| Research background and purpose:To analyze the clinical efficacy of thoracolumbar injury classification and severity score(TLICS)4 points in thoracolumbar fracture has been treated by Tianji orthopaedic robot assisted the pedicle screw internal fixation,and the clinical effects of different treatments are discussed for thoracolumbar fracture patients with TLICS=4.Materials and Methods:Retrospective analysis was performed on 103 patients with TLICS=4 thoracolumbar fracture who were hospitalized in the Department of Orthopedics of Sichuan Academy of Medical Sciences and Sichuan People’s Hospital from November 2017 to December 2022.According to preoperative doctor-patient communication,44 patients were treated with robot-assisted pedicle screw internal fixation(robot group).Thirty patients were treated with conservative therapy(conservative group),and 29 patients were finally treated with traditional freehand pedicle screw internal fixation(freehand group).Patients in the three groups were followed up by telephone and outpatient service at three months,six months and the last follow-up time.The basic information and related complications at admission were compared among the three groups.The Visual Analogue Scale(VAS)score at admission,at discharge,at 3,at 6 months after discharge and the last follow-up was compared among the three groups.And Oswestry Disability Index(ODI)scores at admission,discharge and at 3,6 months and the last follow-up were compared.And the Compression Ratio(CR)of the three groups at admission,at discharge and the last followup.Finally,the operative time,intraoperative bleeding,fluoroscopy dose,fluoroscopy frequency and fluoroscopy time between the two groups were analyzed.The CT plain scan plus three-dimensional reconstruction was performed after surgery,and the accuracy of the internal fixation of pedicle screws in the two groups was analyzed according to Gertzbein-Robbins criteria.Result:A total of 103 patients with thoracolumbar fracture were included in this study.There were no statistically significant differences among the three groups in basic information,such as age,gender,body mass index and the injury segments of vertebrae,VAS,ODI and CR scores at admission(P>0.05).Among the three groups,the length of hospital stay in the robot group and the conservative group was significantly shorter than that in the freehand group(P<0.05).The bed time of the robot group was significantly lower than that of the conservative group and the freehand group(P<0.05),and the freehanded group was lower than the conservative group(P<0.05).The VAS score of the three groups at discharge was lower in the robot group than in the freehand group and conservative group,and the freehand group was also lower than the conservative group,and the difference was statistically significant(P<0.05).At 3 months after discharge,the VAS score of the robot group and the freehand group was lower than the conservative group(P<0.05).However,there was no significant difference in VAS scores at 6 months after discharge and at the last follow-up(P>0.05).At 3 months after discharge,ODI scores were lower in the robot group than in the freehand group and conservative group(P<0.05).What’s more,the freehand group was also lower than the conservative group,and the difference was statistically significant(P<0.05).There was no significant difference between the three groups at 6 months after discharge and the last follow-up(P>0.05).CR at discharge and the last follow-up was lower in the robot group and the freehand group than in the conservative group,and the difference was statistically significant(P<0.05).And there was no significant difference in complications among the three groups(P>0.05).Finally,the operating time,intraoperative bleeding,fluoroscopy dose,fluoroscopy frequency and fluoroscopy time between the two groups of surgical treatment were compared,and the robot group was significantly lower than the freehand group(P<0.05).In addition,there are 264 screws: grade A 258 screws;grade B 4 screws and grade C 2 screws in the robot group,with an accuracy of 99.24%.There were 174 screws:grade A 159 screws;grade B 6 screws;grade C 8 screws and grade D 1 screw in the freehand group,and the accuracy rate was 94.83%.The robot group was significantly higher than the freehand group(P<0.05).Conclusion:All three treatment methods are optional for patients with TILICS=4 thoracolumbar fracture.However,with the help of Tianji Orthopaedics robot,the early clinical effect of robot-assisted surgical treatment is better than that of conservative treatment and freehand treatment,and robot-assisted treatment has the advantages of high screw placement accuracy and less trauma.In addition,the fluoroscopy exposure of medical staff and patients in the process of pedicle screw internal fixation is low,which reflects the concept of early rehabilitation.However,for patients with thoracolumbar fracture with TILICS=4,the appropriate treatment should be selected according to the patient’s specific situation. |
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