目的：探究机器人辅助椎弓根螺钉内固定术对无神经损伤胸腰椎骨折患者的临床疗效及其影响因素。方法：选取2021年 1 月—2024 年 3 月在北京市平谷区医院行机器人辅助椎弓根螺钉内固定术的 149 例无神经损伤胸腰椎骨折患者为研究对 象，依据其术后临床疗效分为发生组（n=25，临床疗效不佳）和未发生组（n=124，临床疗效良好）。对比两组患者临床 相关资料，针对差异指标进行共线性分析，未存在共线性问题的指标纳入 Logistic 回归模型中分析患者术后疗效不佳的 相关因素，并构建临床预测模型，通过绘制受试者工作特征（ROC）曲线评估列线图模型的预测能力。结果：两组患者 亚洲人骨质疏松自我筛查工具（OSTA）指数、术前椎体压缩程度、骨密度、术后早期负重、异体红细胞输注、术前白蛋 白浓度对比存在显著差异（P<0.05）。采用 R 语言将所有差异变量进行 VIF 共线性分析，各差异变量 VIF ≤ 10，容忍度 ≥ 0.1，不存在共线性问题。将上述指标纳入 Logistic 回归模型中，结果发现术前椎体压缩程度、术后早期负重、异体红 细胞输注、术前白蛋白浓度为术后临床疗效不佳发生的危险因素（P<0.05），OSTA 指数、骨密度为临床疗效不佳发生的 保护因素（P<0.05）。建立列线图预测模型，ROC 曲线下面积（AUC）值为 0.948，表示该模型具有较好的风险预测度。 结论：OSTA 指数、术前椎体压缩程度、骨密度、术后早期负重、异体红细胞输注、术前白蛋白浓度均为影响无神经损伤胸 腰椎骨折患者术后临床疗效的独立影响因素，通过上述指标能够为临床术前筛查高危群体并采取相关措施提供理论参考依据。

Objective: To explore impact factors on clinical efficacy of robot-assisted pedicle screw internal fixation in thoracolumbar fracture patients without nerve injury. Methods: 149 thoracolumbar fracture patients without nerve injury who underwent robot-assisted pedicle screw internal fixation in Beijing Pinggu Hospital from January 2021 to March 2024 were selected. They were divided into the occurrence group (n=25, poor clinical outcomes) and the non-occurrence group (n=124, good clinical outcomes) based on the different clinical outcomes. Clinical data of the two groups of patients were compared to analyze the collinearity for the different indicators, and the indicators without collinearity were included in the logistic regression model to analyze the factors related to the poor postoperative outcomes by constructing a clinical prediction model, and the receiver operating characteristic (ROC) curves was drawn to assess the predictive ability of the model. Results: Significant differences were found in the Osteoporosis Self-screening Tool for Asians (OSTA) index, preoperative vertebral compression, bone mineral density, early postoperative weight-bearing, allogeneic red blood cell transfusion, and preoperative albumin concentration between the two groups of patients (P<0.05). The above difference variables were subjected to VIF collinearity analysis using the R language, and there was no collinearity for each difference variable with VIF ≤ 10 and tolerance ≥ 0.1. These variables were included in a logistic regression model, and it was found that the degree of preoperative vertebral compression, early postoperative weight-bearing, allogeneic red blood cell transfusion, and preoperative albumin concentration were all risk factors for poor postoperative clinical outcomes (P<0.05), and the OSTA index and bone mineral density were all protective factors for poor clinical outcomes (P<0.05). The nomogram prediction model was developed, and the area under the ROC curve (AUC) was 0.948, indicated that the model had a good degree of risk prediction. Conclusion: OSTA index, preoperative vertebral compression, bone mineral density, early postoperative weight-bearing, allogeneic red blood cell transfusion, and preoperative albumin concentration are all independent factors affecting the postoperative clinical outcomes of thoracolumbar fracture patients, and the above indicators can provide theoretical reference for preoperative screening of high-risk groups and the adoption of relevant measures.

