Comparison between the short-term efficacy of robotic navigation and traditional minimally invasive percutaneous pedicle nail fixation in the treatment of thoracolumbar compression fractures without nerve injury
Zhou Pinghui, Ma Bingxu, Ye Yuchen, Zhang Shihui, Fu Yuchun, Zhang Changchun, Guan Jianzhong
Department of Orthopaedic, the First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, China
Abstract：Objective This study aimed to investigate the short-term efficacy of robot-guided and traditional C-arm X-ray machine fluoroscopy percutaneous pedicle screw fixation in the treatment of thoracolumbar compression fractures. Methods A retrospective cohort design was adopted. From January 2021 to December 2022, 30 patients with thoracolumbar compression fracture treated in the Department of Orthopedics of the First Affiliated Hospital of Bengbu Medical University were enrolled in this study. The 30 patients including 14 males and 16 females aged 20-58 (44.6±11.4) years were divided into two groups according to different surgical methods: 17 cases were treated with traditional C-arm X-ray machine fluoroscopic percutaneous manual nail placement, and 13 cases were treated with posterior percutaneous pedicle screw fixation under the guidance of "TiRobot" orthopedic robot as the robot group. The observation indicators were as follows: (1) baseline data such as gender, age, injury factors, time from injury to operation, and injured vertebral segment were compared between the two groups. (2) The operation time, intraoperative blood loss, number of intraoperative fluoroscopy, proportion of medical staff with radiation dose >0.01 mSv, time of pedicle screw placement, hospital stay, and occurrence of complications such as postoperative nerve injury, incision infection, and loose internal fixation were compared between the two groups. (3) The visual analogue scale (VAS)scores of the anterior edge of the injured vertebrae, Cobb angle of the injured vertebrae, and low back pain were compared between the two groups before surgery, 7 days after surgery, and 3 months after surgery. Results (1) No significant difference in the baseline data between the two groups (all P values >0.05). (2) The operation was successfully performed for all 30 patients, and no complications such as nerve damage, incision infection, and internal fixation loosening occurred after the surgery. The operation time of the robot group was (125.0±5.8) min, which was longer than that of the traditional group at (100.1±8.1) min. The robot group had a hospital stay time of (8 [7,8]) days, fluoroscopy times of ([9.2±3.2] times), of screw nailing time ([3.5±0.6] min), and proportion of radiation agent of >0.01 mSv (3/13), all of which were statistically significantly lower than those of the traditional group (10 [10.0, 10.5]) days, [11.5±2.2] times, [5.4±0.7] min, [12/17]; all P values <0.05). No significant difference in intraoperative blood loss was observed between the two groups (P >0.05). (3) The 30 patients were followed up for 3 months. Intragroup comparison showed lower VAS score of low back pain and ratio of Cobb angle in the sagittal plane of the injured vertebra but higher height ratio of the anterior edge of the injured vertebra after operation than before operation with statistical significance (all P values <0.05). No significant difference in the VAS score of low back pain, Cobb angle in the sagittal plane of the injured vertebra, and height ratio of the anterior edge of the injured vertebra was found between the two groups before operation and 7 days and 3 months after surgery (all P values >0.05). Conclusion Thoracolumbar compression fractures without nerve injury can be treated by robot-guided percutaneous pedicle screw fixation and traditional C-arm X-ray machine fluoroscopy. Robotic navigation is better than traditional surgical methods in terms of reducing number of fluoroscopy and radiation dose of medical staff during surgery and shortening screw placement time.
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Zhou Pinghui, Ma Bingxu, Ye Yuchen, Zhang Shihui, Fu Yuchun, Zhang Changchun, Guan Jianzhong. Comparison between the short-term efficacy of robotic navigation and traditional minimally invasive percutaneous pedicle nail fixation in the treatment of thoracolumbar compression fractures without nerve injury. Chinese Journal of Anatomy and Clinics, 2024, 29(3): 166-171.
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2024, Vol. 29 
