中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (22): 4647-4652.doi: 10.12307/2025.433

• 组织工程骨材料 tissue-engineered bone • 上一篇    下一篇

局部麻醉下机器人辅助经皮椎体后凸成形伤椎注入骨水泥的患者体验分析

李佳鸿，林  书，唐六一，胡  豇，俞  阳，张  伟   

  1. 四川省医学科学院·四川省人民医院(电子科技大学附属医院)骨科，四川省成都市   610072
  • 收稿日期:2024-03-05 接受日期:2024-05-10 出版日期:2025-08-08 发布日期:2024-10-08
  • 通讯作者: 林书，副主任医师，四川省医学科学院·四川省人民医院(电子科技大学附属医院)骨科，四川省成都市 610072
  • 作者简介:李佳鸿，男，1989年生，四川省成都市人，汉族，2017年重庆医科大学毕业，硕士，主治医师，主要从事脊柱退变、脊柱骨折方面的研究。
  • 基金资助:
    四川省科技厅科技支撑项目(2022YFS0018)，项目负责人：唐六一；四川省科技厅科技支撑项目(2022YFS0019)，项目负责人：林书；国家重点研发计划项目(2022YFC2407506)，项目负责人：胡豇

Patient experience of robot-assisted percutaneous kyphoplasty with bone cement injection into injured vertebrae under local anesthesia

Li Jiahong, Lin Shu, Tang Liuyi, Hu Jiang, Yu Yang, Zhang Wei   

  1. Li Jiahong, Lin Shu, Tang Liuyi, Hu Jiang, Yu Yang, Zhang Wei
  • Received:2024-03-05 Accepted:2024-05-10 Online:2025-08-08 Published:2024-10-08
  • Contact: Lin Shu, Associate chief physician, Department of Orthopedics, Sichuan Academy of Medical Sciences · Sichuan Provincial People’s Hospital (Affiliated Hospital, University of Electronic Science and Technology of China), Chengdu 610072, Sichuan Province, China
  • About author:Li Jiahong, Master, Attending physician, Department of Orthopedics, Sichuan Academy of Medical Sciences · Sichuan Provincial People’s Hospital (Affiliated Hospital, University of Electronic Science and Technology of China), Chengdu 610072, Sichuan Province, China
  • Supported by:
    Science and Technology Support Project of Science and Technology Department of Sichuan Province, No. 2022YFS0018 (to TLY); Science and Technology Support Project of Science and Technology Department of Sichuan Province, No. 2022YFS0019 (to LS); National Key Research and Development Program of China, No. 2022YFC2407506 (to HJ)

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摘要：

文题释义：
骨质疏松性椎体压缩性骨折：因骨质疏松导致脊柱椎体的骨量丢失或下降，骨组织微结构发生改变，骨脆性增加，常常因扭伤、摔伤、外力撞伤等因素导致椎体压缩变扁，引起椎体压缩性骨折。  
骨科机器人：一般由主机、光学跟踪系统、导航定位系统、手术规划系统、机械臂等结构组成，能根据主刀医生的手术规划，执行手术医生穿刺定位或内植物置入功能，具有灵敏度高、定位准确等特点。

