机器人辅助MIS-TLIF与徒手开放TLIF治疗腰椎退行性疾病的比较:2年随访

doi:10.6040/j.issn.1671-7554.0.2022.1113

摘要/Abstract

摘要： 目的前瞻性比较了机器人辅助微创经椎间孔入路腰椎椎体间融合术(MIS-TLIF)和徒手开放经椎间孔入路腰椎椎体间融合术(TLIF)的临床疗效和影像学改变。方法研究包括127例在山东大学齐鲁医院接受手术的腰椎退行性疾病的患者。73例患者接受了机器人辅助下MIS-TLIF(机器人组),54例患者接受了开放徒手TLIF(徒手组)。机器人组进一步分为单节段机器人组(n=52)和双节段机器人组(n=21)。徒手组进一步分为单节段徒手组(n=39)和双节段徒手组(n=15)。临床结果观察指标为视觉模拟量表(VAS)评分、Oswestry残疾指数(ODI)评分、手术时间、术中透视次数、术中出血量、术后住院时间和术后并发症。影像学指标为螺钉放置的准确性、关节突关节侵扰(FJV)、融合状态以及2年随访时近端邻近节段的椎间盘高度变化。结果机器人组术后3 d腰痛VAS评分、失血量均低于徒手组(P<0.05)。两组术后2年腰痛及下肢痛VAS和ODI评分、术后住院时间差异无统计学意义(P>0.05)。机器人组的手术时间比徒手组长(P<0.05),单节段机器人组的手术时间比单节段徒手组长(P<0.05),而双节段机器人组和双节段徒手组之间的手术时间差异无统计学意义(P>0.05)。对患者而言,机器人组术中透视次数明显多于徒手组(P<0.05)。对于外科医生来说,机器人组的术中透视次数明显低于徒手组(P<0.05)。在机器人组中,三个导针出现术中漂移,另外一例患者的椎弓根螺钉穿透椎弓根外壁。在徒手组中,两枚椎弓根螺钉穿透了椎弓根内壁。机器人组临床可接受的螺钉置入比例(A级和B级)准确率明显高于徒手组(P<0.05)。徒手组的平均FJV分级明显高于机器人组(P<0.05)。在术后2年的随访中,两组之间的椎间融合状态差异无统计学意义(P>0.05);但机器人组近端邻近节段的椎间高度的下降明显小于徒手组(P<0.05)。结论在TLIF手术中,相比于开放徒手椎弓根螺钉置入,机器人辅助经皮椎弓根螺钉置入是一种更安全、更准确的替代方法。

关键词: 腰椎退行性疾病, 机器人手术, 椎弓根螺钉, 椎体间融合, 关节突侵扰, 邻近节段退变

Abstract: Objective To prospectively compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and freehand open transforaminal lumbar interbody fusion(TLIF)in patients with degenerative lumbar spinal diseases. Methods A total of 127 patients with lumbar degenerative diseases receiving surgery in Qilu Hospital of Shandong University were enrolled, including 73 who underwent robot-assisted MIS-TLIF(group A)and 54 who underwent open TLIF(group B). Group A was subdivided into subgroup AI(52 single-level patients)and subgroup AII(21 double-level patients). Group B was subdivided into subgroup BI(39 single-level patients)and subgroup BII(15 double-level patients). The clinical outcome parameters were compared, including the Visual Analog Scale(VAS)score, Oswestry Disability Index(ODI)score, operation time, number of intraoperative fluoroscopies, intraoperative blood loss, postoperative hospital stay, and postoperative complications. The radiographic measures included the accuracy of screw placement, facet joint violation(FJV), fusion status, and change in disc height at the proximal adjacent segment at 2-year follow-up. Results Group A had lower VAS score for back pain at 3 days postoperatively, and less blood loss than group B(P<0.05). There were no significant differences between the two groups in terms of postoperative hospital stay, VAS score and ODI score at 2 years postoperatively(P>0.05). Group A needed longer operation time than group B(P<0.05), subgroup AI needed longer operation time than subgroup BI(P<0.05); however, there was no significant difference between subgroups AII and BII(P>0.05). The number of intraoperative fluoroscopies for patients was significantly higher in group A than in group B(P<0.05), while it was significantly lower in group A than in group B for surgeons(P<0.05). In Group A, three guide pins exhibited drift and one patient developed a lateral wall violation by a pedicle screw. In Group B, two pedicle screws caused an inner wall violation. The rate of clinically acceptable screws(grades A and B)was higher in group A than in group B(P<0.05). The FJV grade was significantly higher in group B than in group A(P<0.05). During the 2-year follow-up, there was no significant difference in classification of interbody fusion between the two groups(P>0.05), but the decrease in disc height at the proximal adjacent segment was significantly less in group A than in group B (P<0.05). Conclusion Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand open pedicle screw insertion in TLIF.

Key words: Degenerative lumbar spinal diseases, Robotic surgery, Pedicle screw, Lumbar fusion, Facet joint violation, Adjacent segment disease

中图分类号:

R681.5+7

王政,孙小刚,李超,王连雷,李冬来,原所茂,田永昊,刘新宇. 机器人辅助MIS-TLIF与徒手开放TLIF治疗腰椎退行性疾病的比较:2年随访[J]. 山东大学学报 (医学版), 2023, 61(3): 97-106.

WANG Zheng, SUN Xiaogang, LI Chao, WANG Lianlei, LI Donglai, YUAN Suomao, TIAN Yonghao, LIU Xinyu. Comparison of robot-assisted minimally invasive and freehand open transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases: a 2-year follow-up[J]. Journal of Shandong University (Health Sciences), 2023, 61(3): 97-106.

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