Quadrant系统下椎间融合辅助机器人治疗老年单节段腰椎退变的临床研究

Clinical research on interbody fusion assisted by Quadrant systemand robot in the treatment of single segment lumbar degenerative

目的比较Quadrant通道下减压、椎间融合辅助机器人经皮置入椎弓根螺钉和传统后路开放手术治疗老年单节段腰椎退变性疾病的临床疗效及影像学情况。方法前瞻性收集2014年8月至2015年1月手术治疗单节段腰椎退变性疾病患者50例,随机分为经通道减压、融合辅助机器人经皮置钉组(机器人组)及传统后路开放手术组(开放组)。机器人组24例,通过机器人进行术前规划,机器人臂经皮置入椎弓根螺钉,在Mast Quadrant通道辅助下进行减压、椎间融合。开放组26例,采用传统的后路开放手术。观察两组患者术中出血量、手术时间、术中及术后并发症发生情况,分别于术后3周、1、6、12个月随访并比较两组患者的疼痛视觉模拟评分(VAS),Oswestry功能障碍指数(ODI)及MRI上测量的多裂肌面积及萎缩比,并通过CT观察术后12个月的椎间融合情况。结果所有患者均获得满意随访,随访时间12~15个月,平均(12.9±0.4)个月。机器人组手术时间为99.7(20.1)min,开放组为101.6(31.7)min,差异无统计学意义(Z=-0.197,P>0.05)。机器人组患者的术中出血量和术后引流量分别为207.9(59.8)ml、90.6(45.6)ml少于开放组[297.5(80.1)ml、180.6(78.4)ml],差异具有统计学意义(Z=1.517,P<0.05;Z=2.168,P<0.05)。两组患者术前及术后各个时间点的ODI、VAS评分随着随访时间的延长,均明显降低。术后12个月机器人组多裂肌的萎缩比[(6.2±1.1)%]低于开放手术组[(17.1±2.1)%],差异具有统计学意义(x^2=0.008,P<0.001)。CT显示术后12个月椎间均达到骨性愈合,未见内固定相关并发症。结论经通道减压、融合辅助机器人经皮置钉和传统的后路开放手术治疗单节段腰椎退变性疾病均能取得较好的临床疗效,但经通道减压、融合辅助机器人经皮置钉术对局部肌肉的创伤较小,更有利于恢复。

Objectives To compare the clinical effect and imaging changes between robot assisted percutaneous pedicle screws insertion via interbody fusion and decompression under quadrant system and conventional posterior open surgery in senile lumbar degenerative patients with single segment. Methods A prospective study was performed in 50 lumbar degenerative patients involved one level segment from August 2014 to January 2015, they were divided into robot group and open surgery group randomly. Preoperative plans and percutaneous pedicle screw insertion of twenty- four patients in robot group were achieved by robot,decompression and interbody fusion were carried out under Quadrant Mast channel. Twenty-six patients in open surgery group underwent traditional open surgery. The intraoperative blood loss, duration of operation,intraoperative and postoperative complications were comparied between two groups. The amount and ratio of muscle atrophy were measured by MRI, visual analogue scale (VAS) and oswestry disability index (ODI) were observed at 3 weeks, 1, 6, 12 months postoperatively. The lumbar interbody fusion were observed through CT images at 12 months postoperatively. Results All cases were well followed- up with a times pan of 12- 15 months (12.9±0.4) months on the average). The operation time in the robot group was 99.7 (20.1) min compared to 101.6(31.7) min in open surgery group, there was no significant difference between two groups (Z=0.197, P>0.05). In the robot group, the median intraoperative blood loss and postoperativee suction drainage were 207.9 (59.8)mland90.6(45.6) ml, which were significantly lower than the open surgery group [297.5(80.1)mland180.6 (78.4) ml)], with statistical significance (Z=1.517,P<0.05; Z=2.168,P<0.05).ODIandVASscores of both groups decreased significantly over time. The muscle atrophy oratio in robot group [(6.2±1.1)%] was significantly lower than that in open group [(17.1±2.1)%] at 12 months postoperatively with statistically significant differences (c2=0.008, P<0.001). CT scan showed interval bone healing at 12 months follow- up in two groups, and no internal fixation related complications were found. Conclusion Both robot assisted percutaneous pedicle screws insertion via a channel decompression and fusion and conventional posterior open surgery can achieve excellent clinical efficacy in lumbar degenerative diseases with single segment. But less local muscle injury and better recovery were observed using robot assisted percutaneous pedicle screws insertion via a channel decompression and fusion.