Objective:

To compare the safety and accuracy of manual and robot-assisted cortical bone trajectory (CBT) screws fixation in the treatment of lumbar degenerative diseases with osteoporosis.

Methods:

The clinical data of 58 cases of lumbar degenerative disease with osteoporosis treated by CBT screw fixation between February 2017 and February 2019 were analyzed retrospectively. Among them, 29 cases were fixed with CBT screws assisted by robot (group A), 29 cases were fixed with CBT screws by hand (group B). There was no significant difference between the two groups in terms of gender, age, body mass index, lesion type, T-value of bone mineral density, and operative segment ( P>0.05), with comparability. The accuracy of implant was evaluated by Kaito’s grading method, and the invasion of CBT screw to the superior articular process was evaluated by Babu’s method.

Results:

The operation time and intraoperative blood loss in group A were significantly less than those in group B ( t=-8.921, P=0.000; t=-14.101, P=0.000). One hundred and sixteen CBT screws were implanted in the two groups. At 3 days after operation, according to the Kaito’s grading method, the accuracy of implant in group A was 108 screws of grade 0, 6 of grade 1, and 2 of grade 2; and in group B was 86 screws of grade 0, 12 of grade 1, and 18 of grade 2; the difference was significant ( Z=4.007, P=0.000). There were 114 accepted screws (98.3%) in group A and 98 (84.5%) in group B, the difference was significant ( χ ²=8.309, P=0.009). At 3 days after operation, according to Babu’s method, there were 85 screws in grade 0, 3 in grade 1, and 2 in grade 2 in group A; and in group B, there were 91 screws in grade 0, 16 in grade 1, 5 in grade 2, and 4 in grade 3; the difference was significant ( Z=7.943, P=0.000). No serious injury of spinal cord, nerve, and blood vessel was found in the two groups. One patient in group A had delayed cerebrospinal fluid leakage, and 2 patients in group B had mild anemia. Both groups were followed up 10-14 months (mean, 11.6 months). The neurological symptoms were improved, and no screw loosening or fracture was found during the follow-up.

Conclusion:

Compared with manual implantation of CBT screw, robot-assisted spinal implant has higher accuracy, lower incidence of invasion of superior articular process, and strong holding power of CBT screw, which can be applied to the treatment of lumbar degenerative diseases with osteoporosis.

目的:

对比徒手与机器人辅助皮质骨轨迹（cortical bone trajectory，CBT）螺钉内固定治疗合并骨质疏松症的腰椎退行性疾病的安全性与准确性。.

方法:

回顾分析 2017 年 2 月—2019 年 2 月采用 CBT 螺钉内固定技术治疗的 58 例合并骨质疏松症的腰椎退行性疾病患者临床资料。其中 29 例采用机器人辅助方式植入 CBT 螺钉（A 组），29 例采用徒手植入 CBT 螺钉（B 组）。两组患者性别、年龄、体质量指数、病变类型、骨密度 T 值及手术节段等一般资料比较差异均无统计学意义（ P>0.05），具有可比性。术后采用 Kaito 等的分级方法评价植钉精准度，采用 Babu 等的方法评估 CBT 螺钉对上关节突的侵犯情况。.

结果:

A 组手术时间及术中出血量均明显少于 B 组（ t=−8.921， P=0.000； t=−14.101， P=0.000）。两组患者分别植入 116 枚 CBT 螺钉。术后 3 d 根据 Kaito 等的分级方法评价植钉精准度，A 组 0 级 108 枚、1 级 6 枚、2 级 2 枚，B 组 0 级 86 枚、1 级 12 枚、2 级 18 枚，比较差异有统计学意义（ Z=4.007， P=0.000）；A 组可接受植钉 114 枚（98.3%），B 组 98 枚（84.5%），比较差异有统计学意义（ χ ²=8.309， P=0.009）。术后 3 d 根据 Babu 等的方法评估 CBT 螺钉对上关节突的侵犯情况，A 组 0 级 85 枚、1 级 3 枚、2 级 2 枚，B 组 0 级 91 枚、1 级 16 枚、2 级 5 枚、3 级 4 枚，比较差异有统计学意义（ Z=7.943， P=0.000）。两组患者均未出现因植钉失误造成的严重脊髓、神经及血管损伤。A 组 1 例出现迟发性脑脊液漏，B 组术后第 1 天复查血常规发现有 2 例患者出现轻度贫血。两组患者均获随访，随访时间 10～14 个月，平均 11.6 个月。术后神经症状均改善良好，随访期间未见螺钉松动、断裂发生。.

结论:

与徒手植入 CBT 螺钉相比，机器人辅助植钉精准度更高，对侵犯上关节突的发生率更低，且 CBT 螺钉把持力强，可应用于合并骨质疏松症的腰椎退变性疾病治疗。.