2D透视引导机器人辅助TESSYS手术治疗腰椎间盘突出症

2D guided robot assisted TESSYS surgery for lumbar disc herniation

目的通过比较2D透视引导机器人辅助下和常规行TESSYS手术治疗腰椎间盘突出症的临床疗效,探讨2D引导机器人辅助TESSYS手术的可行性及注意事项。方法回顾性分析2019年7月至2020年4月分别采用2D引导机器人辅助和常规方法行TESSYS手术治疗的70例腰椎间盘突出症患者资料,男34例,女36例,年龄(44.57±6.10)岁(范围27~60岁)。2D引导机器人辅助行TESSYS手术组(机器人组)32例;常规方法行TESSYS手术组(常规组)38例。比较两组患者的穿刺次数、透视次数、穿刺-通道建立时间、手术时间,手术前后和末次随访时的视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)以验证其临床疗效,并对并发症情况进行分析。结果机器人组和常规组患者年龄、性别、体重指数、手术节段、腰椎间盘突出Michigan State University(MSU)分级、随访时间比较,差异均无统计学意义(均P>0.05)。所有患者均完成手术。机器人组穿刺次数(1.22±0.79)次,常规组(4.66±1.86)次,差异有统计学意义(t=10.320,P<0.001);机器人组透视次数(10.97±1.96)次,常规组(17.45±4.30)次,差异有统计学意义(t=8.313,P<0.001);机器人组穿刺-通道时间(10.66±3.62)min,常规组(20.21±5.47)min,差异有统计学意义(t=8.446,P<0.001);机器人组手术时间(62.25±6.68)min,常规组(72.89±10.48)min,差异有统计学意义(t=4.956,P<0.001)。机器人组术前VAS评分(6.91±0.93)分、术后第1天(2.97±0.65)分、末次随访(1.53±0.51)分,常规组术前(7.29±1.14)分、术后第1天(2.89±0.56)分、末次随访(1.42±0.50)分;机器人组术前ODI 40.13%±1.54%、术后第1天17.28%±1.69%、末次随访10.84%±1.25%,常规组术前40.03%±1.46%、术后第1天17.42%±2.45%、末次随访10.92%±1.17%,差异均无统计学意义(均P>0.05)。机器人组椎间盘残留2例(6.3%),常规组4例(10.5%),差异无统计学意义(P>0.05)。结论2D引导机器人辅助TESSYS手术治疗腰椎间盘突出症,可在经皮靶点穿刺阶段规划穿刺路径,刚性制导准确穿刺靶点,在降低穿刺次数、透视次数方面优势明显。

Objective To compare the clinical efficacy of two-dimensional(2D)fluoroscopic guided robot-assisted and conventional TESSYS surgery in the treatment of lumbar disc herniation,the feasibility and precautions of 2D fluoroscopic guided robot-assisted TESSYS surgery were discussed.Methods A retrospective analysis was performed on 34 male and 36 female patients aged 44.57±6.10 years(range 27 to 60 years)who received 2D guided robot-assisted TESSYS surgery and conventional TESSYS surgery from July 2019 to April 2020.2D guided robot assisted TESSYS surgery group(the robot group)32 cases,conventional TESSYS surgery(the conventional group)38 cases.The number of puncture,number of fluoroscopy,puncture-channel time,operation time,visual analogue scale(VAS)and Oswestry disability index(ODI)before and after surgery and at the last follow-up were compared between the two groups to verify the clinical efficacy,and the complications were analyzed.Results There were no significant differences in age,gender,body mass index,surgical level,Michigan State University(MSU)grading and average follow-up time between the robot group and the conventional group(all P>0.05).All patients completed surgery.The number of puncture times was 1.22±0.79 in the robot group and 4.66±1.86 in the conventional group,and the difference was statistically significant(t=10.320,P<0.001).The number of fluoroscopy in the robot group was 10.97±1.96 times,and that in the conventional group was 17.45±4.30 times,the difference was statistically significant(t=8.313,P<0.001).The puncture-channel time of the robot group was 10.66±3.62 min and that of the conventional group was 20.21±5.47 min,and the difference was statistically significant(t=8.446,P<0.001).The operation time of the robot group was 62.25±6.68 min,and that of the conventional group was 72.89±10.48 min,the difference was statistically significant(t=4.956,P<0.001).VAS scores of the robot group were 6.91±0.93 points before surgery,2.97±0.65 points 1 d after surgery,and 1.53±0.51 points at the last follow-up,while those of the conventional group were 7.29±1.14 points before surgery,2.89±0.56 points 1 d after surgery,and 1.42±0.50 points at the last follow-up.The ODI index of the robot group was 40.13%±1.54%before surgery,17.28%±1.69%1 day after surgery,and 10.84%±1.25%at the last follow-up,while that of the conventional group was 40.03%±1.46%before surgery,17.42%±2.45%1 day after surgery,and 10.92%±1.17%at the last follow-up.There were no statistically significant differences(all P>0.05).Two patients(6.3%)in the robot group and four(10.5%)in the conventional group had residual disc,there was no significant difference(P>0.05).Conclusion 2D guided robot assisted TESSYS surgical treatment of lumbar disc herniation,which can plan puncture path in the stage of percutaneous target puncture,rigid guidance and accurate puncture target,and has obvious advantages in reducing puncture times and fluoroscopy times.