摘要
目的应用Meta分析综合评价机器人辅助与徒手置入椎弓根螺钉的准确性和安全性,为临床决策提供参考依据。方法计算机检索中国期刊全文数据库、中国生物医学文献数据库、万方数据库、PubMed、The Cochrane Library数据库中关于机器人辅助与徒手置入椎弓根螺钉治疗胸腰椎疾病的文献资料,徒手置钉包括经皮透视徒手置钉和开放切口徒手置钉,检索时间为2010年1月~2020年12月。使用Cochrane Library提供的RevMan 5.4.1软件进行Meta分析。结果共筛选出12篇随机对照研究,共计纳入患者606例,其中机器人辅助置钉组309例,徒手置钉组297例。共计置入椎弓根螺钉3230枚,其中机器人辅助置钉组1628枚,徒手置钉组1602枚。机器人辅助组置钉精度(A级)优于徒手组[RR=1.10,95%CI(1.04,1.16),P<0.05]、对近端关节面的侵扰例数少于徒手组[RR=0.24,95%CI(0.10,0.60),P<0.05]、术中透视时间[WMD=-5.62,95%CI(-13.06,1.81),P<0.05]少于徒手组,差异有统计学意义(P<0.05)。两者在置钉精度(A+B级)[RR=1.03,95%CI(0.99,1.07),P=0.13]、手术时间[WMD=5.88,95%CI(-7.75,19.51),P=0.40]、术中出血量[WMD=-16.09,95%CI(-48.42,16.24),P=0.33]、并发症例数[RR=0.50,95%CI(0.20,1.26),P=0.14]、住院时间[WMD=-1.04,95%CI(-2.96,0.87),P=0.29]方面差异无统计学意义(P>0.05)。结论两种置钉方式在置钉精度(A+B级)、手术时间、术中出血量、并发症例数、住院时间方面无显著性差异。机器人辅助置钉精度(A级)更高,对近端关节面的侵扰更少,术中透视时间更少,机器人辅助置钉准确性和安全性更高。
Objective To comprehensively evaluate the accuracy and safety of robot-assisted(RA)and free-hand(FH)placement of pedicle screws by Meta analysis,and to provide evidence for clinical procedure.Methods Databases including CNKI,CBM,Wanfang Database,PubMed,The Cochrane Library were searched for studies of RA placement of pedicle screws and FH placement of pedicle screws for the treatment of thoracolumbar diseases.FH included percutaneous fluoroscopic screw placement and open incision screw placement.The studies were searched from January 2010 to December 2020.Meta-analysis was performed using RevMan 5.4.1 software provided by Cochrane Library.Results A total of 12 randomized controlled studies were selected,including 606 patients,including 309 cases in RA and 297 cases in FH.A total of 3230 pedicle screws were placed,including 1628 screws in the RA and 1602 screws in the FH.The pedicle screw insertion accuracy in the RA(grade A)was better than that in the FH[RR=1.10,95%CI(1.04,1.16),P<0.05],and the number of proximal facet violations was less than FH[RR=0.24,95%CI(0.10,0.60),P<0.05],intraoperative radiation time was less than FH[WMD=-5.62,95%CI(-13.06,1.81),P<0.05]with statistically significant difference(P<0.05).There were no significant differences in the accuracy of screw placement(grade A+B)[RR=1.03,95%CI(0.99,1.07),P=0.13],operation time[WMD=5.88,95%CI(-7.75,19.51),P=0.40],intraoperative blood loss[WMD=-16.09,95%CI(-48.42,16.24),P=0.33],incidence of complications[RR=0.50,95%CI(0.20,1.26),P=0.14]and length of hospital stay[WMD=-1.04,95%CI(-2.96,0.87),P=0.29]between the two groups(P>0.05).Conclusion There are no significant differences in the pedicle screw insertion accuracy(grade A+B),operation time,intraoperative blood loss,incidence of complications and length of hospital stay between the two screw placement methods.RA screw placement has higher accuracy(grade A),less proximal facet violations,and higher accuracy and safety.
作者
高松森
周鲁平
曹云
李伟
陶晖
杨庆国
GAO Song-sen;ZHOU Lu-ping;CAO Yun;LI Wei;TAO Hui;YANG Qing-guo(The First Affiliated Hospital ofAnhui Medical University,Hefei,Anhui 230031,China)
出处
《颈腰痛杂志》
2022年第1期1-9,共9页
The Journal of Cervicodynia and Lumbodynia
基金
国家自然科学基金项目(编号:82072492)。
