斜外侧腰椎椎间融合术联合镜下减压、机器人辅助内固定的临床效果评价  

Clinical evaluation of the effects of lumbar oblique lateral interbody fusion combined with endoscopic decompression and intraoperative robot-assisted internal fixation

作　　者：杨漪舸 行勇刚[2] 王振兴 姜洋 陈永刚 YANG Yige;XING Yonggang;WANG Zhenxing;JIANG Yang;CHEN Yonggang(Shenyang Jishuitan Hospital,Shenyang 110027;Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035)

机构地区：[1]沈阳积水潭医院,沈阳110027 [2]首都医科大学附属北京积水潭医院,北京100035

出　　处：《北京生物医学工程》2023年第5期496-502,共7页Beijing Biomedical Engineering

摘　　要：目的比较斜外侧腰椎椎间融合术(oblique lateral interbody fusion,OLIF)联合镜下减压、“天玑”骨科手术机器人辅助内固定与传统腰椎后路椎间融合术(traditional posterior lumbar interbody fusion,TLIF)的临床效果,探讨机器人辅助内固定的临床应用价值。方法择2020年6月至2021年6月期间,因为单节段腰椎退行性疾病进行脊柱外科手术治疗的41例患者开展回顾性分析。以OLIF联合镜下减压、“天玑”骨科手术机器人辅助内固定组的16例作为研究组,以传统TLIF组的25例为对照组。通过对比两组患者的手术用时、术中出血量、术后总引流量与住院天数、腰椎前凸角、椎间隙高度、椎间隙融合、ODI指数、腰背部和下肢疼痛VAS评分与并发症情况,评价OLIF联合镜下减压、“天玑”骨科手术机器人辅助内固定效果。结果研究组的手术时间(253.48 min±17.96 min)长于对照组(150.00 min±24.49 min)(t=14.548,P<0.001);住院天数(4.94 d±0.85 d)少于对照组(7.44 d±3.40 d);术中出血量(60.00 mL±10.95 mL)少于对照组(226.00 mL±50.25 mL);术后椎间隙高度(15.90 mm±0.18 mm)高于对照组(13.10 mm±1.59 mm)(t=4.242,P<0.01);腰椎前凸角(43.10°±5.49°)高于对照组(39.26°±11.18°)(t=3.297,P<0.01);术后3d时腰背部疼痛VAS评分(0.44±0.51)低于对照组(2.84±1.03)(t=6.301,P<0.001);而术后3 d时下肢疼痛VAS评分,以及末次随访时的ODI指数、腰背部疼痛VAS评分、下肢疼痛VAS评分比较差异无统计学意义。结论OLIF联合镜下减压、“天玑”骨科手术机器人辅助内固定治疗腰椎退行性疾病通过镜下直接减压解决了OLIF只能进行间接减压的缺点,在保证减压、固定、融合效果良好的基础上,具有微创、术中辐射少、并发症少、术后恢复快、腰前凸恢复效果良好、椎间隙高度恢复良好等优势。Objective To compare the clinical effects of robot-assisted internal fixation with“TiRobot”orthopedic surgical robot combined with oblique lateral interbody fusion(OLIF)and endoscopic decompression with those of traditional posterior lumbar interbody fusion(TLIF),and to explore the clinical application value of robot-assisted internal fixation.Methods A retrospective analysis was conducted on 41 patients who underwent spinal surgery for single-segment lumbar degenerative diseases between June 2020 and June 2021.Among them,16 cases in the OLIF combined with endoscopic decompression and"TiRobot"orthopedic surgical robot-assisted internal fixation group were selected as the study group,and 25 cases in the traditional TLIF group were selected as the control group.Surgical parameters including operative time,intraoperative blood loss,postoperative drainage volume,hospital stay duration,lumbar lordosis angle,intervertebral height,intervertebral fusion,oswestry disability index(ODI),visual analog scale(VAS)scores for lumbar and leg pain,as well as complications were compared between the two groups to evaluate the effectiveness of OLIF combined with endoscopic decompression and"TiRobot"Orthopedic Surgical robot-assisted internal fixation.Results Compared with the control group,the study group had longer operative time[(253.48±17.96)min vs.(150.00±24.49)min](t=14.548,P<0.001),shorter hospital stay[(4.94±0.85)days vs.(7.44±3.40)days],and less intraoperative blood loss[(60.00±10.95)mL vs.(226.00±50.25)mL],with significant differences(t=-2.871,-12.962,P<0.01).The study group exhibited higher postoperative intervertebral height[(15.90±0.18)mm vs.(13.10±1.59)mm]and lumbar lordosis angle[(43.10±5.49)°vs.(39.26±11.18)°],with statistical significance(t=4.242,3.297,P<0.01).The VAS scores for lumbar pain at 3 days postoperatively[(0.44±0.51)vs.(2.84±1.03)]were lower in the study group(t=6.301,P<0.001).However,there were no statistically significant differences between the two groups in VAS scores for leg pain at 3

关 键 词：OLIF 镜下减压 手术机器人 椎间融合术 微创手术 

分 类 号：R318.04[医药卫生—生物医学工程]