机器人辅助内镜下腰椎椎间融合术治疗腰椎管狭窄症早期疗效观察  

Early efficacy of robot assisted unilateral biportal endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis

作　　者：陶瑜晶 叶丙霖[2] 桑廷瑞 陈伟国 赵恒 张万乾 谢芋涛 任毅 杨建霞 TAO Yujing;YE Binglin;SANG Tingrui;CHEN Weiguo;ZHAO Heng;ZHANG Wanqian;XIE Yutao;REN Yi;YANG Jianxia(Orthopedics of Traditional Chinese Medicine in Gansu University of Chinese Medicine,Lanzhou 730030;Minimally-Invasive Spinal Orthopedics Department of Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050;Spine and Orthopaedics Department of Baoji Traditional Chinese Medicine Hospital,Baoji 721001)

机构地区：[1]甘肃中医药大学,兰州730030 [2]甘肃省中医院脊柱微创骨科,兰州730050 [3]宝鸡市中医院脊柱骨科,宝鸡721001

出　　处：《颈腰痛杂志》2025年第1期55-59,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：甘肃省卫生健康行业科研计划项目(GSWSKY2022-20)。

摘　　要：目的观察机器人辅助内镜下腰椎椎间融合术(UBE-TLIF)治疗腰椎管狭窄症(LSS)的早期疗效。方法回顾性纳入2022年10月至2023年4月在甘肃省中医院脊柱微创骨科采用机器人辅助下UBE-TLIF手术治疗LSS患者32例;患者均有腰腿痛症状。其中男15例,女17例,责任阶段为L_(2-3)患者7例,L_(3-4)患者6例,L_(4-5)患者10例,L_(5)-S_(1)患者9例,平均病程(39.24±12.15)个月,平均年龄(63.00±7.21)岁。对手术时长、患者下地活动起始时间以及术后并发症状况予以记录。运用疼痛视觉模拟评分(VAS)、功能障碍指数(ODI)及改良MacNab标准来评定疗效。结果手术时间(160~220)min,平均180 min;术中出血量平均70 mL;术后下床时间6~48 h,中位时间27 h。所有手术均顺利完成,硬膜撕裂、神经血管损伤及伤口感染等并发症均未出现。所有患者均获得随访,随访时间3~12个月,平均为6个月。术后3 d、1个月、末次随访时的腰痛及下肢痛VAS评分、改良ODI均较术前有改善,差异有统计学意义(P<0.05)。末次随访按改良MacNab评分评价:优17例、良13例、可2例,优良率93.7%。随访期间没有出现复发。结论采用UBE-TLIF具有手术操作灵活、视野清晰、术中探查范围广、创伤小的优点,可有效进行椎管减压,是治疗LSS的有效方法,值得临床推广与应用。Objective To observe the early efficacy of robot-assisted unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF)in the early treatment of lumbar spinal stenosis(LSS).Methods Thirty-two patients were retrospectively included from October 2022 to April 2023 who were treated for LSS with robot-assisted UBE-TLIF surgery in our department;all of them had symptoms of low back and leg pain.There were 15 males and 17 females,the stage of responsibility was 7 patients with L_(2-3),6 patients with L_(3-4),10 patients with L_(4-5),and 9 patients with L_(5)-S_(1).The average duration of the disease was(39.24±12.15)months,and the average age was(63.00±7.21).The duration of the operation,the time when the patients started to move down to the floor and the postoperative complications were recorded.Pain visual analogue score(VAS),functional disability index(ODI)and modified MacNab criteria were used for efficacy evaluation.Results Surgical time was 160-220 min,with a mean of 180 min;intraoperative bleeding was 70 mL;postoperative time out of bed was 6-48 h,with a median of 27 h.All surgeries were completed successfully,and there were no complications,such as dural tear,neurovascular injury and wound infection.All patients were followed up for 3-12 months,with a mean of 6 months.Comparing the preoperative and postoperative VAS scores of low back pain and lower extremity pain at 3 d,1 month,and at the last follow-up,the modified ODI improved compared with the preoperative period,and the difference was statistically significant(P<0.05).At the last follow-up,according to the modified MacNab score,17 cases were excellent,13 cases were good,and 2 cases were acceptable,with an excellent rate of 93.7%.There was no recurrence during the follow-up period.Conclusion The use of UBE-TLIF has the advantages of flexible surgical operation,clear field of vision,wide intraoperative exploration,and small trauma,and can effectively decompress the spinal canal,which is an effective method for the treatment of LSS,and is w

关 键 词：机器人辅助 单侧双通道脊柱内镜 椎间融合术 腰椎管狭窄症 脊柱微创 临床疗效 

分 类 号：R681.5[医药卫生—骨科学]