机器人与透视下辅助经椎间孔椎体间融合术治疗腰椎间盘突出症的病例对照研究  

A case-control study of minimally invasive transforaminal interbody fusion with the assistance of robot and traditional fluoroscopy in the treatment of single-space lumbar disc herniation

作　　者：陈豪杰 黄小强[1,3] 高林 张嘉男[1] 刘世长 陈林娜 郝定均 张子龙[2] 乔瑞 杨佳瑞 CHENHao-jie;HUANG Xiao-qiang;GAO Lin;ZHANG Jia-nan;LIU Shi-chang;CHEN Lin-na;HAO Ding-jun;ZHANG Zi-long;QIAO Rui;YANG Jia-rui(不详;Department of Orthopaedics,Red Cross Hospital Affiliated to Xi'an Jiaotong University,Xi’an710054,Shaanxi,China)

机构地区：[1]西安交通大学附属红会医院骨科,陕西西安710054 [2]西安医学院,陕西西安710068 [3]西安市第五人民医院,陕西西安710082

出　　处：《中国骨伤》2022年第2期101-107,共7页China Journal of Orthopaedics and Traumatology

基　　金：陕西省重点研发计划资助项目(编号:2019SF-192)。

摘　　要：目的:比较透视与机器人辅助下微创经椎间孔椎体间融合术(minimal invasive transforaminal lumbarinterbody fusion,MIS-TLIF)治疗单间隙腰椎间盘突出症的安全性与置钉准确性。方法:回顾性分析2019年3月至2020年2月采用MIS-TLIF手术方式治疗的52例单间隙腰椎间盘突出症临床资料。其中24例患者采用脊柱机器人辅助MIS-TLIF治疗(A组);28例患者采用透视下辅助MIS-TLIF治疗(B组)。记录两组患者术中出血量,手术时间,术中透视次数,手术前后视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分以及手术相关并发症。术后通过CT平扫采用Gertzbein-Robbins对螺钉精准度进行评级。其中A级和B级被评估为满意置钉,C、D、E级被评估为置钉错误,采用Babu等方法评估螺钉对上关节突的侵犯情况。结果:A组手术时间、术中出血量及术中透视次数均少于B组(P<0.05)。末次随访所有患者VAS及JOA评分较术前明显改善(P<0.05),但组间比较差异无统计学意义(P>0.05)。A、B组置入螺钉分别为96枚和112枚。术后3 d根据Gertzbein-Robbins分类法评估两组置钉精准度,A组中A级90枚,B级5枚,C级1枚,无D、E级置钉;B组中A级84枚,B级16枚,C级8枚,D级4枚,无E级置钉;两组比较差异有统计学意义(Z=-3.709,P=0.000)。A组满意置钉率为98.96%(95/96);B组满意置钉率为89.29%(100/112),两组比较差异有统计学意义(χ^(2)=8.254,P=0.004)。术后3 d根据Babu等方法评估椎弓根螺钉对上关节突关节侵犯情况,其中A组0级90枚,1级4枚,2级2枚,3级0枚;B组0级86枚,1级12枚,2级10枚,3级4枚,两组比较差异有统计学意义(Z=-3.433,P=0.001)。两组患者均未出现因置钉失误造成的严重脊髓、神经及血管损伤及其他手术相关并发症。两组患者均获随访,时间6~12(9.06±1.60)个月。术后神经症状均改善良好,随访期间未见症状复发及内固定松动、断裂的情况。结论:与透视下Objective:To compare the safety and nail placement accuracy of fluoroscopy-assisted and robot-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single-space lumbar disc herniation.Methods:The clinical data of 52 patients with single-space lumbar disc herniation treated by MIS-TLIF from March 2019 to February 2020 were retrospectively analyzed.Among them,24 patients were treated by robot-assisted MIS-TLIF(group A)and 28 patients were treated by fluoroscopy-assisted MIS-TLIF(group B).The intraoperative blood loss,operation time,intraoperative fluoroscopy times,preoperative and postoperative visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)scores and operation-related complications were recorded in two groups.Gertzbein-Robbins grade according to CT scan was used to evaluate the nail placement after operation.Grade A and B were evaluated as satisfactory nail placement,and grade C,D,and E were evaluated as error placement.Babu's method was used to evaluate the screw's invasion to the superior articularprocess.Results:The operation time,intraoperative blood loss and intraoperative fluoroscopy times in group A were less than those in group B(P<0.05).VAS and JOA scores of all patients at the final follow-up were significantly improved compared with those before operation(P<0.05),but there was no statistically significant difference between the groups(P>0.05).There were 96 and 112 screws in group A and group B,respectively.Three days after operation,according to the Gertzbein-Robbins grade to evaluate the nail placement accuracy,there were 90 screws of grade A,5 of grade B,1 of grade C,no grade D and E in group A;there were 84 screws of grade A,16 of grade B,8 of grade C,4 of grade D,no grade E in group B;the difference between two groups was statistically significant(Z=-3.709,P=0.000).The satisfactory rate of screw placement in group A was 98.96%(95/96),and that of group B was 89.29%(100/112),the difference between two groups was statistically significant(χ^(2

关 键 词：机器人 脊柱融合术 椎间盘移位 病例对照研究 

分 类 号：R681.5[医药卫生—骨科学]