机器人辅助微创通道下经椎间孔椎间融合术治疗单节段腰椎间盘突出症的临床疗效  

Clinical effects of robot-assisted minimal invasive transforaminal lumbar interbody fusion in the treatment of single-segment lumbar disc herniation

作　　者：姜超 张永远 王晓晖 陈喆 王仝昊 王致远 田方 卢庆[1] 尹思[2] 杜恒[2] 郝定均[1] JIANG Chao;ZHANG Yongyuan;WANG Xiaohui;CHEN Zhe;WANG Tonghao;WANG Zhiyuan;TIAN Fang;LU Qing;YIN Si;DU Heng;HAO Dingjun(Department of Spine Surgery,Honghui Hospital of Xi’an Jiaotong University,Xi’an 710054;Department of Orthopedics,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;The First Department of Traumatic Orthopedics,Baoji Hospital of Traditional Chinese Medicine,Baoji 721001,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,陕西西安710054 [2]西安交通大学第一附属医院骨科,陕西西安710061 [3]宝鸡市中医医院骨伤一科,陕西宝鸡721001

出　　处：《西安交通大学学报（医学版）》2022年第5期713-719,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金重点项目资助(No.81830077)。

摘　　要：目的比较机器人辅助微创通道下经椎间孔椎间融合术(robot-assisted minimal invasive transforaminal lumbar interbody fusion,RA-MIS-TLIF)与微创通道下经椎间孔椎间融合术(minimal invasive transforaminal lumbar interbody fusion,MIS-TLIF)治疗单节段腰椎间盘突出症的临床效果及术中置钉准确率。方法回顾性收集2018年1月至2019年8月西安交通大学附属红会医院收治的69例单节段腰椎间盘突出症患者的临床资料,其中RA组应用RA-MIS-TLIF,共33例,MIS-TLIF组应用MIS-TLIF,共36例。收集患者年龄、性别、体质指数、是否合并糖尿病、症状持续时间等一般资料,记录手术时间、术中出血量、术中透视次数、置钉准确率、伤口引流量、住院时间、术后并发症及融合率等围手术期相关指标,评估患者术前及术后3 d、6个月、12个月及末次随访的下腰痛疼痛视觉模拟评分(visual analogue scale,VAS)、下肢痛VAS评分和腰椎日本骨科学会评分(Japanese Orthopaedic Association Scores,JOA)。结果RA组与MIS-TLIF组患者均顺利完成手术,术后随访时间[(14.82±1.83)月vs.(15.11±1.62)月]差异无统计学意义(P>0.05)。RA组的术中出血量[(116.67±18.48)min vs.(128.06±22.53)min]、术中透视次数[(12.42±2.28)vs.(15.67±2.46)]、置钉准确率(93.18%vs.84.03%)、伤口引流量[(73.03±23.52)mL vs.(88.33±28.54)mL]、伤口引流管拔除时间[(39.76±9.34)h vs.(44.97±10.84)h]、住院时间[(6.45±1.52)d vs.(7.69±1.85)d]均小于MIS-TLIF组,差异具有统计学意义(P<0.05),而两组手术时间差异无统计学意义(P>0.05)。两组患者术后下腰痛、下肢痛VAS及腰椎JOA评分均较术前改善且差异具有统计学意义(P<0.001),但两组之间同一时间点各指标差异未见统计学意义(P>0.05);两组患者的融合率及并发症的发生率差异未见统计学意义(P>0.05)。结论RA-MIS-TLIF和MIS-TLIF的临床效果均良好,但前者可减少术中出血、术中透视次数、提高置钉准确率Objective To compare the clinical effects and screw placement accuracy for treating lumbar disc herniation between robot-assisted minimal invasive transforaminal lumbar interbody fusion(RA-MIS-TLIF)and minimal invasive transforaminal lumbar interbody fusion(MIS-TLIF).Methods We retrospectively recruited 69 patients with single segment lumbar disc herniation treated between January 2018 and August 2019 at Honghui Hospital of Xi’an Jiaotong University.There were cases of 33 RA-MIS-TLIF(RA group)and 36 MIS-TLIF(MISTLIF group).Subsequently,the patients’baseline characteristics were collected,including age,gender,body mass index,complication with diabetes,duration of symptoms,operated segment,and follow-up time.We also collected perioperative parameters such as operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,wound drainage,hospitalization duration,postoperative complicatins,and fusion rate.Lower back pain,lower extremity pain visual analogue score(VAS),and lumbar Japanese Orthopaedic Association Scores(JOA)were obtained preoperatively,postoperative 3 days/6 months/12 months,and the last follow-up.Results All the procedures were successfully completed and the follow-up time was 14.82±1.83(RA group)and15.11±1.62(MIS-TLIF group)months,without significant difference(P>0.05).Compared with MIS-TLIF group,RA group had less intraoperative blood loss[(116.67±18.48)min vs.(128.06±22.53)min],fluoroscopy frequency[(12.42±2.28)vs.(15.67±2.46)],screw placement accuracy(93.18%vs.84.03%),postoperative drainage[(73.03±23.52)mL vs.(88.33±28.54)mL],and shorter hospitalization stay[(6.45±1.52)d vs.(7.69±1.85)d](all P<0.05).However,operation time did not significantly differ(P>0.05).The VAS of lower back pain and lower extremity pain,and lumbar JOA were significantly improved after the operation(P<0.001).At the same time point,there was no significant difference between the two groups(P>0.05).Meanwhile,fusion rate and incidence of complications did not significantly diff

关 键 词：机器人 腰椎间盘突出症 微创通道下经椎间孔椎间融合术 置钉准确性 

分 类 号：R687.3[医药卫生—骨科学] R681[医药卫生—外科学]