“天玑”骨科手术机器人辅助经皮螺钉内固定治疗单纯腰椎峡部裂的疗效观察

TiRobot-assisted percutaneous screw fixation for treatment of simple lumbar spondylolysis

背景螺钉内固定术是治疗单纯腰椎峡部裂的有效手术方法,但传统开放手术创伤与置钉难度较大,技术要求较高。“天玑”骨科手术机器人辅助下置钉具有精准、微创的特点,在其辅助下行腰椎峡部螺钉内固定术的临床效果有待分析。目的探讨“天玑”骨科手术机器人辅助下经皮螺钉内固定术治疗单纯腰椎峡部裂的疗效及应用价值。方法回顾性分析2019年1-6月于北京积水潭医院行峡部螺钉内固定治疗的单纯腰椎峡部裂患者47例,其中24例行传统开放手术,23例在“天玑”骨科机器人辅助下行经皮微创固定手术。比较两组的手术时间、出血量、术后下地时间、术后住院日,分析术前、术后3 d、术后3个月、6个月的腰痛视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI),术后6个月行三维CT扫描评估螺钉位置,分析手术效果。结果47例患者中,传统开放组男性14例,女性9例,平均年龄23岁;机器人辅助微创手术组男性15例,女性9例,平均年龄24岁。机器人辅助微创手术组在手术时间[(87.5±9.4)min vs(100.6±12.3)min]、出血量[(5.2±1.1)mL vs(38.7±5.2)mL]、术后下地时间[(16.1±5.6)h vs(21.9±5.7)h]、术后住院日[(1.3±0.5)d vs(2.0±0.5)d]方面明显优于传统开放组(P均<0.05)。两组均无并发症,术后6个月无内固定失败病例,无腰椎滑脱发生,无腰椎不稳。两组术后各时间点的腰痛VAS评分和ODI均明显优于术前(P<0.01),术后3 d机器人微创手术组腰痛VAS评分明显低于传统开放手术组(2.04±1.15 vs 3.04±1.12,P<0.01)。结论“天玑”骨科手术机器人辅助经皮螺钉内固定治疗单纯腰椎峡部裂损伤小、恢复快、稳定性可靠,对于年轻的单纯腰椎峡部裂患者有良好的早期治疗效果。

Background Internal fixation is an effective surgical method for the treatment of simple lumbar spondylolysis,but the traditional open surgery is invasive and requires high technical skills.TiRobot-assisted percutaneous screw fixation is accurate and minimally invasive,however,its clinical effect for simple lumbar spondylolysis needs to be analyzed.Objective To investigate the clinical outcomes of the TiRobot-assisted percutaneous screw fixation in the treatment of simple lumbar spondylolysis.Methods A retrospective analysis was performed on 47 patients with simple lumbar spondylolysis treated by screw internal fixation in Beijing Jishuitan Hospital from January to June in 2019.Among them,24 cases underwent traditional open surgery,and 23 cases underwent percutaneous minimally invasive fixation surgery assisted by TiRobot.The operating time,blood loss,lumbar VAS score and Oswestry disability index before,at 3 days,3 months and 6 months after operation of the two groups were analyzed.Screw position was evaluated by CT scan at 6 months after surgery,and the clinical results were analyzed.Results There were 15 males and 9females in the open surgery group(mean age,24 years),and 14 males and 9 females in the TiRobot group(mean age,23 years).The operating time([100.6±12.3 vs 87.5±9.4]min),blood loss([38.7±5.2 vs 5.2±1.1]mL),time to mobilization([21.9±5.7 vs16.1±5.6]h)and postoperative hospital day([1.3±0.5 vs 2.0±0.5]d)in the TiRobot group were significantly greater than those in the open surgery group.There were no complications occurred in both of the two groups,and no internal fixation failure,no lumbar spondylolisthesis,and no lumbar instability occurred at 6 months after surgery.The low back pain VAS and ODI score at all the postoperative time points were significantly better than those before surgery(P<0.01),and the low back pain VAS at 3 days after minimally invasive surgery in the TiRobot group was significantly lower than that in the open surgery group(2.04±1.15 vs 3.04±1.12,P<0.01).Conclusion TiRobot-assisted percutaneous screw internal fixation has a good early treatment effect for young patients with simple lumbar spondylolysis,with minimal invasion and quicker recovery.