| Objective:To compare the clinical results between percutaneous robot-assisted solid pedicle screw fixation and percutaneous robot-assisted canulated pedicle screw fixation for thoracolumbar fracture.Data and Methods:A retrospective review was conducted to 31 patients with thoracolumbar fracture who underwent percutaneous pedicle screw fixation assisted by Domestic TiRobot system,a multiindication orthopedic surgical robot,between November 2018 and December 2020 at the spine surgery department of our hospital.The patients were divided into percutaneous robotassisted solid pedicle screw fixation group(SPS group,12 cases)and percutaneous robotassisted canulated pedicle screw fixation group(CPS group,19 cases),according to the variety of screws used.Perioperative indexes,such as operation time,intraoperative blood loss and hospitalization cost,were compared between the two groups.All patients underwent computed tomography and three-dimensional reconstruction after surgery.The accuracy of pedicle screw placement was evaluated according to Gertzbein-Robbins classified standards:grade A(screw completely within the pedicle),grade B(pedicle cortical breach<2 mm),grade C(pedicle cortical breach≥2 to<4 mm),grade D(pedicle cortical breach≥4 to<6 mm),or grade E(pedicle cortical breach≥6 mm).The screw placement accuracy was calculated as follows:(the number of grade A)/(the total number of screws)×100%.The relative height of the anterior margin of the fractured vertebra,Cobb angle of fracture segment,Visual Analogue Score(VAS)and Oswestry disability index(ODI)were recorded to evaluate postoperative recovery before surgery,and at 1 week,3 months,6 months postoperatively.To compare and analyze the difference of clinical results between solid screw and canulated screw by percutaneous robot-assisted pedicle screw fixation for thoracolumbar fracture.Results:Thirty-one cases were included in this study(17 males and 14 females),and were divided into percutaneous robot-assisted solid pedicle screw fixation group(SPS group,12 cases)and percutaneous robot-assisted canulated pedicle screw fixation group(CPS group,19 cases).All patients were followed up,mean 15.0±1.9 months(range from 12 to 18 months).No complications,such as vessel or nerve injuries,loosening of fixation,screw breakage were found in either group A or B,until the last followed up.The operative time and blood loss were not statistically comparable between the 2 groups(P>0.05).The hospitalization expenses were significantly less in SPS group than in CPS group(P<0.05).A total of 76 pedicle screws were implanted in SPS group of 12 cases,including 75 grade A screws,and 1 grade B screws,98.68%of the screws were perfectly positioned.A total of 102 pedicle screws were implanted in CPS group of 19 cases,including 100 grade A screws,and 2 grade B screws,98.04%of the screws were perfectly positioned.There were no statistically differences between the two groups in terms of accuracy rate of pedicle screw placement(P>0.05).The relative height of the anterior margin of the fractured vertebra,Cobb angle of fracture segment,VAS and ODI were significantly improved than pre-operation in two groups(P<0.05)at 1 week,1 month,and 12 months after surgery(P<0.05),but There were no significant differences when compare among 2 groups(P>0.05).Conclusion:Compared with percutaneous robot-assisted canulated pedicle screw fixation,using solid screw performed the similarly satisfactory clinical efficacy in thoracolumbar fracture,which remains not only the advantages of little surgical trauma,low blood loss,accurate pedicle screw placement,high restoration effect and fast recovery,but also reduce the cost of hospitalization.So,it has certain clinical promotion value. |
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