侧卧体位下机器人辅助内固定治疗强直性脊柱炎合并胸腰椎骨折

Treatment of ankylosing spondylitis with thoracolumbar fractures by robot-assisted internal fixation in lateral decubitus position

目的:探讨侧卧体位下机器人辅助内固定治疗强直性脊柱炎(ankylosing spondylitis,AS)合并胸腰椎骨折的效果。方法:回顾性分析2018年1月至2020年6月收治的26例强直性脊柱炎合并胸腰椎骨折患者的临床资料,按手术方式不同分为观察组和对照组,其中观察组8例,男4例,女4例;在侧卧位下行机器人辅助经皮椎弓根钉内固定术,年龄55~85(66.25±9.42)岁,病程(4.00±0.76)d;T112例,T122例,L13例,L21例。对照组18例,男6例,女12例,患者在俯卧位下行常规经皮椎弓根钉内固定术,年龄48~81(61.22±9.53)岁,病程(4.11±0.83)d;T102例,T113例,T124例,L17例,L22例。比较两组患者的术中出血量、术中操作时间、摆放体位时间、术后神经并发症情况,观察术后1 d及术后3个月疼痛视觉模拟评分(visual analogue scale,VAS)和术前及术后3个月Oswestry功能障碍指数(Oswestry Disability Index,ODI)。依据Gertzbein-Robbins标准评估椎弓根螺钉位置的准确性。结果:术后两组患者均没有因椎弓根螺钉置入导致神经损伤。观察组和对照组术中出血量为(34.13±4.61)ml、(78.17±22.02)ml,术中操作时间为(92.13±9.82)min、(106.22±11.55)min,摆放体位时间为(10.00±2.14)min、(15.17±2.66)min,差异均有统计学意义(P<0.05)。观察组和对照组患者术后1 d VAS分别为(2.38±0.52)分、(4.56±0.98)分,差异有统计学意义(P<0.05),而术后3个月两组患者VAS及ODI差异无统计学意义(P>0.05)。螺钉准确率观察组为96.88%(62/64);对照组为81.48%(88/108),差异有统计学意义(P<0.05)。结论:侧卧体位下机器人辅助内固定治疗强直性脊柱炎合并胸腰椎骨折,能够缩短手术体位的摆放时间和术中操作时间,显著提高内固定置钉的准确率,减轻术后早期疼痛,减少术中失血量和术后并发症,利于患者术后早期快速康复。

Objective:To explore the effect of robot-assisted internal fixation in lateral decubitus position for the treatment of ankylosing spondylitis(AS)complicated with thoracolumbar fractures.Methods:The clinical data of 26 patients with ankylosing spondylitis complicated with thoracolumbar fractures treated from January 2018 to June 2020 was retrospectively analyzed.According to different surgical methods,these patients were divided into observation group and control group.There were 8 patients in observation group,which were treated with robot-assisted percutaneous screw fixation in lateral decubitus position,including 4 males and 4 females,aged form 55 to 85 years old with an mean of(66.25±9.42)years,the course of disease was(4.00±0.76)days on average,2 cases were T11 fracture,2 cases were T12,3 cases were L1 and 1 case was L2.And there were 18 patients in control group,which were treated with conventional percutaneous screw fixation in prone position,including 6 males and 12 females,aged from 48 to 81 years old with a mean of(61.22±9.53)years,the course of disease was(4.11±0.83)days on average,2 cases were T10 injury,3 cases were T11,4 cases were T12,7 cases were L1,and 2 cases were L2.The intraoperative blood loss,operation time,position time and postoperative neurological complications were compared between two groups.Postoperative visual analogue scale(VAS)at 1d and 3 months,and Oswestry Disability Index(ODI)before and 3 months after operation were observed.According to Gertzbein-Robbins standard to evaluate the accuracy of pedicle screw placement.Results:There was no nerve injury due to pedicle screw placement in both groups.The intraoperative blood loss in observation group and control group was(34.13±4.61)ml and(78.17±22.02)ml,operation time was(92.13±9.82)min and(106.22±11.55)min,position time was(10.00±2.14)min and(15.17±2.66)min,the differences was statistically significant(P<0.05);VAS of the two groups were(2.38±0.52)points and(4.56±0.98)points one day after surgery,respectively,with statistically significant differences(P<0.05),while VAS and ODI three months after surgery showed no statistically significant differences(P>0.05).The screw accuracy was 96.88%(62/64)in observation group and 81.48%(88/108)in control group,the difference was statistically significant(P<0.05).Conclusion:Robot-assisted internal fixation in lateral decubitus position for the treatment of ankylosing spondylitis complicated with thoracolumbar fractures can shorten the position time and operation time,significantly improve the accuracy of internal fixation screw placement,relieve the early postoperative pain,reduce intraoperative blood loss and postoperative complications,and facilitate the fast track rehabilitation of patients.