脊柱机器人辅助系统在MIS-TLIF手术中的临床应用价值  

Clinical application value of spinal robot assisted system in MIS-TLIF surgery

作　　者：刘洋 刘道阔[1] 李长宽 王志伟 赵冲 王艳[1] 胡思斌[1] 王玥军 LIU Yang;LIU Daokuo;LI Changkuan;WANG Zhiwei;ZHAO Chong;WANG Yan;HU Sibin;WANG Yuejun(Department of Spine and Spinal Cord Surgery,Hebei Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院脊柱脊髓外科,河北省沧州市061000

出　　处：《组织工程与重建外科》2024年第3期300-304,共5页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：河北省自然医学科学基金(20232137);国家自然科学基金(31640042)。

摘　　要：目的研究脊柱机器人辅助系统在微创经椎间孔椎间融合术(MIS-TLIF)中的临床应用价值。方法选取2019年3月至2022年11月收治的因腰椎退行性疾病而接受手术治疗的78例患者,根据不同手术方式分为传统MISTLIF组(A组,41例)与机器人MIS-TLIF组(B组,37例)。比较两组围手术期指标(术中出血量、手术时间、切口长度和透视次数),术后CT检查结果(螺钉置钉准确度、螺钉外展角),功能恢复情况:疼痛视觉模拟评分(VAS)、日本矫正外科学会(JOA)评分,以及围手术期并发症情况。结果B组的手术时间、术中出血量、透视次数均少于A组,切口长度短于A组(P<0.05)。A组植入164枚螺钉,B组植入148枚,B组可接受螺钉显著多于A组(P<0.05)。A组螺钉外展角为18.12°±7.50°,B组为23.56°±6.64°,B组外展角度大于A组(P<0.05)。术后1个月时,两组VAS评分均较术前下降,JOA评分上升(P<0.05),但两组间比较差异无统计学意义(P>0.05)。两组均未发生血管、神经等严重并发症情况;A组3例定位错误、2例硬膜囊撕裂,经对应治疗均恢复;B组无早期并发症。B组早期并发症发生率低于A组(P<0.05)。结论脊柱机器人辅助系统能缩短MIS-TLIF手术时间、减少患者术中出血量,提高椎弓根螺钉置入的准确度,具有较高的临床应用价值。Objective To study the clinical application value of spinal robot assisted system in minimally invasive transforaminal fusion(MIS-TLIF)surgery.Methods From March 2019 to November 2022,78 patients who underwent surgical treatment for lumbar degenerative diseases were divided into traditional MIS-TLIF group(group A,41 cases)and robotic MIS-TLIF group(group B,37 cases)according to different surgical methods.Perioperative indicators(intraoperative bleeding,surgical time,incision length,and fluoroscopy frequency),postoperative CT findings(screw placement accuracy,screw abduction angle),functional recovery(VAS,JOA scores),and perioperative complications were compared between the two groups.Results The intraoperative bleeding volume and fluoroscopy frequency in Group B were less than those in Group A,and the operative time and incision length were shorter than those in Group A(P<0.05).A total of 164 screws were implanted in Group A,148 in Group B.The acceptable screws in Group B were significantly higher than those in Group A(P<0.05).The abduction angle of screws in Group A was 18.12°±7.50°,and that in Group B was 23.56°±6.64°.The abduction angle in Group B was greater than that in Group A(P<0.05).One month after surgery,the VAS score of the two groups decreased compared to that before surgery,while the JOA score increased(P<0.05).However,there was no statistically significant difference between the two groups(P>0.05).There were no serious complications such as blood vessels and nerves in both groups;In group A,3 patient had a positioning error and 2 patient had a dural sac tear,all of which recovered after corresponding treatment;Group B had no early complications.The incidence of early complications in Group B was lower than that in Group A(P<0.05).Conclusion The spinal robot assisted system can shorten the operation time of MIS-TLIF,reduce intraoperative bleeding,and improve the accuracy of pedicle screw placement.It has high clinical application value.

关 键 词：脊柱机器人辅助系统 微创经椎间孔椎间融合术 椎弓根螺钉 置入准确度 

分 类 号：R318.01[医药卫生—生物医学工程]