TiRobot navigation versus conventional minimally invasive percutaneous pedicle screw fixation for treating thoracolumbar spine fractures

doi:10.12307/2026.801

Abstract

Abstract: BACKGROUND: The precision of pedicle screw placement directly impacts the prognosis of minimally invasive surgery for thoracolumbar fractures. Given the technological disparity between TiRobot assisted intelligent navigation and conventional C-arm 2D fluoroscopy, this study focuses on neurologically intact cases to demonstrate the former’s advantages through multidimensional evaluation of screw placement accuracy, surgical efficiency, and perioperative clinical metrics.
OBJECTIVE: To compare the clinical efficacy of percutaneous pedicle screw fixation under the guidance of the TiRobot system with traditional percutaneous pedicle screw fixation using "C" arm X-ray fluoroscopy for the treatment of thoracolumbar spine fractures without associated nerve injury.
METHODS: Retrospective analysis was conducted on 37 patients with single-segment thoracolumbar fractures treated surgically at the Second Hospital of Shanxi Medical University from November 2022 to March 2024. The trial group (the TiRobot-assisted group) included 18 cases, with 10 males and 8 females, and a total of 108 pedicle screws were implanted. The control group (the traditional "C" arm X-ray fluoroscopy group) included 19 cases, with 12 males and 7 females, and a total of 114 pedicle screws were implanted. The study compared general information, surgical time, intraoperative blood loss, intraoperative fluoroscopy duration, postoperative hospital stay, preoperative, 1-week postoperative, 6-month postoperative, and 12-month postoperative visual analog scale scores for lower back pain, lower back Oswestry disability index, percentage of anterior height of the injured vertebra, Cobb angle of sagittal plane kyphosis of the injured vertebra, screw placement accuracy, and facet joint involvement rate.
RESULTS AND CONCLUSION: (1) The general information of the two groups of patients, surgical time, intraoperative blood loss, postoperative hospital stay days, visual analog scale scores, Oswestry disability index, percentage of the anterior edge height of the injured vertebra, and Cobb angle difference in the sagittal plane of the injured vertebra were all statistically insignificant (all P > 0.05). (2) The fluoroscopy time during surgery was significantly shorter in the trial group than that in the control group, with a statistically significant difference (P < 0.05). (3) The accuracy rate of screw placement in the trial group was 95.4%, and the rate of facet joint invasion was 2.8%. In the control group, the accuracy rate of screw placement was 86.0%, and the rate of facet joint invasion was 10.5%. The accuracy rate of screw placement in the trial group was higher than that in the control group, and the rate of facet joint invasion was lower than that in the control group, with both data differences being statistically significant (P < 0.05). (4) It is indicated that the percutaneous pedicle screw internal fixation under the guidance of TiRobot-assisted has higher accuracy than the traditional group of screws, which can effectively protect the facet joints and other spinal structures behind the spine, facilitate the reconstruction of spinal stability, and can effectively reduce the radiation exposure time of patients and medical staff during the operation.

Key words: ">thoracolumbar fracture, percutaneous pedicle screw fixation, orthopedic robot, assistance, radiation exposure time

CLC Number:

Xue Ningning, Zhao Yibo, Zhao Xiaofeng, Qi Detai, Wang Haomin, Zhao Bin. TiRobot navigation versus conventional minimally invasive percutaneous pedicle screw fixation for treating thoracolumbar spine fractures[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(27): 7123-7129.

Figures/Tables 9

2.4 围术期指标比较对照组术中出血量为(52.79±4.55) mL，试验组为(49.72±4.99) mL，两组之间差异接近显著(P=0.059)，但无统计学差异。两组患者的手术时间、住院天数相比，差异无显著性意义(P=0.111，0.694)；对照组术中透视时间显著长于试验组(P < 0.001)。见表3。 2.5 影像学参数比较两组患者术后1周及6，12个月的Cobb角均较术前显著改善且差异有显著性意义(P < 0.001)，术后6，12个月角度维持稳定，术后1周及6，12个月两组间相比差异无显著性意义，提示两种治疗方法的矫正效果相当(P > 0.05)。见表4。两组患者术后1周及术后6，12个月的伤椎椎体前缘高度百分比均较术前显著改善且差异有显著性意义(P < 0.001)，术后1周、6，12个月两组间相比差异无显著性意义(P > 0.05)。见表5。 2.6 置钉准确率比较试验组置入108枚螺钉(A级103枚，B级5枚，C、D、E级均为0枚)，准确率为95.4%；对照组置入114枚螺钉(A级98枚，B级14枚，C级2枚，D、E级均为0枚)，准确率为86.0%。说明试验组和对照组在置钉Certzbein-Robbins改良分级上的差异有显著性意义(χ2=5.728，P=0.017 < 0.05)，试验组的置钉准确率优于对照组。见表6。 2.7 关节突侵犯率比较试验组共置入108枚螺钉，其中关节突关节侵犯分级为0级的105枚，1级3枚，2，3级均为0枚，侵犯率为2.8%；对照组共置入114枚螺钉，其中关节突关节侵犯分级为0级的102枚，1级11枚，2级1枚，3级有0枚，侵犯率为10.5%。提示试验组关节突关节侵犯率低于对照组，且差异有显著性意义(χ2=5.285，P=0.022)。见表7。 2.8 目测类比评分比较两组术前目测类比评分相近，术后1周及6，12个月均呈现显著下降趋势(均P < 0.001)。纵向比较显示，两组术后6，12个月目测类比评分较术后1周进一步改善(均P < 0.05)；组间分析则提示两组之间术前及术后各时点目测类比评分相比，差异均无显著性意义(P=0.685，0.506，0.200，0.075)。研究表明，两种干预方式均能持续有效缓解疼痛，且术后长期效果优于早期，但两组间疗效差异无显著性意义(P > 0.05)。见表8。 2.9 Oswestry功能障碍指数比较两组术后1周及6，12个月的Oswestry功能障碍指数均较术前显著降低，且差异有显著性意义 (P < 0.001)，术后6，12个月的Oswestry功能障碍指数较术后1周进一步显著改善 (P < 0.05)，表明术后患者的功能障碍得到了显著改善。术前及术后各时点Oswestry功能障碍指数两组间对比，差异均无显著性意义(P=0.606，0.351，0.053，0.053)，表明两组间功能障碍改善情况无显著性差异。见表9。"

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