中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (36): 5833-5838.doi: 10.12307/2024.683

• 骨科植入物 orthopedic implant • 上一篇    下一篇

机器人辅助椎弓根螺钉内固定治疗寰枢椎脱位

陈文创1，李  勇2，鲁  尧2，张梅刃3，陈海云3，余照宇2   

  1. 1广州中医药大学第二临床医学院，广东省广州市   510006；广东省中医院珠海医院，2骨三科，3骨六科，广东省珠海市   519015
  • 收稿日期:2023-09-01 接受日期:2023-11-13 出版日期:2024-12-28 发布日期:2024-02-28
  • 通讯作者: 余照宇，硕士，主治医师，广东省中医院珠海医院骨三科，广东省珠海市 519015
  • 作者简介:陈文创，男，1997年生，湖北省黄冈市人，广州中医药大学在读硕士，主要从事中西医结合治疗脊柱疾患方面的研究。
  • 基金资助:
    珠海市科技创新局项目基金(2220004000372)，项目负责人：陈海云

Robot-assisted pedicle screw internal fixation in treatment of atlantoaxial dislocation

Chen Wenchuang1, Li Yong2, Lu Yao2, Zhang Meiren3, Chen Haiyun3, Yu Zhaoyu2   

  1. 1Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China; 2Third Department of Orthopedics, 3Sixth Department of Orthopedics, Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine, Zhuhai 519015, Guangdong Province, China
  • Received:2023-09-01 Accepted:2023-11-13 Online:2024-12-28 Published:2024-02-28
  • Contact: Yu Zhaoyu, Master, Attending physician, Third Department of Orthopedics, Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine, Zhuhai 519015, Guangdong Province, China
  • About author:Chen Wenchuang, Master candidate, Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
  • Supported by:
    Zhuhai Science and Technology Innovation Bureau Project Fund, No. 2220004000372 (to CHY)

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摘要：


文题释义：

寰枢椎脱位：指因各种原因导致寰枢椎解剖结构异常、稳定性丧失，寰枢关节对应关系发生错位，是一种可能导致残疾和死亡的危重疾病。手术治疗是可靠的治疗手段，但上颈椎血管和神经的走行复杂，常常存在骨性结构变异，提高其手术安全性和成功率一直是脊柱外科医生追求的目标。
机器人辅助置钉技术：基于手术安全和精准的理念，结合生物工程最新研究成果，通过采集术中三维数据，协助医生进行手术操作。通过智能算法，为医生提供精准的导针置入路径，提高手术安全性和稳定性，实现手术的精准操作。


背景：寰枢椎脱位因手术难度极高、风险极大，曾被国际骨科界视为“手术禁区”。然而，随着骨科智能数字化的迅速发展，机器人辅助导航置钉技术被广泛应用于临床，显著降低了手术难度和手术风险，提高了手术安全性，但是将该技术应用于治疗寰枢椎脱位的报道较少。

目的：探究机器人辅助椎弓根螺钉内固定治疗寰枢椎脱位的应用价值。
方法：回顾性分析2021年10月至2022年7月于广东省中医院珠海医院在机器人辅助导航下行C1-C2椎弓根螺钉内固定治疗的5例寰枢椎脱位患者的病历资料。记录手术时间、颈部切口长度、出血量、术后引流量、住院时间，关注有无脑脊液漏、椎动脉损伤、神经损伤、术区感染等并发症发生，收集术前及末次随访颈部疼痛目测类比评分、美国脊椎损伤学会脊髓损伤分级、日本骨科协会颈椎评分及影像学指标，并评估置钉准确率。

