单侧减压机器人辅助微创经椎间孔腰椎间融合治疗影像学双侧腰椎管狭窄  

Robot-assisted unilateral-decompression minimally invasive transforaminal lumbar interbody fusion for radiographic bilateral lumbar stenosis

作　　者：姜树东 任龙喜[1] 郭函[1] 梁得华 张彤童 刘正[1] Jiang Shudong;Ren Longxi;Guo Han;Liang Dehua;Zhang Tongtong;Liu Zheng(Department of Spinal Surgery,Chui Yang Liu Hospital Affiliated to Tsinghua University,Beijing 112200,China)

机构地区：[1]清华大学附属垂杨柳医院脊柱外科,北京市112200

出　　处：《中国组织工程研究》2020年第24期3797-3802,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:老年退变性腰椎管狭窄症患者常见双侧神经根管狭窄仅表现为一侧症状,对于无症状或者症状较轻的一侧是否需要减压、如何实施减压手术仍存在争议。目的:回顾性分析双侧腰椎管狭窄但仅有单侧症状且只行单侧入路机器人辅助微创经椎间孔腰椎间融合的病例,比较术前、术后的临床减压效果及影像学变化,分析单侧减压的安全性和有效性。方法:回顾分析同一治疗组采用机器人辅助完成微创经椎间孔腰椎间融合治疗的腰椎管狭窄病例,特点是影像学表现为双侧狭窄,但仅表现为单侧症状,仅行症状侧单侧减压、椎间融合双侧固定。记录手术时间、术中出血量、手术并发症发生情况;测量术前、术后椎管横截面积、椎间孔高度、椎间隙高度、腰椎生理前凸角等;术前、术后采用目测类比评分分别对腰痛及下肢痛进行评估;采用Oswestry功能障碍指数评估腰椎功能;术后末次随访时采用Macnab标准评价疗效。结果与结论:①患者手术时间110-235 min,平均169.4 min;术中出血量70-180 mL,平均112.4 mL;②随访3-8个月,患者术后1个月及末次随访时的腰痛、下肢痛目测类比评分均显著低于术前(P均<0.01);③患者术后1个月及末次随访时的Oswestry功能障碍指数均显著低于术前(P均<0.01);④末次随访采用Macnab标准评价临床效果,其中优15例,良17例,可3例,优良率为91%;⑤患者术后椎管面积、椎间孔高度及椎间隙高度均较术前明显增大,差异有显著性意义(P均<0.01);腰椎前凸角较术前有所增大,但差异无显著性意义(P>0.05);⑥提示采用单侧减压机器人辅助微创经椎间孔腰椎间融合治疗仅表现为单侧症状的双侧腰椎管狭窄症患者,可获得满意疗效。BACKGROUND:In the elderly patients with degenerative lumbar spinal stenosis,bilateral nerve root canal stenosis commonly shows only one side of symptoms.There is still controversy about whether or not decompression is needed on the side without symptoms or with less symptoms and how to operate.OBJECTIVE:To explore the safety and efficacy of robot-assisted unilateral-decompression using minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)technique by investigating a series of cases with the radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms and by comparing clinical decompression effect and imaging changes before and after operation.METHODS:Cases with radiographic bilateral lumbar canal stenosis presenting with unilateral symptoms subjected to unilateral decompression on the affected side,interbody fusion and bilateral fixation after robot-assisted MIS-TLIF in the same treatment group were retrospectively analyzed.Operation time,intraoperative blood loss and complications were recorded.The vertebral canal cross-sectional area,intervertebral foramen height,intervertebral space height,and lumbar lordosis angle were examined before and after surgery.Visual analogue scale scores for low back pain and leg pain were assessed before and after surgery.Oswestry disability index was used to assess lumbar function before and after surgery.Macnab criteria were used to evaluate the efficacy at the final follow-up after surgery.RESULTS AND CONCLUSION:(1)Operation time was 110-235 minutes,averagely 169.4 minutes.Intraoperative blood loss was 70-180 mL,averagely 112.4 mL.(2)After 3-8 months of follow-up,the visual analogue scale scores of low back pain and lower extremity pain 1 month after surgery and in final follow-up were significantly lower than those before operation(both P<0.01).(3)Oswestry disability index 1 month after surgery and in final follow-up was significantly lower than that before operation(both P<0.01).(4)In the final follow-up,MacNab criteria results showed that cli

关 键 词：腰椎管狭窄症 单侧减压 微创 经椎间孔腰椎间融合 机器人 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]