电磁导航手术机器人辅助脊柱内镜与单纯内镜手术治疗腰椎间盘突出症的对比研究  

Comparative study of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot in the treatment of lumbar disc herniation

作　　者：丛志超 余志平 金成镇 孙晓庚 熊伟 王海涛 丛海波 CONG Zhichao;YU Zhiping;JIN Chengzhen;SUN Xiaogeng;XIONG Wei;WANG Haitao;CONG Haibo(Department of Spine Surgery,Limin Hospital of Weihai High District,Weihai,Shandong Province 264209,China)

机构地区：[1]威海高区利民医院脊柱外科,山东威海264209

出　　处：《中华显微外科杂志》2023年第2期139-146,共8页Chinese Journal of Microsurgery

基　　金：泰山学者工程专项经费资助项目(TS201511110)。

摘　　要：目的探讨本团队自主研发的电磁导航手术机器人(ENSR)在辅助脊柱内镜手术治疗腰椎间盘突出症(LDH)的临床效果,并与单纯内镜下手术疗效进行对比。方法回顾威海高区利民医院脊柱外科2021年3月至2021年12月采用脊柱内镜微创治疗LDH患者73例,其中ENSR组38例行ENSR辅助下脊柱内镜手术治疗,单纯内镜组35例采用单纯脊柱内镜手术治疗。术后定期来院复诊或电话、微信随访,比较两组术中透视次数、穿刺次数、上关节突成形次数、手术时间及术前、术后下肢疼痛的视觉模拟评分(VAS)、日本骨科协会评估治疗评分(JOA)、健康调查简表评分(SF-36),术后1周通过改良MacNab标准评估早期疗效。采用SPSS 26.0软件对数据进行统计学分析,P<0.05为差异有统计学意义。结果两组患者年龄、性别、身体质量指数(BMI)等一般资料基本一致,差异无统计学意义(P>0.05);ENSR组术后治疗优良率为97.37%,单纯内镜组为94.29%,两组比较差异无统计学意义(Z=0.90,P>0.05);手术时间、术中透视次数、穿刺次数、成形次数等方面,ENSR组[分别为(67.00±17.00)min、(4±2)次、1次、1次]与单纯内镜组[(分别为82.00±16.00)min、(17±6)次、(9±5)次、(5±2)次]相比显著减少,差异有统计学意义(分别为t=3.87、12.62、9.87,P<0.05);两组患者术后VAS、JOA、SF-36评分与术前相比,差异均有统计学意义(分别为F=106.42、112.14、26.88,P<0.05),两组间术前及术后VAS、JOA、SF-36评分比较,差异均无统计学意义(F=0.95、3.54、0.97,P>0.05)。结论本团队自主研发的ENSR系统是安全、有效的辅助系统,相对于单纯内镜下手术,ENSE系统在减少透视次数、穿刺次数、关节突成形次数、缩短手术时间等方面具有明显优势。Objective To compair the clinical effect of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot(ENSR)system in the treatment of lumbar disc herniations(LDH).MethodsFrom March 2021 to December 2021,73 patients with LDH underwent endoscopic minimally invasive treatment in the Department of Spine Surgery,Limin Hospital of Weihai High District.Thirty-eight patients were treated with endoscopic spine surgery assisted by domestic ENSR system(ENSR group),and 35 patients were treated with endoscopic spine surgery alone(endoscopic group).The patients received follow up regularly by telephone or Wechat.The intraoperative fluoroscopy times,puncture times,upper facet arthroplasty times,operation time,preoperative and postoperative Visual Analogue Scale(VAS),Japanese Orthopaedic Association Scores(JOA),and the MOS item short from health survey(SF-36)were compared between the 2 groups.The early postoperative efficacy was evaluated by modified MacNab criteria at 1 week after surgery.SPSS 26.0 was used to analyse the data.P<0.05 was considered that the difference was statistically significant.ResultsThe age,gender,body mass index(BMI)and other general data of the 2 groups were basically the same,and there was no statistically significant difference(P>0.05).There was no significant difference in the excellent and good rate of postoperative treatment between ENSR group(97.37%)and endoscopic group(94.29%)(Z=0.90,P>0.05).In terms of operation time,intraoperative fluoroscopy times,puncture times,and plasty times,ENSR group[(67.00±17.00)min,(4±2)times,1 time,1 time,respectively]was compared with the endoscopic group[(82.00±16.00]min,(17±6)times,(9±5)times,(5±2)times],and the difference was statistically significant(t=3.87,12.62,9.87,respectively,P<0.05).There were significant differences in VAS,JOA and SF-36 scores between the 2 groups between before and after surgery(F=106.42,112.14,26.88,respectively,P<0.05).There was no significant difference in VAS,JOA and SF-36 scores before

关 键 词：腰椎间盘突出症 电磁导航 手术机器人 脊柱内镜 关节突成形 

分 类 号：R687.3[医药卫生—骨科学]