摘要:

目的回顾性分析对比机器人辅助穿刺经皮椎体成形术(percutaneous vertebroplasty, PVP)与传统徒手穿刺PVP治疗胸腰段骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures, OVCF)的临床疗效。 方法选择2023年10月—2024年2月在江苏大学附属宜兴市人民医院接受PVP治疗的60例单节胸腰段OVCF患者，依据不同的手术方式分为“天玑”骨科机器人辅助穿刺PVP组(A组，n=30)、传统徒手穿刺PVP组(B组，n=30)。记录两组患者的一般临床资料、手术资料及影像学资料。根据患者术前及术后48 h的MRI图像评估胸腰筋膜水肿情况。采用视觉模拟评分法(visual analogue scale, VAS)评估术前及术后48 h腰背部疼痛程度，术后VAS评分≥4分认定为术后疼痛。 结果两组患者的年龄、性别、骨折节段、骨密度、术前VAS评分、术前及术后椎体中线高度、术前及术后Cobb角比较，差异均无统计学意义(P＞0.05)；两组患者的手术总时间、穿刺前麻醉时间、穿刺操作时间、穿刺次数、术后VAS评分比较，差异均有统计学意义(P＜0.05)；对两组患者术后资料进行相关性分析显示，两组的术后VAS评分、术后疼痛、胸腰筋膜水肿之间均存在显著正相关(P＜0.05)。 结论机器人辅助穿刺PVP手术能够显著提升穿刺成功率，减少术中穿刺次数，缩短穿刺操作时间，从而降低术后胸腰筋膜水肿的发生率，使术后疼痛的发生率明显减少。

Abstract:

ObjectiveTo retrospectively compare the clinical efficacy of robot-assisted puncture percutaneous vertebroplasty(PVP) and traditional manual puncture PVP in the treatment of thoracolumbar osteoporotic vertebral compression fractures(OVCF). MethodsA total of 60 patients with single segment thoracolumbar OVCF who received PVP treatment in Yixing Peoples Hospital from October 2023 to February 2024 were selected as study subjects. According to different types of surgery, patients were divided into “Tianji” robot-assisted puncture PVP group(Group A, n=30) and traditional manual puncture PVP group(Group B, n=30). The general clinical information, surgery information, and imaging information of two groups were recorded. The thoracolumbar fascial edema was evaluated via MRI images before and 48 h after surgery. Visual analogue scale(VAS) scores in the two groups were recorded for the evaluation of low back pain before and 48 h after surgery. It was considered as postoperative pain once the postoperative VAS score was ≥4. ResultsThere was no significant difference in age, gender, fracture segment, bone mineral density, preoperative VAS score, preoperative and postoperative midline vertebral height, preoperative and postoperative Cobb angles between the two groups(all P>0.05). There were statistically significant differences in total operation time, pre-puncture anesthesia time, puncture operation time, puncture times, and postoperative VAS score between the two groups(all P<0.05). Correlation analysis showed a significant positive correlation among postoperative VAS score, postoperative pain, and thoracolumbar fascial edema in either group(all P＜0.05). ConclusionRobot-assisted puncture PVP can significantly raise the success rate of puncture, reduce the frequency and operation time of intraoperative puncture, thus reduce the incidence of postoperative thoracolumbar fascia edema, and significantly reduce the incidence of postoperative pain.