机器人辅助与徒手椎弓根螺钉置入在脊柱疾病应用效果的meta分析

doi:10.3969/j.issn.1004-583X.2023.03.002

摘要/Abstract

摘要：

目的比较机器人辅助与徒手置钉两种不同椎弓根螺钉置入方式在脊柱手术中的临床效果,为未来脊柱外科发展方向提供一定理论参考。方法检索2011年2月至2021年2月发表的相关病例对照研究。检索包括Pubmed、Cochrane Library、CNKI、Embase、WF、VIP在内的6个数据库。依据中英文检索策略,共检索到文献418篇,根据条件进一步筛选后最终纳入13篇文献。提取本文所需数据并使用Review manager 5.3软件进行分析。结果机器人辅助下置钉较徒手透视引导下置钉准确度较高(95% $C I$ =2.19~3.61, $P$ <0.01);机器人辅助下与透视引导下置钉手术所需时间相当(95% $C I$ =-0.18~33.96, $P$ =0.05),其余指标均差异无明显统计学意义。结论机器人辅助下较传统徒手置钉准确度更高,是当下治疗脊柱疾病的更安全精准的选择,且机器人术中所需时间、辐射强度及时间呈现下降趋势,在未来脊柱外科的手术中将起重要作用。

关键词: 机器人手术, 透视引导, 椎弓根螺钉, 置钉准确度, 手术时间

Abstract:

Objective To compare the clinical effects of robot-assisted versus free-handed pedicle screw placement in spinal surgery, and to provide a theoretical reference for the future development of spinal surgery. Methods We searched related case-control studies published from February 2011 to February 2021, in six databases including Pubmed, Cochrane Library, CNKI, Embase, WF and VIP. According to Chinese and English retrieval strategies, retrieved eligible 418 documents, further screened and finally included 13 documents. In this paper, we extracted and analyzed the data by Review manager 5.3 software. Results When pedicle screws were used to placed, the accuracy of robot-assisted placement was higher than that of free-hand fluoroscopy-guided (95% $C I$ =2.19-3.61, $P$ <0.01). The time required for robot-assisted and fluoroscopy-guided was similar (95% $C I$ =-0.18-33.96, $P$ =0.05), but the other indicators were comparable between groups. Conclusion Robot-assisted screw placement is more accurate than traditional freehand screw placement, which is a more accurate and safe choice for the treatment of spinal diseases. Moreover, the operation time, radiation dose and time of robot-assisted tend to decline, which will play an important role in spinal surgery in the future.

Key words: robotic surgical procedures, fluoroscopy-guided, pedicle screw, screw placement accuracy, operative time

中图分类号:

李杨, 杜怡斌. 机器人辅助与徒手椎弓根螺钉置入在脊柱疾病应用效果的meta分析[J]. 临床荟萃, 2023, 38(3): 208-215.

Li Yang, Du Yibin. Meta-analysis of the effect of robot-assisted and free-handed pedicle screw placement in spinal diseases[J]. Clinical Focus, 2023, 38(3): 208-215.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.03.002

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I3/208

图/表 10

图1 文献筛选流程图

Fig. 1 Flow chart of documents screening

表1 纳入文献基本特征表

Tab. 1 Basic characteristics of documents included

纳入研究	类型	国家	年份	组别	例数	年龄 (岁)	性别 (男/女)	结局指标	改良Jadad 质量评价(分)
Ringel^[5]	随机对照	德国	2012	机器人辅助	30	68	14/16	①②④⑥⑦	7
				透视引导	30	67	12/18
Feng^[6]	随机对照	中国	2019	机器人辅助	40	67.6±6.5	12/28	①③⑥⑦	5
				透视引导	40	67.9±7.3	13/27
Keric^[7]	回顾性	德国	2017	机器人辅助	52	72.3±11.1	36/30	①②④⑤⑥⑦	6
				透视引导	70	68.0±11.2	13/11
Hyun^[8]	随机对照	韩国	2017	机器人辅助	30	66.5	9/21	①③④⑤⑥⑦	7
				透视引导	30	66.8	8/22
Kim^[9]	随机对照	韩国	2015	机器人辅助	20	64.4±11.9	11/9	①⑥	6
				透视引导	20	64.7±8.6	8/12
Lautado^[10]	回顾性	瑞士	2018	机器人辅助	11	65	-	①	5
				透视引导	48	60.7
Schizas^[11]	随机对照	瑞士	2012	机器人辅助	11	65	6/5	①③④	6
				透视引导	23	66	8/15
Kantelhardt^[12]	回顾性	德国	2011	机器人辅助	55	63.1	52/60	①②④⑥⑦	6
				透视引导	57
Lonjon^[13]	随机对照	法国	2016	机器人辅助	10	63.4±11.0	4/6	①②③④⑥⑦	7
				透视引导	10		4/6
Han^[14]	回顾性	中国	2019	机器人辅助	52	54.6±11.3	55/60	①③④⑥⑦	5
				透视引导	70	56.1±13.4	58/61
Schatlo^[15]	回顾性	德国	2014	机器人辅助	55	52(27-83)	29/26	①②⑥⑦	6
				透视引导	40	58(23-82)	28/12
Roser^[16]	回顾性	德国	2013	机器人辅助	18	-	-	①③④	5
				透视引导	10
田伟^[17]	随机对照	中国	2016	机器人辅助	23	54.9±11.9	17/23	①⑥	5
				透视引导	17

图2 两组置钉准确度比较的森林图

Fig. 2 Forest map of accuracy of pedicle screw placement guided by robot and free-handed

图3 两组术后并发症及翻修例数比较的森林图

Fig. 3 Forest map of complications and revision cases of pedicle screw placement guided by robot and free-handed

图4 两组术中辐射强度比较的森林图

Fig. 4 Forest map of intraoperative radiation intensity of pedicle screw placement guided by robot and free-handed

图5 两组术中辐射时间比较的森林图

Fig. 5 Forest map of intraoperative radiation time of pedicle screw placement guided by robot and free-handed

图6 两组术后VAS分数比较的森林图

Fig. 6 Forest map of postoperative VAS score of pedicle screw placement guided by robot and free-handed

图7 两组术中所需时间比较的森林图

Fig. 7 Forest map of operation time of pedicle screw placement guided by robot and free-handed

图8 两组住院时长比较的森林图

Fig. 8 Forest map of hospitalization time of pedicle screw placement guided by robot and free-handed

图9 发表偏倚 a.椎弓根置钉准确度发表偏倚漏斗图;b.并发症及翻修例数发表偏倚漏斗图;c.术中辐射强度发表偏倚漏斗图;d.辐射时间发表偏倚漏斗图;e.术后VAS发表偏倚漏斗图;f.术中所需时间发表偏倚漏斗图; g. 住院时长发表偏倚漏斗图

Fig.9 Publication of bias a. Funnel plot of accuracy of pedicle screw placement; b. Funnel plot of complications and revision cases; c. Funnel plot of intraoperative. radiation intensity; d. Funnel plot of intraoperative radiation time; e. Funnel plot of postoperative VAS score; f. Funnel plot of operation time; g. Funnel plot of hospitalization time

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