临床误诊误治

目的 探讨骨科机器人辅助经皮穿刺椎体成形术（PVP）治疗骨质疏松性椎体压缩性骨折（OVCF）后凸畸形患者的效果及安全性。方法 选取2021年4月至2024年3月接受治疗的114例OVCF后凸畸形患者作为研究对象，采用随机数字表法分为观察组（给予骨科机器人辅助PVP治疗）和对照组（给予传统X线透视辅助PVP治疗）各57例。比较2组手术相关指标，术前、术后1 d及术后3个月伤椎前缘高度及伤椎Cobb角、手术前后疼痛视觉模拟评分法（VAS）评分和术后并发症发生率。结果 观察组手术时间、术中出血量、术中X线透视次数及术者辐射量均短于或小于对照组（P<0.01）。术后1 d,2组伤椎前缘高度增加，伤椎Cobb角减小，且观察组伤椎前缘高度大于对照组、伤椎Cobb角小于对照组（P<0.05）；术后3个月，2组伤椎前缘高度较术后1d时减小，伤椎Cobb角较术后1d时增大（P<0.05），但2组间比较无明显差异（P>0.05）。2组术后1 d及术后3个月疼痛VAS评分较术前均降低，术后3个月疼痛VAS评分低于术后1 d(P<0.05)，但2组各时间点疼痛VAS评分比较均无明显差异（P>0.05）。观察组术后并发症总发生率为12.28%(7/57)低于对照组的28.07%(16/57)，差异有统计学意义（P<0.05）。结论 骨科机器人辅助PVP在治疗OVCF后凸畸形中展现出良好的临床优势，可减少患者术中出血量、术中X线透视次数及术者辐射量，更好地恢复伤椎前缘高度和Cobb角，并降低术后并发症发生率。

Objective To investigate the effect and safety of robot-assisted percutaneous vertebroplasty(PVP) in the treatment of osteoporotic vertebral compression fractures(OVCF) with kyphosis. Methods A total of 114 patients with OVCF and kyphosis treated from April 2021 to March 2024 were selected as the research subjects. They were divided into the observation group(orthopedic robot-assisted PVP, n=57) and the control group(traditional X-ray fluoroscopy-assisted PVP, n=57) according to random number table method. The operation-related indexes, the anterior height of the injured vertebra, the Cobb angle of the injured vertebra,the visual analogue scale(VAS) score, and the incidence of postoperative complications were recorded and compared between the two groups before operation and at 1 d and 3 months after operation. Results The duration of operation, intraoperative blood loss, the number of intraoperative fluoroscopy and radiation dose received by operators in the observation group were shorter or less than those in the control group(P<0.01). At 1 d after operation, the anterior height of the injured vertebra was increased, while the Cobb angle of the injured vertebra was decreased in the two groups; the anterior height of the injured vertebra in the observation group was greater than that in the control group, and the Cobb angle of the injured vertebra in the observation group was smaller than that in the control group(P<0.05). At 3 months after operation, the anterior height of the injured vertebra was decreased, and the Cobb angle of the injured vertebra was increased when compared with that at 1 d after operation in both groups(P<0.05), but there was no significant difference between the two groups(P>0.05). The VAS pain scores at 1 d and 3 months after operation were significantly lower than those before operation in both groups, and the VAS scores at 3 months after operation were lower than those at 1 d after operation(P<0.05), but there was no significant difference in VAS scores between the two groups at each time point(P>0.05). The postoperative complications of the observation group was 12.28%(7/57), which was lower than 28.07%(16/57) of the control group, showing significant difference(P<0.05). Conclusion Orthopedic robot-assisted PVP shows good clinical advantages in the treatment of kyphosis after OVCF, which can reduce the intraoperative blood loss, times of intraoperative fluoroscopy and radiation dose received by operators, better restore the anterior vertebral height and Cobb Angle, and reduce the incidence of postoperative complications.