机器人辅助单体位和双体位斜外侧腰椎椎间融合内固定术疗效比较  

Comparison of Robot-Assisted Oblique Lateral Interbody Fusion and Internal Fixation in Single Position and Reposition Surgery

作　　者：房彦名 袁强[2] 韩晓光[2] 何达[2] 田伟[1] Fang Yanming;Yuan Qiang;Han Xiaoguang;He Da;Tian Wei(Peking University Fourth School of Clinical Medicine,Beijing 100035,China;Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京大学第四临床医学院,北京100035 [2]北京积水潭医院脊柱外科,北京100035

出　　处：《实用骨科杂志》2023年第1期1-5,共5页Journal of Practical Orthopaedics

基　　金：北京市医院管理中心创新梦工场项目(202109);国家自然科学基金项目(U1713221)。

摘　　要：目的 本文旨在研究机器人辅助斜外侧腰椎椎间融合(oblique lateral interbody fusion, OLIF)内固定术在单体位和双体位手术中的临床效果。方法 回顾性收集2018年7月至2021年9月接受同一外科医生单体位机器人辅助OLIF手术的12例患者,其中男性4例,女性8例;平均年龄(59.17±8.72)岁。根据年龄、性别、身体质量指数(body mass index, BMI)和手术节段按1︰2比例匹配双体位机器人辅助OLIF组患者24例,其中男性8例,女性16例;平均年龄(59.50±7.76)岁。收集患者BMI、手术节段、手术时间、术中失血量、透视次数、术后住院时间和非计划二次手术资料。统计分析上位椎间盘高度、腰椎前凸角、手术节段椎间孔高度、小关节侵犯、螺钉偏离距离和螺钉安全等级等影像学参数并计算螺钉可接受率的变化。结果 两组手术时间、失血量、术后住院时间、上段椎间盘高度、腰椎前凸角和椎间孔高度比较差异无统计学意义(P>0.05)。单体位组的辐照次数低于双体位组(P=0.038)。术后两组手术节段椎间孔高度较术前均增加(P<0.01)。单体位组螺钉可接受率为98%,双体位组为97%。结论 机器人辅助OLIF单体位手术与双体位手术具有同等的安全性和准确性,单体位手术可以减少手术辐照次数,提高椎间孔高度,但无法减少手术时间和失血量。Objective To study clinical effect of robot-assisted oblique lateral interbody fusion(RAOLIF) and internal fixation in single position or reposition surgery.Methods Twelve patients underwent single-position RAOLIF surgery operated by the same surgeon from July 2018 to September 2021 were retrospectively collected.The patients included four males and eight females aging(59.17±8.72) years.Twenty-four patients with matched age, gender, body mass index(BMI) and surgical segment were included in robot-reposition RAOLIF group.The patients were(59.50±7.76) years old.There were eight males and sixteen females.BMI,operation segments, operative time, intraoperative blood loss, times of radiations, length of postoperative hospital stay and unplanned secondary surgery were collected.Radiology parameters as disc height of upper segment, lumbar lordosis angle, foraminal height of surgical segment, facet joint invasions, screw deviation distance and screw breach grade were measured and analyzed.Screw acceptable rate was calculated.Results There was no difference between two groups in operation time, blood loss, postoperative hospital stay, disc height of upper segment, lumbar lordosis angle, and intervertebral foramen height(P>0.05).Number of radiation times in single position group was lower than reposition group(P=0.038).After surgery, foraminal height of surgical segment was increased in both groups(P<0.01).Screw accessibility rate was 98% in single group and 97% in reposition group.Conclusion RAOLIF surgery in single position has the same safety and accuracy as reposition surgery.It could reduce the surgical radiation and improve foraminal height, though could not decrease the operation time and blood loss.

关 键 词：机器人辅助手术 单体位手术 斜外侧腰椎椎间融合术 螺钉置入 

分 类 号：R681.5[医药卫生—骨科学]