基金项目：平谷区医院科研项目（pgyyqn2024-02） 

Foundation Item: Pinggu District Hospital Scientific Research Project (pgyyqn2024-02) 

引用格式：王彭，张德光 . 机器人辅助椎弓根螺钉内固定术对无神经损伤胸腰椎骨折患者临床疗效的影响因素分析 [J]. 机器人外科学杂志（中 英文），2025，6（2）：222-228，234. 

Citation: WANG P, ZHANG D G. Impact factors on the clinical efficacy of robot-assisted pedicle screw internal fixation in thoracolumbar  fracture patients without nerve injury[J]. Chinese Journal of Robotic Surgery, 2025, 6(2): 222-228, 234. 

通讯作者（Corresponding Author）：王彭（WANG Peng），Email：deihuaipeng@163.com

[1] 杨海青 , 李海波 , 张瑞 , 等 . 定量 CT 骨性影像学参数和骨密度对 胸腰椎骨折患者 PVP 术后继发骨折的预测效能 [J]. 临床误诊误治 , 2024, 37(9): 78-83. 

[2] Blixt S, Burmeister F, Mukka S, et al. Reliability of thoracolumbar burst fracture classification in the Swedish Fracture Register[J]. BMC Musculoskelet Disord, 2024, 25(1): 281. 

[3] TIAN D S, ZHONG H Z, ZHU B, et al.Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report[J]. J Orthop Surg Res, 2023, 18(1): 584. 

[4] Gavira N, Amelot A, Cook A R, et al.Thoracolumbar spinal fracture in children: Conservative or surgical treatment?[J]. Neurochirurgie, 2022, 68(3): 309-314. 

[5] Trungu S, Ricciardi L, Forcato S, et al. Percutaneous pedicle screw fixation without arthrodesis of 368 thoracolumbar fractures: long-term clinical and radiological outcomes in a single institution[J]. Eur Spine J, 2023, 32(1): 75-83. 

[6] Sezer C, Sezer C.Pedicle screw fixation with percutaneous vertebroplasty for traumatic thoracolumbar vertebral compression fracture[J]. Niger J Clin Pract, 2021, 24(9): 1360-1365. 

[7] Masson D, Mezjan I, Pretat P H, et al. Mono-segmental percutaneous screw fixation in the management of AoSpine thoracolumbar type B fracture in patients with ankylosing spondylitis: a new treatment[J]. Neurochirurgie, 2023, 69(5): 101464. 

[8] LU Q L, KANG H, XIONG C J, et al.Percutaneous uniplanar pedicle screw-rod system with injured vertebra fixation for thoracolumbar burst fracture and technique notes[J]. J Coll Physicians Surg Pak, 2022, 32(10): 1295-1299. 

[9] 茅剑平 , 李祖昌 , 范明星 , 等 . 机器人辅助与徒手椎弓根螺钉置入在 胸腰椎骨折手术中的精度及手术即时效果的比较 [J]. 中国微创外科 杂志 , 2020, 20(6): 534-539. 

[10] Moon M S, Yu C G, Jeon J M, et al.Usefulness of percutaneous pedicle screw fixation for treatment of lower lumbar burst(A3-A4)fractures: comparative study with thoracolumbar junction fractures[J]. Indian J Orthop, 2023, 57(9): 1415-1422. 

[11] LU J, CHEN Y N, HU M W, et al.Systematic review and meta-analysis of the effect of using percutaneous pedicle screw internal fixation for thoracolumbar fractures[J]. Ann Palliat Med, 2022, 11(1): 250-259. 

[12] 中国高血压防治指南修订委员会 , 高血压联盟 ( 中国 ), 中华医学会 心血管病学分会中国医师协会高血压专业委员会 , 等 . 中国高血压 防治指南 (2018 年修订版 )[J]. 中国心血管杂志 , 2019, 24(1): 24-56. 

[13] 中华医学会糖尿病学分会 . 中国 2 型糖尿病防治指南 (2020 年版 )[J]. 中华内分泌代谢杂志 , 2021, 37(4): 311-398. 

[14] 中华医学会外科学分会外科感染与重症医学学组 , 中国医师协会外 科医师分会肠瘘外科医师专业委员会 . 中国手术部位感染预防指南 [J]. 中华胃肠外科杂志 , 2019, 22(4): 301-314.

