A meta-analysis on the accuracy and safety of robot-assisted and conventional freehand open approach in pedicle screw fixation / 国际生物医学工程杂志

ABSTRACT

Objective To compare and analyze the accuracy and safety of robot-assisted and conventional freehand open approach in pedicle screw fixation using meta-analysis.Methods PubMed,Embase,Cochrane,China Biology Medicine,Wanfang and CNKI databases were searched by computer retrieval to identify the relevant literatures published before December1,2016.The qualified literatures were selected according to the preestablished the inclusion criteria and exclusion criteria,and processed for data extraction and quality evaluation.The RevMan 5.3 software was used for the meta-analysis.The relative risk (RR) and 95％ confidence interval (CI) were adopted to represent the effect differences in the dichotomous variable data.The effect difference of continuous variable data was represented by mean difference (MD) or standardized mean difference (SMD).When P＜0.05 and 95％ CI does not contain the value of 1,the difference was considered statistically significant.Results A total of 266 patients were enrolled,including 138 cases of robot-assisted group and 128 cases of conventional freehand open group,in which 1 200 screws were implanted,including 608 screws by robot-assisted system and 592 screws by conventional freehand open approach.The Gertzbein-Robbins grading criteria (grade A to C) were used.The results showed that there was no significant difference in the accuracy of pedicle screw fixation between the robotic-assisted and conventional freehand open approach according to the grading criteria,i.e.grades A (RR =1.07,95％CI0.82,1.39,I2=46％,P=0.62),grades B (RR=l.56,95％CI0.86,2.82,I2=0％,P=0.14) and grades C (RR=0.91,95％CI0.32,2.55,I2=0％,P=0.85).For the two groups,the difference was no statistically significance in the complication rate (RR=0.33,95％CI0.05,2.17,I2=0％,P=0.25),and in the revision rate (RR=0.53,95％CI0.10,2.90,I2=0％,P=0.47).The difference was statistically significance in the overall surgical time (MD=20.90,95％CI5.54,36.26,I2=15％,P=0.008),and in the exposure time (MD=-1.19,95％CI-1.63,-0.75,I2=15％,P＜0.000 01).The difference was no statistically significance in the distance between screws and facet joint surfaces (SMD=-1.15,95％CI0.79,1.51,I2=16％,P＜0.000 01).Conclusions Compared with the conventional freehand open approach,the current evidence cannot confirm that the robot-assisted system has significant advantages in the surgical accuracy of pedicle screw fixation and complication rate.The spinal surgical robot-assisted system,as a new technology,has considerable potential for further development and application in spinal surgery.