机器人辅助微创通道下经椎间孔腰椎椎间融合术治疗腰椎退行性疾病临床分析

Robotic assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease

目的探讨机器人辅助下微创通道下经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion, MIS-TLIF)治疗腰椎退行性疾病的临床疗效。方法 93例腰椎退行性疾病患者,其中腰椎间盘突出症35例,腰椎管狭窄症31例,腰椎滑脱症(Meyerding分度Ⅰ°~Ⅱ°)27例,其中采用机器人辅助下MIS-TLIF治疗者45例为观察组,采用常规MIS-TLIF治疗者48例为对照组。比较2组手术时间和术中出血量;术后3 d行CT检查,采用Andrew法评价2组椎弓根螺钉置钉准确率;术后12个月,采用Macnab标准评价2组治疗效果;术后3 d及术后3、4、5、6个月行腰椎X线和CT检查,比较2组螺钉和椎间融合器位置及椎间融合情况。结果观察组术中出血量[(148.89±7.75)mL]少于对照组[(192.92±8.74)mL](P<0.05),手术时间[(132.60±20.69)min]与对照组[(135.44±32.99)min]比较差异无统计学意义(P>0.05);观察组椎弓根螺钉置钉准确率(98.15%)高于对照组(86.13%)(P<0.05);观察组治疗优良率(95.56%)高于对照组(85.42%)(P<0.05);术后3 d及术后3、4、5、6个月,2组腰椎X线和CT均显示螺钉及椎间融合器无断裂、移位等并发症,术后6个月病变节段骨性融合良好,观察组融合时间[(4.62±0.49)个月]与对照组[(4.58±0.50)个月]比较差异无统计学意义(P>0.05)。结论机器人辅助下MIS-TLIF治疗腰椎退行性疾病可提高椎弓根螺钉置入准确性,减少手术创伤,提高临床治疗效果。

Objective To investigate the clinical outcomes of robotic assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) in the treatment of lumbar degenerative disease. Methods A retrospective analysis was conducted on 93 patients with lumbar degenerative disease including 35 patients with lumbar disc herniation, 31 patients with lumbar spinal stenosis and 27 patients with lumbar spondylolisthesis of Ⅰ-Ⅱ degrees according to the Meyerding’s classification method, in which 45 patients were treated with robot-assisted MIS-TLIF(observation group), and 48 patients were treated with conventional MIS-TLIF(control group). The intraoperative blood loss and operation lasting time were compared between two groups. CT was performed on the 3 rd postoperative day, and Andrew method was used to evaluate the accuracy of pedicle screw placement in two groups, and the operation outcome was evaluated by Macnab standard in 12 months after operation. X-ray and CT examination of lumbar vertebrae were performed on the 3 rd postoperative day and in 3, 4, 5 and 6 months after operation to compare the position of screw and intervertebral fusion cage as well as the situation of intervertebral fusion between two groups. Results The intraoperative blood loss was less in observation group((148.89±7.75) mL) than that in control group((192.92±8.74) mL)(P<0.05), and the operation lasting time showed no significant difference between observation group((132.60±20.69) min) and control group((135.44±32.99) min)(P>0.05). The accuracy of pedicle screw was higher in observation group(98.15%)than that in control group(86.13%)(P<0.05).The excellent and good rate was higher in observation group(95.56%)than that in control group(85.42%)(P<0.05).X-ray and CT of lumbar spine showed no complications such as breakage and displacement of screw and interbody fusion cage in two groups on the 3 rd postoperative day and in 3,4,5 and 6 months after operation.In 6 months after operation,the images showed fine osseous fusion of lesion segments,and there was no significant difference in the average fusion time between observation group((4.62±0.49)months)and control group((4.58±0.50)months)(P>0.05).Conclusion The robotic assisted MIS-TLIF is a simple and safe method for the treatment of lumbar degenerative diseases.It can improve the accuracy of pedicle screw placement,effectively reduce surgical trauma and improve clinical outcomes.