脊柱骨折作为骨科常见创伤之一，多由直接或间接外力引起，主要累及脊柱和周围软组织。脊柱骨折 后正常生理结构改变，常导致脊髓神经受损、受压，且由于椎管内含脆弱神经，解剖结构复杂，对于手术精准性要求 较高。机器人手术系统拥有自由度较高的机械臂，术者可利用计算机实时导航跟踪、动态监测进针的精度与安全性， 并能提高穿刺及置钉成功率，避免二次骨质破坏，减轻术者工作负荷。同时，机器人辅助治疗和康复方式在临床治疗 中的应用，可为患者提供持续性神经治疗和康复，增加患者肌肉活动性，改善神经损伤情况，有利于患者肢体功能康复。 本研究主要分析机器人辅助手术在脊柱骨折伴脊髓神经损伤中的应用，旨在为脊柱骨折伴脊髓神经损伤治疗提供指导。

As a kind of common orthopedic injuries, spinal fracture is mostly caused by direct or indirect external forces, mainly involving the spine and surrounding soft tissues. Normal physiological structure changes after spinal fracture can lead to spinal cord injury and compression. Since the vertebral canal is the vertebral column that stores an integral portion of the central nervous system, its anatomical structure is complex and requires high surgical accuracy during surgery. With the high degree of freedom of robot arm in the robotic surgical system, surgeons can use the real-time tracking system to dynamically monitor the insertion of spinal needle accurately and safely. It could also improve the success rate of puncturing and nail placement, avoid secondary bone destruction, and lighten surgeons’ work load. Meanwhile, the application of robot-assisted surgery and rehabilitation way in clinical practice could provide patients with continuous neurological treatment and rehabilitation, improve patients’ muscle activity and reduce nerve damage, which is conducive to rehabilitation of patients’ limb function. The application of robot-assisted surgery in spinal fracture with spinal cord injury was mainly analyzed in this study, hoping to provide guidance for the treatment of spinal fracture with spinal cord injury.

收稿日期：2023-11-13  录用日期：2024-01-15 

Received Date: 2023-11-13  Accepted Date: 2024-01-15

 基金项目：苏州市临床重点病种诊疗技术专项项目（LCZX202205） 

Foundation Item: Key Clinical Diseases Diagnosis and Treatment Technology Special Project of Suzhou City (LCZX202205) 

通讯作者：范志海，Email：fanzh2006@163.com 

Corresponding Author: FAN Zhihai, Email: fanzh2006@163.com 

引用格式：吴博宇，范志海 . 机器人辅助手术治疗脊柱骨折伴脊髓神经损伤的研究进展 [J]. 机器人外科学杂志（中英文）， 2024，5（2）：194-198. 

Citation: WU B Y, FAN Z H. Research progress of robot-assisted surgery in the treatment of spinal fracture with spinal cord injury[J]. Chinese Journal of Robotic Surgery, 2024, 5(2): 194-198.

[1] Mazzone G L, Coronel M F, Mladinic M, et al. An update to pain management after spinal cord injury: from pharmacology to circRNAs[J]. Rev Neurosci, 2022, 34(6): 599-611.

[2] Myers M A, Hall S, Wright A, et al. Spinal fractures incurred by sports-related injuries[J]. World Neurosurg, 2021. DOI: 10.1016/j.wneu.2021.04.111. 

[3] 冯俊飞 , 何江涛 . 脊髓圆锥损伤诊断与治疗的进展 [J]. 临床骨科杂志 , 2019, 22(6): 758-761. 

[4] Funayama T, Tsukanishi T, Fujii K, et al. Characteristic imaging findings predicting the risk of conservative treatment resistance in fresh osteoporotic vertebral fractures with poor prognostic features on magnetic resonance imaging.[J]. J Orthop Sci, 2022, 27(2): 579-584. 

[5] LIU B C, GAO Y T, YE K F, et al. Cervical spine fracture prediction by simple plain X-ray in ankylosing spondylitis patients after low-energy trauma.[J]. Orthop Surg, 2022, 14(11): 2939-2946. 

[6] Poullain F, Champsaur P, Pauly V, et al. Vertebral trabecular bone texture analysis in opportunistic MRI and CT scan can distinguish patients with and without osteoporotic vertebral fracture: a preliminary study[J]. Eur J Radiol, 2023. DOI: 10.1016/j.ejrad.2022.110642. 

[7] 周德明 , 颉奎 , 张涛 , 等 . X 线平片、螺旋 CT、 MRI 检查在脊柱骨折临床诊断中的应用价值 [J]. 中 国医学创新 , 2020, 17(5): 109-112. 

[8] 包乾录 , 王力军 , 杨豪 . 外周血 miR-124 和 TNF-α 水平检测对创伤性脊柱骨折合并脊髓损伤的诊断 价值 [J]. 中国实用医刊 , 2020, 47(11): 54-57. 

[9] Sousa A, Rodrigues C, Barros L, et al. Early versus late spine surgery in severely injured patients-which is the appropriate timing for surgery?[J]. Global Spine J, 2021, 12(8): 2192568221989292. 

[10] Ahern D P, McDonnell J, Doinn T Ó, et al. Timing of surgical fixation in traumatic spinal fractures: a systematic review[J]. The Surgeon, 2020, 18(1): 37-43. 

