机器人辅助MIS-TLIF手术治疗腰椎退行病的初步结果  

Primary outcomes of robot-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases

作　　者：姜树东 郭函[1] 梁得华 张彤童 刘正[1] 任龙喜[1] JIANG Shu-dong;GUO Han;LIANG De-hua;ZHANG Tong-tong;LIU Zheng;REN Long-xi(Department of Spinal Surgery,Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]清华大学附属垂杨柳医院脊柱关节外科,100022

出　　处：《中国矫形外科杂志》2020年第7期586-591,共6页Orthopedic Journal of China

摘　　要：[目的]通过比较传统与机器人辅助MIS-TLIF的临床效果,探讨骨科手术机器人辅助完成腰椎MIS-TLIF手术的应用价值。[方法]回顾性分析本院行MIS-TLIF手术治疗的32例单节段退行性腰椎疾病患者临床资料,其中传统MIS-TLIF组20例,机器人MIS-TLIF组12例。比较两组的临床和影像资料。[结果]32例患者手术均顺利完成,两组患者均未发生血管、神经损伤等严重并发症,机器人组无早期并发症。而传统组术中定位错误1例;硬膜囊撕裂1例;硬膜外血肿1例。与传统组相比,机器人组手术时间显著缩短,手术出血量明显减少(P<0.05)。32例患者随访5~10个月,两组患者末次随访时VAS和ODI评分均较术前显著降低(P<0.05),但是,相同时间点两组间VAS和ODI评分的差异均无统计学意义(P>0.05)。末次随访时根据Macnab评价标准,机器人组:优5例,良6例,可1例,优良率为91.67%(11/12);传统MIS-TLIF组:优8例,良10例,可2例,优良率为90.00%(18/20)。两组间差异无统计学意义(P>0.05)。影像评估方面,机器人组的置钉准确性显著优于传统组(P<0.05)。[结论]机器人辅助下MIS-TLIF治疗单节段退行性腰椎疾病可取得与传统MIS-TLIF相同的临床疗效。骨科手术机器人辅助MIS-TLIF可缩短手术时间、降低并发症。[Objective]To evaluated the significance of robot used in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)by comparing the clinical outcomes of traditional and robot-assisted MIS-TLIFs for degenerative lumbar diseases.[Methods]A retrospective study was conducted on 32 patients who underwent MIS-TLIF for single segment degenerative lumbar diseases.Of them,20 patients received traditional MIS-TLIF,while the remaining 12 patients underwent robot-assisted MIS-TLIF.The clinical and radiographic data were compared between the two groups.[Results]All the 32 patients had surgical procedures performed smoothly without iatrogenic neurovascular injuries.No early serious complications happened in anyone of the robot group,whereas positioning error in 1 case,dural tear in 1 case and epidural hematoma in 1 case occurred in the traditional group.Compared with the traditional group,the robot group had significantly decreased operation time and intraoperative blood loss(P<0.05).All the 32 patients were followed up for 5~11 months.The VAS and ODI scores significantly decreased at latest follow up compared with those before operation in both groups(P<0.05),although no significant differences in the 2 scores were proved at any matching time point between the two groups(P>0.05).According to Macnab criteria at the latest follow up,the clinical consequences were graded as excellent in 7,good in 3 and fair in 2 with excellent and good rate of91.67%(11/12)in the robot group,whereas excellent in 11,good in 6 and fair in 3 with excellent and good rate of 90.00%(18/20)in the traditional group,which was not statistically significant(P>0.05).In term of radiographic assessment,the robot group proved significantly superior to the traditional group regarding to the accuracy of pedicle screw placement(P>0.05).[Conclusion]The robot-assisted MIS-TLIF owns the same efficacy as traditional X-ray assisted MIS-TLIF in the treatment of single level degenerative lumbar diseases.In comparation,this new technique does decrease the operat

关 键 词：机器人 微创手术 腰椎 椎间融合术 

分 类 号：R681.57[医药卫生—骨科学]