Objective: To explore the clinical application of Orthopedic Tianji Robot in the treatment of thoracolumbar fractures with minimally invasive percutaneous pedicle screw internal fixation.
Methods: The clinical data of 46 patients with thoracolumbar fractures treated by minimally invasive percutaneous pedicle screw internal fixation from June 2018 to January 2020 in Gansu Provincial People's Hospital was retrospectively analyzed. According to the different aided equipments, the patients were divided into a C-arm X-ray plus robot assisted nail placement group (observation group) and simple C-arm X-ray assisted nail placement group (control group). Twenty-two patients in observation group, including 12males and 10 females, aged from 24 to 61 years old, with a mean of(40.23±12.19) years, 3 cases were T11 vertebrae fracture, 8 cases were T12, 9 cases were L1, and 2 cases were L2. And there were 24 cases in control group, including 15 males and 9 females, aged from 26 to 58 years old, with a mean of (42.88±10.31) years, 3 cases were T11 vertebrae fracture, 10 cases were T12, 7 cases were L1, and 4 cases were L2. The operation time, the number of intraoperative fluoroscopy, intraoperative blood loss, the days of hospitalization, and postoperative complications were recorded. Preoperative and postoperative VAS at 3 days, 1 week and 3 months were compared between two groups. The sagittal Cobb angle of the injured vertebral body and the percentage of the anterior edge height of the vertebral body were observed before and after operation, and evaluate the accuracy of nail placement according to the Gertzbein-Robbins classification criteria with collected postoperative CT images.
Results: All patients were followed up for 5 to 12 months with an average of (7.07±0.83) months. There was no significant differences in intraoperative blood loss, operation time and hospitalization days between two groups (P>0.05). The number of intraoperative fluoroscopy was (5.62±0.51) times in observation group and (12.54±0.52) in control group, the difference between two groups was statistically significant (P<0.05). The VAS, the percentage of the height of the injured vertebra anterior edge and the Cobb angle of the injured vertebral plane at each time point after operation were improved(P<0.05), but the difference between two groups was not statistically significant (P>0.05). One case of postoperative incision infection occurred in the control group, which was cured after active dressing changes. There were no serious complications such as screw loosening and breakage in all patients, and there was no statistically significant difference in the incidence of complications between two groups(P>0.05). The postoperative nail placement accuracy ratesof the observation group and the control group were 98.4% (126/128) and 90.3% (121/134), respectively, and the difference was statistically significant (P<0.05).
Conclusion: In the surgical treatment of thoracolumbar fractures, compared with simple C-arm fluoroscopy, the pedicle screw placement assisted by Orthopedic Tianji Robot overcomes the shortcomings of surgeon's physiological tremor, fatigue and multiple intraoperative fluoroscopy, improves the accuracy of screw placement, and is a more accurate and safer way of pedicle screw placement for thoracolumbar fractures.
Keywords: Orthopedic Tianji Robot; Pedicle screw; Thoracolumbar fractures.