[11] 经亚威 , 徐继胜 , 陈坤峰 , 等 . 急诊手术与择期手 术对胸腰椎骨折伴脊髓神经损伤患者神经功能的 影响对比 [J]. 四川解剖学杂志 , 2020, 28(4): 83-84. 

[12] Pransky J. ROBODOC-surgical robot success story[J]. Industrial Robot, 1997, 24(3): 231-233. 

[13] Wolf A, Jaramaz B, Lisien B, et al. MBARS: mini boneattached robotic system for joint arthroplasty[J]. Int J Med Robot, 2005, 1(2): 101-121. 

[14] 梁国穗 , 王军强 . 外科机器人的发展历程及临床应 用 [J]. 中华骨科杂志 , 2006, 26(10): 707-710. 

[15] Kantelhardt S R, Martinez R, Baerwinkel S, et al. Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement[J].Eur Spine J, 2011, 20(6): 860-868. 

[16] 王亚楠 , 刘海军 , 邵诗泽 , 等 . Renaissance 脊柱手 术机器人在胸腰椎骨折中的临床应用 [J]. 脊柱外科 杂志 , 2021, 19(2): 89-93. 

[17] 刘建全 , 刘黎军 , 黄俊锋 , 等 . 机器人导航定位系 统辅助下经皮空心螺钉内固定治疗股骨颈骨折 [J]. 中华创伤骨科杂志 , 2015, 17(8): 692-698. 

[18] 田伟 , 张琦 , 李祖昌 , 等 . 一站对多地 5G 远程控制 骨科机器人手术的临床应用 [J]. 骨科临床与研究杂 志 , 2019, 4(6): 349-354. 

[19] 吴瑞 , 周纪平 , 杨凯 , 等 . 脊柱手术机器人在胸腰椎 骨折微创手术中的应用 [J]. 中国骨伤 , 2022, 35(2): 118-122. 

[20] Devito D P, Kaplan L, Dietl R, et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study[J]. Spine(Phila Pa 1976), 2010, 35(24): 2109-2115. 

[21] 于笑笙 , 陈修远 , 陈皓 , 等 . 骨科机器人辅助微创 精准手术治疗胸腰段骨折的初步经验 [J]. 脊柱外科 杂志 , 2020, 18(6): 369-375. 

[22] 郭松 , 付强 , 杭栋华 , 等 . Mazor 脊柱机器人辅助改 良经皮椎体成形术治疗腰椎骨质疏松性骨折的疗效 分析 [J]. 中国脊柱脊髓杂志 , 2021, 31(9): 818-824. 

[23] 范明星 , 刘亚军 , 段芳芳 , 等 . 机器人辅助胸腰椎 椎弓根螺钉内固定术的学习曲线和临床意义 [J]. 骨 科临床与研究杂志 , 2018, 3(4): 213-217. 

[24] Meshkini A, Sarpoolaki M K, Vafaei A, et al. The efficacy of intrathecal methyl-prednisolone for acute spinal cord injury: a pilot study[J]. Heliyon, 2023, 9(4): e15548. 

[25] 王侃 , 朱泽宇 , 朱德生 , 等 . 外骨骼机器人在下肢 运动障碍患者中的临床研究进展 [J]. 中华神经科杂 志 , 2020, 53(6): 454-459. 

[26] 腾明辉 , 郑幼珍 , 蒙爱逊 . 下肢智能康复机器人联 合 PNF 技术在不完全性截瘫脊髓损伤患者中的应 用价值研究 [J]. 反射疗法与康复医学 , 2022(2): 41- 44, 48. 

[27] 姚嘉欣 , 李哲 . 下肢康复机器人在脊髓损伤康复中 的应用 [J]. 中国现代医生 , 2020, 58(35): 187-192. 

[28] 向小娜 , 宗慧燕 , 何红晨 . 下肢外骨骼康复机器人 对脊髓损伤患者步行能力改善的研究进展 [J]. 中国 康复医学杂志 , 2020, 35(1): 119-122. 

[29] 石芝喜 , 蔡朋 , 刘明检 , 等 . 下肢步行机器人对脊 髓损伤后日常生活能力及步行能力的影响 [J]. 中国 康复 , 2018, 33(3): 211-214. 

[30] 王锋 , 李靖龙 . 下肢外骨骼机器人在脊髓损伤中 的应用研究进展 [J]. 实用医学杂志 , 2022, 38(23): 3012-3016. 

[31] 杨瑞雪 , 王佳 , 李坚 , 等 . 机器人辅助步态训练对 完全性脊髓损伤患者功能状态、行走和生活质量 的影响 [J]. 颈腰痛杂志 , 2022, 43(6): 885-887. 

[32] 李勇强 , 张霞 , 邱怀德 , 等 . 下肢康复机器人用于 治疗中枢神经损伤的研究进展 [J]. 中国康复医学杂 志 , 2023, 38(7): 1012-1016. 

[33] SUN X P, SHI J J, BAO Y, et al. Safety and effectiveness of electromyography-induced rehabilitation treatment after epidural electrical stimulation for spinal cord injury: study protocol for a prospective, randomized, controlled trial[J]. Neural Regen Res, 2023, 18(4): 819-824. 

[34] GarcíaAlén L, Kumru H, CastilloEscario Y, et al. Transcutaneous cervical spinal cord stimulation combined with robotic exoskeleton rehabilitation for the upper limbs in subjects with cervical SCI: clinical trial[J]. Biomedicines, 2023, 11(2): 589.