结果与结论：①5例患者均顺利完成手术，均未出现血管、神经损伤等并发症，且均获得随访，随访时间为12-20个月；②5例患者共置入20枚颈椎椎弓根螺钉，其中A类螺钉9枚，B类螺钉10枚，C类螺钉1枚，置钉准确率为95%；③末次随访时，目测类比评分为(0.80±0.71)分，较术前(4.00±2.83)分明显下降；日本骨科协会评分为(14.80±0.84)分，较术前(8.00±0.71)分明显升高；而寰齿前间隙由术前(7.86±3.25) mm减小至(2.82±0.93) mm，寰枢椎管储备间隙由术前(6.74±1.99) mm增大至(12.10±3.51) mm，延髓颈髓角由术前(133.32±13.55)˚增大至(153.44±9.53)°，斜坡椎管角由术前(128.02±9.92)˚增大至(143.25±12.99)˚；以上末次随访指标结果均较术前改善，差异有显著性意义(P均< 0.05)；④术后影像学随访提示所有患者植骨区均获得骨性融合，无内固定松动、断裂或拔出等情况出现；⑤提示该方法可以避免依赖医生的经验和手感，保证上颈椎螺钉置钉的准确性，降低手术风险，并在中期随访中获得了满意的疗效。

https://orcid.org/0009-0004-1383-9179 (陈文创)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 机器人导航, 寰枢椎脱位, 椎弓根螺钉, 置钉, 准确性

Abstract: BACKGROUND: Atlantoaxial dislocation, because of its high difficulty and high risk of surgery, has been regarded as the “surgical restricted area” by the international orthopedic community. However, with the rapid development of intelligent digitization in orthopedics, robot-assisted navigation screw placement technology has been widely used in clinical practice, which significantly reduces the difficulty and risk of surgery and improves the safety of surgery. However, there are few reports on the application of this technique in the treatment of atlantoaxial dislocation. 
OBJECTIVE: To explore the application value of robot-assisted pedicle screw internal fixation in the treatment of atlantoaxial dislocation. 
METHODS: The medical records of five patients with atlantoaxial dislocation treated with C1-C2 pedicle screw fixation under robot-assisted navigation in Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to July 2022 were retrospectively analyzed. Operation time, length of neck incision, blood loss, postoperative drainage volume, and length of hospital stay were recorded. Attention should be paid to cerebrospinal fluid leakage, vertebral artery injury, nerve injury, operative area infection and other complications. The visual analog scale score of neck pain, the spinal cord injury grade of the American Spinal Injury Association, the cervical spine score of the Japanese Orthopaedic Association, and the imaging indicators were collected before surgery and at the last follow-up. Screw placement accuracy was assessed.
RESULTS AND CONCLUSION: (1) Five patients were successfully completed surgery, without vascular, nerve injury or other complications, and were followed up for 12-20 months. (2) A total of 20 cervical pedicle screws were placed in 5 patients, including 9 type A screws, 10 type B screws, and 1 type C screw. The accuracy of screw placement was 95%. (3) At the last follow-up, the visual analog scale score was (0.80±0.71) points, which was significantly lower than that before operation (4.00±2.83) points; the Japanese Orthopaedic Association score was (14.80±0.84) points, which was significantly higher than that before operation (8.00±0.71) points. Anterior atlantodental interval decreased from (7.86±3.25) mm to (2.82±0.93) mm; space available of the spinal cord increased from (6.74±1.99) mm to (12.10±3.51) mm; cervicomedullary angle increased from (133.32±13.55)° to (153.44±9.53)°; clivus-canal angle increased from (128.02±9.92)° to (143.25±12.99)°. The results of the last follow-up indexes were improved compared with those before operation, and the differences were significant (all P < 0.05). (4) Postoperative imaging follow-up showed that all patients had bone fusion in the bone graft area, and no internal fixation loosening, fracture or pull-out occurred. (5) This method can avoid relying on the doctor’s experience and hand feeling, ensure the accuracy of upper cervical screw placement, reduce the risk of surgery, and obtain satisfactory results in mid-term follow-up. 

Key words: robot navigation, atlantoaxial dislocation, pedicle screw, screw placement, accuracy

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