机器人辅助微创经椎间孔腰椎椎间融合治疗腰椎退行性疾病:置钉精度及其安全性

Robot-assisted minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases:accuracy and safety of screw placement

背景:针对腰椎退行性疾病的治疗,机器人辅助下的微创经椎间孔腰椎椎间融合(minimally invasive transforaminal lumbar interbody fusion,MIS-TLIF)与传统的MIS-TLIF比是否更加精准、创伤更少、是否更加有利于患者及术者的健康,目前并没有相关的研究报道。目的:通过对比传统MIS-TLIF的临床和影像学资料,探讨骨科机器人辅助MIS-TLIF在腰椎退行性疾病中的临床应用价值。方法:回顾分析2018年1月至2020年11月于四川省医学科学院•四川省人民医院骨科治疗的72例腰椎退行性疾病患者临床资料,其中33例应用机器人辅助MIS-TLIF治疗(机器人组),39例应用传统MIS-TLIF治疗(传统组)。比较两组基本临床指标,包括手术时间、术中出血量、住院天数、手术并发症、辐射次数、辐射剂量以及辐射时间。临床疗效评估采用Oswestry功能障碍指数及疼痛目测类比评分;以Macnab标准评估两种手术方案的优良率;以Gertzbein-Robbins分级标准判断经皮螺钉的精度。结果与结论:①两组患者性别、年龄及病变节段基线资料差异无显著性意义(P>0.05);②两组术后均改善了患者Oswestry功能障碍指数和腰腿痛目测类比评分,在术前、术后及末次随访时两组间差异均无显著性意义(P>0.05);两组术后均无严重血管或神经并发症的发生,Macnab优良率及并发症上两组间差异无显著性意义(P>0.05);③机器人组手术时间和住院天数较传统组更短,并且术中出血量少于传统组;④机器人组辐照次数、辐照剂量及辐射时间较传统组明显缩短;⑤术后影像学检查显示,机器人组的置钉精度优于传统组(99.24%vs.91.03%,χ^(2)=9.78,P=0.002);⑥结果说明,在腰椎退行性疾病的手术治疗中,相较于传统MIS-TLIF,机器人辅助MIS-TLIF的手术效率更高,术中辐射更少,内固定精度更高,具有良好的临床应用价值。

BACKGROUND: For the treatment of lumbar degenerative disorders, there are no relevant studies whether robot-assisted minimally invasive transforaminal lumbar interbody fusion is more accurate, less invasive, and more beneficial to the health of patients and operators compared with traditional minimally invasive transforaminal lumbar interbody fusion.OBJECTIVE: To evaluate the clinical value of robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery by comparing the clinical and radiographic data with conventional minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases. METHODS: A retrospective study was conducted in 72 patients with lumbar degenerative diseases from January 2018 to November 2020 in Department of Orthopedic Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital. Of them, 33 patients underwent robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery(robot group) and 39 patients received conventional minimally invasive transforaminal lumbar interbody fusion surgery(traditional group). Basic clinical outcomes included comparison of operative time, intraoperative blood loss, hospital stay, operative complications, fluoroscopic dose, fluoroscopic time and fluoroscopic frequency between the two groups. Clinical outcomes were assessed using Oswestry disability index and visual analogue scale score. Excellent and good rate of the two surgical options was evaluated using Macnab’s criteria. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screws. RESULTS AND CONCLUSION:(1) There were no statistically significant differences in gender, age and lesion segment between the two groups(P > 0.05).(2) Patients in both traditional and robot groups had improved Oswestry disability index and visual analogue scale scores. There were no statistically significant differences between the two groups at pre-operation, post-operation and at the last follow-up(P > 0.05). No major vascular or neurological complications were found post-operatively in both groups. Moreover, there was no statistical significance in Macnab criteria and complications between the two groups(P > 0.05).(3) Operative time and hospital stay of the robot group were significantly shorter than those in the traditional group. The intraoperative blood loss was significantly lower in the robot group than that in the traditional group.(4) The significantly lower fluoroscopic frequency and dose, as well as shorter fluoroscopic time were found in the robot group compared with the traditional group.(5) Postoperative imaging studies showed that the accuracy of percutaneous pedicle screw placement in the robot group was superior than that in the traditional group(99.24% vs. 91.03%, χ;=9.78, P=0.002).(6) It is concluded that compared with the traditional group, the robot-assisted minimally invasive transforaminal lumbar interbody fusion has higher surgical efficiency, less intraoperative radiation and superior accuracy of screw fixation, which has a good clinical value in the treatment of lumbar degenerative diseases.