机器人辅助微创手术与非手术治疗在胸腰椎损伤分类与严重度评分4分胸腰椎骨折患者中的临床疗效研究

Clinical effect of robot-assisted minimally invasive surgery and non-surgical treatment in patients presenting thoracolumbar fracture with a Thoracolumbar Injury Classification and Severity Score of four

目的 分析在胸腰椎损伤分类与严重度评分(Thoracolumbar Injury Classification and Severity Score,TLICS)4分胸腰椎骨折中应用天玑骨科机器人系统辅助椎弓根螺钉内固定的临床疗效。方法 回顾性分析2019年1月-2021年1月四川省医学科学院·四川省人民医院符合选择标准的38例TLICS 4分胸腰椎骨折患者,依据医患沟通结果,其中18例采用机器人辅助置钉(机器人组),20例采用传统保守治疗(非手术组)。观察两组住院期间并发症,出院后通过电话及门诊随访两组患者,比较两组患者入院时、出院时及出院后3、6个月时疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分,以及出院后3、6个月时的Oswestry功能障碍指数(Oswestry Disability Index,ODI)评分。结果 两组患者年龄、性别、体质量指数、伤椎节段分布等一般资料比较差异均无统计学意义(P>0.05)。两组住院期间均未出现严重并发症。两组住院时间差异无统计学意义(P>0.05),机器人组比非手术组卧床时间更短[(4.83±0.92) vs.(43.05±2.70) d,P<0.05]。在出院时[(2.50±0.51)vs.(5.05±1.00)分]、出院后3个月时[(1.83±0.71)vs.(3.10±0.72)分]和出院后6个月时[(1.50±0.51)vs.(1.90±0.79)分]机器人组比非手术组VAS评分更低(P<0.05),在出院后3个月时[(21.89±1.41)vs.(30.40±3.00)分]和出院后6个月时[(10.72±2.37)vs.(12.10±2.29)分]机器人组ODI评分明显低于非手术组(P<0.05)。结论 对于TLICS4分的胸腰椎骨折患者,机器人辅助下手术治疗的早期临床疗效优于非手术治疗。

Objective To analyze the clinical effect of TINAVI robotic system-assisted pedicle screw internal fixation for thoracolumbar fracture with a Thoracolumbar Injury Classification and Severity Score(TLICS) of 4.Methods A total of 38 patients with TLICS 4 thoracolumbar fracture treated between January 2019 and January 2021who met the selection criteria of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. According to the results of doctor-patient communication, 18 cases were treated with robot-assisted minimally invasive surgery(robot group), and 20 cases were treated with traditional conservative treatment(non-surgical group). Complications during hospitalization were observed. After discharge, the patients in the two groups were followed up by telephone and outpatient clinic. The Visual Analogue Scale(VAS) score at admission, at discharge,and 3 and 6 months after discharge, and the Oswestry Disability Index(ODI) score 3 and 6 months after discharge were compared between the two groups. Results There were no statistically significant difference in age, sex, body mass index or distribution of injured vertebrae segment between the two groups(P>0.05). No serious complication occurred in any group during hospitalization. The difference in the length of hospital stay between the two groups was not statistically significant(P>0.05). The bed rest in the robot group was shorter than that in the non-surgical group [(4.83±0.92) vs.(43.05±2.70) d, P<0.05]. The VAS scores at discharge(2.50±0.51 vs. 5.05±1.00), 3 months after discharge(1.83±0.71 vs.3.10±0.72) and 6 months after discharge(1.50±0.51 vs. 1.90±0.79) in the robot group were lower than those in the nonsurgical group(P<0.05). The ODI scores 3 months after discharge(21.89±1.41 vs. 30.40±3.00) and 6 months after discharge(10.72±2.37 vs. 12.10±2.29) in the robot group were significantly lower than those in the non-surgical group(P<0.05). Conclusion For patients with TLICS 4 thoracolumbar fracture, the early clinical effect of robot-assisted surgical treatment is better than that of non-surgical treatment.