[15] Azizi A, Azizzadeh A, Tavakoli Y, et al.Thoracolumbar fracture and spinal cord injury in blunt trauma: a systematic review, meta-analysis, and metaregression[J]. Neurosurg Rev, 2024, 47(1): 333. 

[16] Prajapati H P, Kumar R. Thoracolumbar fracture classification: evolution, merits, demerits, updates, and concept of stability[J]. Br J Neurosurg, 2021, 35(1): 92-97. 

[17] 阎凯 , 张琦 , 刘波 , 等 . 天玑Ⅱ机器人辅助胸腰椎椎弓根螺钉内固定 术的临床应用 [J]. 北京生物医学工程 , 2022, 41(3): 297-301. 

[18] Kapoen C, Liu Y, Bloemers F W, et al. Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level-a systematic review and meta-analysis[J]. Eur Spine J, 2020, 29(10): 2491-2504. 

[19] XU L, LIN X, WU C, et al. Is unilateral pedicle screw fixation as effective as bilateral pedicle screw fixation in transforaminal lumbar interbody fusion: a meta-analysis of randomized controlled trials[J]. Eur Spine J, 2023, 32(2): 700-711. 

[20] 张林 , 陈晓钢 , 季沐梵 , 等 . 术前椎体压缩程度联合骨密度对胸腰椎 骨折椎弓根螺钉内固定术后椎体高度再丢失的预测 [J]. 河北医科大 学学报 , 2023, 44(3): 274-278. 

[21] 范鑫 , 陈国军 , 李顺东 . 青娥丸方防治骨质疏松性椎体压缩性骨折 行球囊扩张椎体后凸成形术后椎体高度再丢失临床研究 [J]. 新中医 , 2023, 55(5): 130-135. 

[22] 温羡宏 , 张国烈 , 谢浩亮 , 等 . 椎弓根钉内固定结合骨水泥灌注治疗 胸腰椎爆裂骨折 [J]. 颈腰痛杂志 , 2007, 28(6): 487-489. 

[23] 中华医学会骨质疏松和骨矿盐疾病分会 . 原发性骨质疏松症诊疗指 南 (2017)[J]. 中国全科医学 , 2017, 20(32): 3963-3982. 

[24] 申科律 , 计李超 , 成茂华 , 等 . 胸腰椎骨折椎弓根螺钉内固定术后椎 体高度再丢失的相关影响因素分析 [J]. 中华创伤杂志 , 2021, 37(11): 990-996. 

[25] 袁航 , 杨永竑 , 谢亚明 . 骨质疏松性椎体压缩骨折 PKP 术后伤椎 高度丢失的相关因素分析 [J]. 中国骨与关节损伤杂志 , 2021, 36(5): 456-460. 

[26] 包欣南 , 吴采荣 . 经椎弓根椎体支柱块置入治疗胸腰椎骨折的短期 疗效观察 [J]. 中华创伤杂志 , 2010, 26(9): 822-825. 

[27] 夏青 , 朱浩 , 李锋 . 异体红细胞输注与胸腰椎骨折内固定术后感染的 关系研究 [J]. 颈腰痛杂志 , 2021, 42(6): 815-817. 

[28] 穆雪萌 , 张恒岩 , 张保中 , 等 . 髋部骨折术后手术部位感染的危险因 素分析及列线图预测模型的建立 [J]. 中华骨与关节外科杂志 , 2024, 17(7): 616-621. 

[29] Rentenberger C, Okano I, Salzmann S N, et al.Perioperative risk factors for early revisions in stand-alone lateral lumbar interbody fusion[J]. World Neurosurg, 2020.DOI: 10.1016/j.wneu.2019.10.164. Epub 2019 Nov 4. 

[30] 徐宵寒 , 虞雪融 , 黄宇光 . 围术期异体红细胞输注与术后感染相关性 分析的研究进展 [J]. 中国医学科学院学报 , 2022, 44(3): 497-503. 

[31] Cutrell J B, Barros N, McBroom M, et al.Risk factors for deep sternal wound infection after cardiac surgery: Influence of red blood cell transfusions and chronic infection[J]. Am J Infect Control, 2016, 44(11): 1302-1309.