机器人辅助穿刺较徒手穿刺在脊柱内镜手术治疗中的优势分析  

Analysis of Advantages of Robot-Assisted Puncture Over Freehand Puncture in Endoscopic Spinal Surgery

作　　者：耿保伟 杨华东 张西峰 Geng Baowei;Yang Huadong;Zhang Xifeng(Department of Surgery,Beijing Tsinghua Changgeng Hospital,Beijing 102218,China;Department of Orthopaedics,Beijing Tsinghua Changgeng Hospital,Beijing 102218,China)

机构地区：[1]北京清华长庚医院外科部,北京102218 [2]北京清华长庚医院骨科,北京102218

出　　处：《实用骨科杂志》2023年第5期385-389,共5页Journal of Practical Orthopaedics

摘　　要：目的比较经皮机器人辅助穿刺定位法较徒手穿刺定位法在脊柱内镜手术治疗中的优势。方法回顾性分析2022年3月至2022年6月在北京清华长庚医院行经皮椎间孔镜下腰椎间盘髓核摘除术的62例患者,所纳入病例均为L_(4~5)单节段突出者,结合简氏技术(easy technique,Easy-T)操作定位法,均采取后外侧入路进行手术。随机分为两组,30例患者选择机器人辅助下穿刺定位(机器人组),其中男21例,女9例;年龄19~72岁,平均年龄(45.2±16.7)岁。另外32例选择经徒手穿刺定位(常规组),其中男17例,女15例;年龄23~68岁,平均年龄(47.6±19.5)岁。记录两组患者术中透视次数、出血量、手术时间及术前及术后1 d、1周、1个月、3个月的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese orthopaedic association,JOA)评分,记录术中、术后并发症情况。结果所有患者均顺利完成手术,随访时间3~6个月,平均随访时间(4.6±2.1)个月。机器人组患者术中透视次数、手术时间、出血时间均少于常规组,差异有统计学意义(P<0.05)。术后1 d、1周、1个月、3个月时,两组患者VAS评分、ODI评分、JOA评分均较术前改善,差异有统计学意义(P<0.05)。两组患者术前及术后1 d、1周、1个月、3个月VAS评分、JOA评分、ODI评分比较差异均无统计学意义(P>0.05)。结论两组患者术后均能获得长期满意的效果。但机器人辅助穿刺定位较徒手穿刺定位术中透视次数少、出血量少、手术操作时间短,且机器人辅助穿刺下无需术前影像学规划,能结合Easy-T定位法,穿刺目标靶点更加精准、理想,术中能保留更多健康组织,更加突出微创理念。Objective To compare the advantages of percutaneous robot-assisted puncture localization with freehand puncture localization in endoscopic spinal surgery.Methods A retrospective analysis was performed on 62 patients who underwent percutaneous intervertebral foraminoscopic excision of intervetebral disk herniation from March 2022 to June 2022.The included patients were all single level herniation of L_(4~5).Combined with easy technique(Easy T)operation localization method,all patients were operated through posterolateral approach.Thirty patients were randomly divided into two groups,including 21 males and 9 females,aged 19~72 years,with an average age of(45.2±16.7)years.The other 32 patients underwent freehand puncture positioning(routine group),including 17 males and 15 females,aged 23~68 years,with an average age of(47.6±19.5)years.The number of intraoperative fluoroscopy,the amount of blood loss,the operation time and the pain visual analogue scale before,1 day,1 week,1 month and 3 months after surgery were recorded in the two groups.Oswestry disability index(ODI),and the Japanese orthopaedic association(JOA)score were recorded for intraoperative and postoperative complications.Results All patients successfully completed the operation,the follow-up time was 3~6 months,and the mean follow-up time was(4.6±2.1)months.The number of intraoperative fluoroscopy,operation time and bleeding time in the robot group were less than those in the conventional group,and the differences were statistically significant(P<0.05).At 1 day,1 week,1 month and 3 months after surgery,VAS score,ODI score and JOA score of 2 groups were improved compared with those before surgery,and the differences were statistically significant(P<0.05).There were no significant differences in VAS score,JOA score and ODI score between 2 groups before surgery and 1 day,1 week,1 month and 3 months after surgery(P>0.05).Conclusion Both groups of patients can obtain long-term satisfactory results after surgery.However,compared with hands-free puncture pos

关 键 词：脊柱内镜 机器人穿刺 徒手穿刺 微创 

分 类 号：R681.53[医药卫生—骨科学]