机器人辅助微创和开放徒手经椎间孔腰椎椎体间融合术治疗单节段退行性腰椎滑脱临床疗效及对邻近节段退变的影响  

Effectiveness of robot-assisted minimally invasive and open freehand transforaminal lumbar interbody fusion in treatment of single-level degenerative lumbar spondy-lolisthesis and the influence on adjacent segment degeneration

作　　者：郭松 张冶 尚军 孟磊 李东风 李政阳 王明月 GUO Song;ZHANG Ye;SHANG Jun;MENG Lei;LI Dongfeng;LI Zhengyang;WANG Mingyue(Department of Spine Surgery,Xuzhou Renci Hospital,Xuzhou Jiangsu,221005,P.R.China)

机构地区：[1]徐州仁慈医院脊柱外科,江苏徐州221005

出　　处：《中国修复重建外科杂志》2024年第11期1379-1385,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较机器人辅助微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)和开放徒手TLIF治疗单节段退行性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)的临床疗效差异,并分析影响术后发生邻近节段退变(adjacent segmental degeneration,ASD)的危险因素。方法回顾分析2019年11月—2021年10月收治且符合标准的116例L_(4、5)DLS患者临床资料。根据手术方式分为机器人组(45例,机器人辅助下MIS-TLIF)和开放组(71例,开放徒手TLIF)。两组患者性别、年龄、身体质量指数、DLS Meyerding分度及术前Pfirrmann分级、Weishaupt分级、L_(3、4)椎间隙高度(disc height,DH)、L_(3、4)椎间活动度、矢状位参数[包括骨盆入射角(pelvic incidence,PI)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)]、Cage高度等基线资料比较差异均无统计学意义(P>0.05)。术后评估椎弓根螺钉对上关节突关节侵犯(facet joint violation,FJV)等级,测量术前和末次随访时矢状位参数及L_(3、4)DH、L_(3、4)DH损失、L_(3、4)椎间活动度。根据术后患者ASD发生情况,采用logistic回归分析TLIF术后发生ASD的危险因素。结果两组患者均获随访,随访时间21~47个月,平均36.1个月;两组随访时间比较差异无统计学意义(P>0.05)。机器人组术后FJV发生情况优于开放组,差异有统计学意义(P<0.05)。末次随访时,两组患者矢状位参数PI、PT、SS、LL变化值比较差异均无统计学意义(P>0.05);机器人组L_(3、4)DH变化值、L_(3、4)DH损失小于开放组,L_(3、4)椎间活动度变化值大于开放组,差异有统计学意义(P<0.05)。末次随访时,机器人组8例(17.8%)、开放组35例(49.3%)发生ASD,两组ASD发生率差异有统计学意义(P<0.05)。logistic回归分析示,开放手术,术前Pfirrmann分级Ⅳ、Ⅴ级,术前Weishaupt分级≥2级和术后FJV等级≥1级是TLIF术后发生ASD的危�Objective To compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and open freehand TLIF for the treatment of single-level degenerative lumbar spondy-lolisthesis(DSL)and analyse the influence on postoperative adjacent segmental degeneration(ASD).Methods The clinical data of 116 patients with L4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed.According to the surgical methods,they were divided into the robotic group(45 cases,who underwent robot-assisted MIS-TLIF)and the open group(71 cases,who underwent open freehand TLIF).There was no significant difference in baseline data such as gender,age,body mass index,DLS Meyerding grading,and preoperative Pfirrmann grading,Weishaupt grading,L_(3,4) intervertebral disc height(DH),L_(3,4) intervertebral mobility,sagittal parameters[including pelvic incidence(PI),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT)],and Cage height(P>0.05).The grade of facet joint violation(FJV)by pedicle screws on the superior articular process was assessed postoperatively.Sagittal parameters,L_(3,4) DH,L_(3,4) DH loss,and L_(3,4) intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred.Based on the occurrence of postoperative ASD,logistic regression analysis was used to identify the risk factors for ASD after TLIF.Results Patients in both groups were followed up 21-47 months,with a mean of 36.1 months;there was no significant difference in the follow-up time between the two groups(P>0.05).The occurrence of postoperative FJV was significantly better in the robotic group than in the open group(P<0.05).At last follow-up,the difference in the change values of sagittal parameters PI,PT,SS,and LL was not significant when comparing the two groups of patients(P>0.05);the change values of L_(3,4) DH and L_(3,4) DH loss in the robotic group were smaller than those in the open group,and the change value of

关 键 词：微创经椎间孔腰椎椎体间融合术 退行性腰椎滑脱 邻近节段退变 机器人手术 

分 类 号：R687.3[医药卫生—骨科学]