骨科机器人辅助下经皮固定小切口减压术治疗晚期胸腰椎转移瘤  

Effectiveness of robot-guided percutaneous fixation and decompression via small incision for advanced thoracolumbar metastases

作　　者：李佳鸿 林书[1] 唐六一[1] 胡豇[1] 万仑[1] 张坤 梁伟民[1] 王珊[1] LI Jiahong;LIN Shu;TANG Liuyi;HU Jiang;WAN Lun;ZHANG Kun;LIANG Weimin;WANG Shan(Department of Orthopedics,Sichuan Academy of Medical Science,People’s Hospital of Sichuan Province,Chengdu Sichuan,610072,P.R.China)

机构地区：[1]四川省医学科学院·四川省人民医院骨科,成都610072

出　　处：《中国修复重建外科杂志》2023年第9期1113-1118,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省医学科学院·四川省人民医院院基金(2021LY09);四川省科技厅科技支撑项目(2022YFS0018、2022YFS0019)。

摘　　要：目的通过与传统开放手术比较,探讨骨科机器人辅助下经皮固定小切口减压术治疗晚期胸腰椎转移瘤的疗效。方法回顾分析2017年6月—2021年1月收治且符合选择标准的57例晚期胸腰椎转移瘤患者临床资料。其中,26例接受骨科机器人辅助下经皮固定小切口减压术(机器人组),31例接受传统开放手术(传统组)。两组患者性别、年龄、身体质量指数、病变节段、原发肿瘤部位以及术前Tokuhashi评分、Tomita评分、脊柱肿瘤不稳定评分(SINS)、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、Karnofsky评分、神经功能Frankel分级等基线资料比较,差异均无统计学意义(P>0.05),具有可比性。比较两组手术时间、住院时间、住院费用、术中失血量、术后引流量、重症监护室(intensive care unit,ICU)观察时间、输血情况、并发症情况以及生存时间,基于术后4 d内CT参照Gertzbein-Robbins分级标准评价植钉准确性,采用VAS评分、ODI、Karnofsky评分、Frankel分级评价患者疼痛、功能及生活质量恢复情况。结果术中机器人组及传统组分别植入257、316枚螺钉,两组植钉准确性差异无统计学意义(P>0.05)。与传统组相比,机器人组手术时间、住院时间、ICU观察时间缩短,术中失血量、术后引流量减少,差异均有统计学意义(P<0.05);住院费用、输血率及并发症发生率差异无统计学意义(P>0.05)。两组患者均获随访,随访时间8~32个月,平均14个月。两组术后7 d VAS评分差异无统计学意义(P>0.05),但术后1、3个月机器人组优于传统组(P<0.05)。机器人组术后ODI变化值优于传统组(P<0.05),术后Karnofsky评分变化值、Frankel分级变化情况与传统组比较,差异无统计学意义(P>0.05)。机器人组中位总生存时间为13个月[95%CI(10.858,15.142)个月],传统组为15个月[95%CI(13.349,16.651)个月],差异无统计学意义(χ^(2)=0.561,P=0.454)。结论与传统开放手术相比,骨Objective To evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases.Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed.Among them,26 cases were treated with robot-guided percutaneous fixation and decompression via small incision(robot-guided group)and 31 cases with traditional open surgery(traditional group).There was no significant difference in gender,age,body mass index,lesion segment,primary tumor site,and preoperative Tokuhashi score,Tomita score,Spinal Instability Neoplastic Score(SINS),visual analogue scale(VAS)score,Oswestry disability index(ODI),Karnofsky score,and Frankel grading between groups(P>0.05).The operation time,hospital stays,hospital expenses,intraoperative blood loss,postoperative drainage volume,duration of intensive care unit(ICU)stay,blood transfusion,complications,and survival time were compared.The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation.The pain,function,and quality of life were evaluated by VAS score,ODI,Karnofsky score,and Frankel grading.Results During operation,257 and 316 screws were implanted in the robot-guided group and the traditional group,respectively;and there was no significant difference in pedicle screw placement accuracy between groups(P>0.05).Compared with the traditional group,the operation time,hospital stays,duration of ICU stay were significantly shorter,and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group(P<0.05).There was no significant difference in hospital expenses,blood transfusion rate,and complications between groups(P>0.05).All patients were followed up 8-32 months(mean,14 months).There was no significant difference in VAS scores between groups at 7 days after operation(P>0.05),but the

关 键 词：骨科机器人 胸腰椎 转移瘤 经皮固定 微创手术 开放手术 

分 类 号：R687.3[医药卫生—骨科学]