微创脊柱融合手术两种辅助置钉方法的对比研究  

Comparative Study between Two Methods of Assisted Pedicle Screw Fixation on Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion

作　　者：侯海涛 申霞 张翔 邵诗泽 席焱海 孙金星 HOU Haitao;SHEN Xia;ZHANG Xiang;SHAO Shize;XI Yanhai;SUN Jining(Department of Spine and Spinal Cord,Shandong Wendeng Osteopathic Hospital,Weihai 264400,Shandong China;The Operating Room,Shandong Wendeng Osteopathic Hospital,Weihai 264400,Shandong China;Department of Spine Surgery,Shanghai Changzheng Hospital,Shanghai 200003,China)

机构地区：[1]山东省文登整骨医院脊柱脊髓科,山东威海264400 [2]山东省文登整骨医院手术室 [3]上海长征医院脊柱外科

出　　处：《中国中医骨伤科杂志》2022年第11期38-43,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

摘　　要：目的:比较微创经椎间孔入路腰椎椎间融合术(MIS-TILF)中Renaissance脊柱手术机器人辅助与X线透视引导下(Fluoroscopic-Guided,FG)的并发症和翻修率。方法:对98例行MIS-TILF的患者进行回顾性研究,分为研究组Renaissance组(R组)和对照组(FG组)。R组49例,采用Renaissance(以色列)脊柱手术机器人辅助置钉。FG组49例,在C臂机(Siemens,德国)透视下经皮置钉。比较置钉准确性和围手术期相关指标,根据Gertzbein-Robbins量表和小关节侵犯,评价椎弓根螺钉置入的准确性。围手术期相关指标主要包括置钉总手术时间、术中X线辐射时间、剂量及手术/伤口并发症和术后翻修率等。结果:R组术后随访时间为12.1~21.3个月,FG组术后随访时间为12.3~16.6个月。R组49例患者共置钉196枚,出现术中螺钉植入不当(椎弓根内侧皮质穿透)2枚,优秀192枚,中等4枚,未出现刀口感染及螺钉松动;FG组49例患者共置钉196枚,出现术中螺钉植入不当8枚,椎弓根内侧皮质穿透2枚,椎弓根外侧皮质穿透6枚,优秀178枚,中等6枚,一般2枚,术后刀口感染1枚,术后螺钉松动2枚。结论:Renaissance辅助MIS-TLIF的治疗方法中,与X线透视引导的手术相比,置钉手术时间、翻修率及并发症并无明显差异,但置钉准确率明显提高,术中辐射暴露更少。Objective:To compare the complication and revision rate of minimally invasive transforaminal lumbar interbody fusion surgery(MIS-TLIF)assisted by Renaissance spinal surgery robot or X-ray fluoroscopy.Methods:98 patients who underwent MIS-TLIF surgery were retrospectively divided into study group(Renaissance spinal surgery robot assisted,R group)and control group(Fluoroscopic-Guided,FG group).49 patients in group R were implanted with screws assisted by reinaisance spinal surgery robot(Israel)percutaneously,while 49 cases in FG group were guided by C-arm fluoroscopy(Siemens,Germany).The accuracy of screw implantation and perioperative related indexes were compared.The accuracy of pedicle screw placement was evaluated according to Gertzbein-Robbins scale and facet joint invasion.The total operation time of screw placement,intraoperative radiation time and dose,complications,and postoperative revision rate were recorded as perioperative related indicators.Results:The average follow-up time was 12.1 to 21.3 months in group R and 12.3 to 16.6 months in group FG.Among the 49 patients(196 screws)in group R,192 cases had excellent screw implantation and 4 case was medium.The medium case was the penetration of the medial cortex of the pedicle,and there was no incision infection and screw loosening in group R.Among the 49 patients(196 screws)in FG group,178 cases were excellent;6 cases were medium,and 2 cases were general,including 2 case of medial pedicle cortical penetration,6 cases of lateral pedicle cortical penetration,1 case of postoperative wound infection and 2 cases of postoperative screw loosening.Conclusion:Compared with X-ray fluoroscopy guided surgery,there is no significant difference in screw implantation time,revision rate and complications,but the accuracy is significantly improved,and the intraoperative radiation exposure is less.

关 键 词：机器人 透视引导 椎弓根螺钉 微创 经椎间孔腰椎椎间融合术 

分 类 号：R687.3[医药卫生—骨科学]