骨科机器人辅助经皮椎体后凸成形治疗多节段脊柱转移瘤.

BACKGROUND: Percutaneous kyphoplasty for multi-segmental spinal metastases has some problems, such as long operation time, high fluoroscopic dose, and easy leakage of bone cement. Robot-guided percutaneous kyphoplasty can optimize surgery and reduce the incidence of complications. OBJECTIVE: To evaluate the safety and advantage of robot-guided percutaneous kyphoplasty in treatment of multi-segmental spinal metastases. METHODS: The clinical data of 43 cases with multi-segmental spinal metastases with no signs of nerve injury from January 2018 to April 2019 were analyzed retrospectively. According to the different operation methods, the patients were divided into robot-guided group (22 cases) and traditional fluoroscopy group (21 cases). There was no significant difference in gender, age, number of diseased vertebrae, source of primary tumor and preoperative visual analogue scale score between the two groups (P > 0.05), with comparability. The data of operation time, fluoroscopy frequency, fluoroscopy dose, the incidence rate of pedicle wall breaking, angle of penetration, and leakage of bone cement were collected in both groups. Visual analogue scale score, the midline vertebral height and Cobb angle were compared preoperatively, 2 days postoperatively, and during the final follow-up between the two groups. RESULTS AND CONCLUSION: (1) The number of diseased vertebrae in the robot-guided group and traditional fluoroscopy group was 79 and 70, respectively. (2) The average operation time, fluoroscopy frequency and fluoroscopy dose in the robot-guided group were significantly lower than those in the traditional fluoroscopy group, and the difference was statistically significant (P < 0.001). (3) The incidence rate of pedicle wall breaking was 6% in the robot-guided group and 21% in the traditional fluoroscopy group, and the difference was statistically significant (χ2 =6.040, P=0.014). (4) The angle of penetration in the robot-guided group was larger than those in the traditional fluoroscopy group (P < 0.001). (5) The leakage rate of bone cement in the robot-guided group was lower than in the traditional fluoroscopy group (8%, 23%,χ2 =6.869, P=0.009). (6) There was no significant difference in visual analogue scale score, the midline vertebral heights and Cobb angle between the two groups before and 2 days after operation and during the final follow-up (P > 0.05). (7) It is indicated that robot-guided percutaneous kyphoplasty in treatment of multi-segmental spinal metastases can reduce operation time, reduce fluoroscopy frequency, reduce fluoroscopy dose, have good accuracy of penetration and low leakage rate of bone cement. [ABSTRACT FROM AUTHOR]