| Purpose:Minimally invasive percutaneous Laminar articular process screw fixation is reliable,less invasive,costly,and can avoid the dissection of the contralateral paravertebral muscle.It can be used as an important step and means of fusion under the microscope,and has a good application prospect.However,this technique has high technical content and is difficult to operate,especially percutaneous laminar articular process screw placement technology,which often needs to be completed with the help of multiple fluoroscopy.In addition,if the screw placement is not successful at one time,it is difficult to adjust the nail path again,so robot-assisted technology has high research value for the clinical application of the procedure.To explore the anatomical basis of spinal robot-assisted lumbar lamina articular process screw placement,as well as the feasibility,safety and clinical effect of clinical application.Method:Obtained raw CT data from patients who had undergone lumbar spine CT examination from May 2018 to December 2019 but had no lumbar spine organic lesions from the imaging department of Qingdao University Affiliated Hospital,a total of 30 patients,aged 21-65 years old,collected all raw CT data Transfer to Mimics 3D reconstruction software to obtain the final 3D reconstructed stereo image and simulate the placement of laminar articular process screws,and measure the inclination angle of the screw,the inclination of the screw head,the thickness of the lower and upper edges of the lamina and the length of the screw along the entry point;Analysis of patients who underwent minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)at the Department of Spine Surgery,Affiliated Hospital of Qingdao University from May 2018 to May 2019,using decompression lateral pedicle screw fixation Contralateral laminar articular process screws were divided into a control group and an experimental group.Group A applied Mazor robot-assisted percutaneous minimally invasive placement of laminar articular process screws.Group B used conventional X-ray fluoroscopy to guide percutaneous minimally invasive placement of vertebrae.Plate articular process screws,statistics of the number of intraoperative radiations,the time required to insert each plate articular process screw and the number of adjustments of the nail tract,statistics of postoperative and various follow-up stages to assess the quality of life related scale(VAS score,ODI index),record the complications such as dura mater and nerve injury,and determine the accuracy of the screws according to the X-ray and CT.Result:The measurement results show that the screw inclination angle gradually decreases from the L1 / 2 segment to the L5 / S1 segment,from 51.22 ± 0.11 ° to 33.70 ± 0.12 °,and the head tilt angle of the screw changes from the L1 / 2 segment to the L5 / S1 segment The segment gradually decreases,from 49.43 ± 1.21 ° to 37.56 ± 0.23 °,the thickness of the lamina gradually decreases from top to bottom,the lower marginal lamina decreases from 6.81 ± 0.31 mm to 4.63 ± 1.30 mm,the upper margin lamina 6.72 ± 0.11 mm reduced to 4.42 ± 0.78 mm,the screw length gradually increased from L1 / 2 segment to L5 / S1 segment,from 3.89 ± 0.77 mm to 5.45 ± 0.76 mm.There were 24 patients in the robot-assisted nail placement group and 31 in the conventional X-ray fluoroscopy guidance group,with an average age of 47.3 years and an average follow-up time of 12.3 months.From the quality of life-related scale,the two groups of patients had low back pain before surgery Compared with the postoperative results,the VAS score and ODI index were significantly improved(P <0.05).There was no significant difference in the VAS score and ODI index of low back and leg pain between the two groups,and there was no statistical significance(P> 0.05);the excellent screw rate in group A was 92.3%,the screw excellent rate in group B was 82.9%,and the average implantation rate in group A was The time of lamina articular process screw was 11.7 ± 5.1 minutes,the average time of group B implantation of each lamina articular process screw was 22.7 ± 0.8 minutes;the average fluoroscopy number of group A was 7.2 ± 1.2 times,and the average fluoroscopy number of group B was 18.3 ± 3.1 times;the average number of nail path adjustments in group A was 0.7 ± 1.2 times,and the average number of nail path adjustments in group B was 2.5 ± 1.6 times.Conclusion:Robot-assisted percutaneous laminar articular process screw technology is accurate,safe,and reliable.Compared with traditional X-ray assisted placement technology,it can also significantly reduce the X-ray radiation of surgeons and patients,and has good application prospects. |
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