Shi Fangfu,He Xianbo,Li Guojun,et al.Precision of screw insertion in Lenke 1A adolescent idiopathic scoliosis using spinal robotics plus simplified intraoperative calibration[J].Journal of Clinical Pediatric Surgery,2026,(01):20-25.[doi:10.3760/cma.j.cn101785-202507046]
脊柱机器人联合术中校准辅助Lenke 1A型青少年特发性脊柱侧凸置钉精度的研究
- Title:
- Precision of screw insertion in Lenke 1A adolescent idiopathic scoliosis using spinal robotics plus simplified intraoperative calibration
- Keywords:
- Scoliosis; Robotic Surgical Procedures; Vertebral Body; Bone Nails; Child
- 摘要:
- 目的 初步探讨脊柱机器人联合术中简易校准技术辅助青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者椎弓根螺钉置入的精确性。方法 本研究为回顾性队列研究,以2023年3月至2025年3月于海南医科大学第一附属医院明确诊断为Lenke 1A型AIS的42例患者为研究对象,根据患者在机器人矫形术中是否使用校准技术,分为机器人组(22例)与机器人校准组(20例)。收集两组基本信息、Risser征分级、置钉数量、术前及术后Cobb角,依据Rao分级评估两组椎弓根螺钉置钉精确性。结果 两组共置入椎弓根螺钉866枚,其中机器人组450枚,机器人校准组416枚。机器人校准组置钉优良率为97.60%,显著高于机器人组的92.18%,差异具有统计学意义(P＜0.05);且机器人校准组凹侧置钉优良率(96.10%)、凹侧1级钉率(6.90%)均明显高于机器人组(88.16%、0.50%),差异具有统计学意义(P＜0.05)。此外,机器人校准组患者总体内侧皮质穿破率、凹侧内侧皮质穿破率均显著低于机器人组(0.5%比4.4%,0.5%比5.9%),但外侧皮质穿破率(3.4%)显著高于机器人组(2.2%),上述差异均具有统计学意义(P＜0.05)。两组均无一例发生严重脊髓神经及血管损伤。结论 术中脊柱震动及椎体旋转会影响脊柱机器人的置钉精度,而术中简易校准技术辅助可显著提高Lenke 1A型AIS患者总体及凹侧椎弓根螺钉置钉优良率,降低内侧皮质穿破率,提升AIS患者手术安全性。
- Abstract:
- Objective To explore the accuracy of pedicle screw placement in adolescent idiopathic scoliosis (AIS) patients assisted by spinal robotics plus a simplified intraoperative calibration technique. Methods For this retrospective study,42 children with Lenke type 1A adolescent idiopathic scoliosis (AIS) underwent corrective surgery at First Affiliated Hospital of Hainan Medical University between March 2023 and March 2025.Based upon whether or not intraoperative robotic calibration technique was applied,they were assigned into two groups of robotic (n=22) and robotic calibration (n=20).Baseline demographic profiles,Risser grade,number of pedicle screws and perioperative Cobb angles were recorded for both groups.The accuracy of pedicle screw placement was evaluated according to the Rao classification scheme. Results A total of 866 pedicle screws were inserted in both groups,including 450 screws in robotic group and 416 screws in robotic calibration group.The excellent screw placement rate was 97.60% in robotic calibration group and 92.18% in robotic group (P<0.05).Moreover,concave-side excellent screw rate (96.10%) and the proportion of concave-side grade 1 screws (6.90%) in robotic calibration group were also significantly higher than those in robotic group (88.16% and 0.50%,respectively) (P<0.05).In addition,overall medial cortical breach rate (0.5%) and concave-side medial cortical breach rate (0.5%) in robotic calibration group were significantly lower than those in robotic group (4.4% and 5.9%,respectively),whereas lateral cortical breach rate (3.4%) was significantly higher than that in robotic group (2.2%) (P<0.05 for all).No severe spinal cord,nerve or vascular injuries occurred in neither groups. Conclusions Intraoperative spinal vibration and vertebral rotation may affect the accuracy of pedicle screw placement using spinal robotics.And using a simplified intraoperative calibration technique significantly improves the overall and concave-side pedicle screw placement accuracy in Lenke type 1A AIS children,lower medial cortical breach rate and thereby enhance surgical safety during AIS corrections.
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备注/Memo
收稿日期:2025-7-21。
基金项目:国家自然科学基金(82160435);2024年度海南省高等学校科学研究项目(Hnky24—28)
通讯作者:陈焕雄,Email:chenhuanxiong86@163.com