机器人辅助经皮微创置钉对斜外侧腰椎椎间融合治疗效果的影响

Effects of robot-assisted percutaneous minimally invasive pedicle screw placement in oblique lumbar interbody fusion

背景:斜外侧腰椎椎间融合这一技术已日趋成熟,但是在后路行椎弓根螺钉内固定时,传统的开放切口X射线透视辅助置钉的手术方式仍然给患者带来较大的创伤。随着科技的进步,机器人辅助手术系统给临床医生提供了新的选择。目的:探讨行斜外侧腰椎椎间融合术时采用骨科机器人辅助经皮微创置钉对临床效果的影响。方法:北京积水潭医院脊柱外科收治的腰椎疾病患者78例,均行斜外侧腰椎椎间融合术,在后路行腰椎椎弓根螺钉内固定时,36例患者(试验组)采取的置钉方式为骨科机器人辅助下经皮微创置钉,42例患者(对照组)采取的置钉方式为X射线透视辅助下开放伤口置钉,比较两组患者的手术时间、目测类比评分、Oswestry功能障碍指数、术中及术后出血量的差异。结果与结论:试验组手术时间短于对照组(P<0.05);试验组术后腰痛症状目测类比评分低于对照组(P<0.05);试验组术中及术后出血量少于对照组(P<0.05)。结果表明,在斜外侧腰椎椎间融合术中行腰椎椎弓根螺钉内固定时,采取骨科机器人辅助经皮微创置入椎弓根螺钉的手术方式可以缩短手术时间、减少术中出血,降低手术并发症的风险,而且对腰背部软组织的损伤更小。

BACKGROUND:The technique of oblique lumbar interbody fusion has become increasingly mature,but when pedicle screw internal fixation is performed through posterior approach,the fluoroscopy-assisted pedicle screw insertion using a traditional open technique still brings greater trauma to the patient.With the advancement of technology,robot-assisted surgery systems have provided clinicians with new options.OBJECTIVE:To explore the clinical outcomes of percutaneous robot-assisted minimally invasive pedicle screw insertion in an oblique lumbar interbody fusion procedure.METHODS:Totally 78 patients with lumbar degenerative disease who attended Department of Spinal Surgery,Beijing Jishuitan Hospital were treated with oblique lumbar interbody fusion.When lumbar pedicle screw internal fixation was performed through posterior approach,36 cases(trial group)underwent percutaneous robot-assisted minimally invasive pedicle screw insertion,and 42 cases(control group)underwent fluoroscopy-assisted open invasive screw insertion.The difference in operation time,visual analogue scale score,Oswestry disability index,intraoperative and postoperative blood loss was compared between the two groups.RESULTS AND CONCLUSION:The operative time of trial group was shorter than that of control group(P<0.05).The postoperative visual analogue scale score of the trial group was lower than that of the control group(P<0.05).The amount of intraoperative and postoperative blood loss in the trial group was less than that in the control group(P<0.05).It is concluded that robot-assisted pedicle screw insertion in oblique lumbar interbody fusion can shorten the operative time,reduce intraoperative blood loss,lessen risk of surgical complications,and reduce the soft tissue damage of lumbar spine.