背景：局部麻醉下传统C臂辅助经皮椎体后凸成形手术需多次透视以调整穿刺方向，工作通道建立时间较长，患者术中疼痛刺激较大；而机器人辅助经皮椎体后凸成形手术可一次性精准穿刺成功，明显改善患者术中体验，同时减少骨水泥渗漏风险。
目的：比较局部麻醉下机器人辅助和传统C臂辅助经皮椎体后凸成形手术的患者体验和其他疗效。
方法：选择四川省医学科学院·四川省人民医院(电子科技大学附属医院)收治的单节段骨质疏松性椎体压缩骨折患者241例，其中132例在局部麻醉下进行机器人辅助经皮椎体后凸成形手术治疗(机器人辅助组)，109例在局部麻醉下进行传统C臂辅助经皮椎体后凸成形手术治疗(传统透视组)，记录患者术中体验评价、骨水泥注射量、手术时间、工作通道建立时间、住院费用及并发症，术后1 d通过影像学评估穿刺偏差与骨水泥渗漏。
结果与结论：①机器人组59例患者术中体验评价为“非常好”，43例为“好”，16例为“一般”，10例为“差”，4例为“非常差”；传统透视组30例患者术中体验评价为“非常好”，44 例为“好”，21例为“一般”，9例为 “差”，5例为“非常差”，两组间术中体验评价比较差异有显著性意义(Z=-2.546，P=0.011)；机器人组患者术中目测类比评分低于传统透视组(t=-9.513，P=0.000)；机器人组、传统透视组愿意在必要时再次接受经皮椎体后凸成形手术的患者分别为84例和47例，组间比较差异有显著性意义(Z=-2.730，P=0.006)；②机器人组患者手术时间、住院费用均多于传统透视组(t=2.860，P=0.003；t=36.522，P=0.000)，工作通道建立时间短于传统透视组(t=-27.066，P=0.000)，穿刺精度优于传统透视组(Z=-3.656，P=0.000)，骨水泥渗漏率低于传统透视组(χ2=7.284，P=0.007)；③结果表明，局部麻醉后在机器人辅助行经皮椎体后凸成形手术患者的手术体验较好，具有穿刺精确、工作通道建立时间短、骨水泥渗漏率低的优势。
https://orcid.org/0000-0001-8185-9754 (林书) 

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 机器人, 骨质疏松性椎体压缩骨折, 经皮椎体后凸成形, 患者体验, 局部麻醉

Abstract: BACKGROUND: Percutaneous kyphoplasty assisted by C-arm under local anesthesia requires continuous adjustment of the puncture direction under multiple C-arm fluoroscopy. The establishment time of the working channel is longer, and the intraoperative pain stimulation of patients is larger. With the help of the robot, the puncture can be successfully performed at one time, which can significantly improve the experience of patients and reduce the risk of bone cement leakage.
OBJECTIVE: To compare the patient experience and other outcomes of percutaneous kyphoplasty using robot-assisted and conventional C-arm fluoroscopy under local anesthesia.
METHODS: A total of 241 patients with single-stage osteoporotic vertebral compression fracture were selected from Sichuan Academy of Medical Sciences · Sichuan Provincial People’s Hospital (Affiliated Hospital, University of Electronic Science and Technology of China). 132 patients underwent robot-assisted percutaneous kyphoplasty under local anesthesia (robot-assisted group). 109 cases of conventional C-arm assisted percutaneous kyphoplasty under local anesthesia (conventional fluoroscopy group). Patients’ intraoperative experience evaluation, bone cement injection amount, operation time, working channel establishment time, hospitalization cost and complications were recorded. Puncture deviation and bone cement leakage were evaluated by imaging on the first day after surgery.
RESULTS AND CONCLUSION: (1) The intraoperative experience of 59 patients in the robot-assisted group was rated as “very good”, 43 as “good”, 16 as “average”, 10 as “poor”, and 4 as “very poor,” while that of 30 patients in the conventional fluoroscopy group was rated as “very good”, 44 cases were “good”, 21 “average”, 9 “poor”, and 5 “very poor.” There was a significant difference between the two groups in intraoperative experience evaluation (Z=-2.546, P=0.011). Intraoperative pain visual analog scale score was lower in the robot-assisted group than that in the conventional fluoroscopy group (t=-9.513, P=0.000). Totally 84 patients in the robot-assisted group and 47 patients in the conventional fluoroscopy group were willing to undergo percutaneous kyphoplasty again when necessary, and there was a significant difference between the two groups (Z=-2.730, P=0.006). (2) The operation time and hospitalization cost of the robot-assisted group were more than those of the conventional fluoroscopy group (t=2.860, P=0.003; t=36.522, P=0.000). The working channel establishment time of robot-assisted group was shorter than that of conventional fluoroscopy group (t=-27.066, P=0.000). The puncture deviation of robot-assisted group was better than that of conventional fluoroscopy group (Z=-3.656, P=0.000). The cement leakage of robot-assisted group was lower than that of conventional fluoroscopy group (χ2=7.284, P=0.007). (3) It is concluded that under local anesthesia, patients with robot-assisted percutaneous kyphoplasty have good surgical experience, with advantages of accurate puncture, short time to establish working channel, and low leakage rate of bone cement.


Key words: robot, osteoporotic vertebral compression fracture, percutaneous kyphoplasty, patient experience, local anesthesia 

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