机器人辅助全内镜下经椎间孔椎间融合术治疗Ⅰ、Ⅱ度腰椎滑脱的疗效

Efficacy of robot-assisted full-endoscopic transforaminal lumbar interbody fusion in the treatment of degree Ⅰ and Ⅱ lumbar spondylolisthesis

目的探讨机器人辅助全内镜下经椎间孔入路腰椎椎间融合术(Endo-TLIF)在Ⅰ、Ⅱ度腰椎滑脱中的治疗效果。方法回顾性收集2020年1月至2022年1月甘肃省人民医院收治的腰椎滑脱且行机器人辅助Endo-TLIF治疗的17例患者的临床资料。记录术后住院天数、术后并发症。计算椎弓根钉置入准确率及单个螺钉置钉时间。末次随访时,采用改良MacNab标准评价临床疗效,Suk法评估椎间融合情况。记录术前、术后1个月、末次随访时相关评分。结果患者手术时长为(126.45±17.28)min,术中出血量(90.00±11.25)mL,术中X线透视(4.10±0.95)次,术后住院(3.54±0.37)d。置钉准确率为97.06%,平均置钉时间为9.75 min。末次随访时所有患者椎间融合良好,改良MacNab评估优良率为94.12%。术后1个月、末次随访时,疼痛视觉模拟(VAS)评分均低于术前,日本骨科协会(JOA)评分高于术前(P<0.05)。患者均无硬膜损伤、神经组织损伤、螺钉松动断裂情况。结论机器人辅助Endo-TLIF治疗Ⅰ、Ⅱ度腰椎滑脱有较好的疗效,且具有置钉精准、创伤小、手术时间短、术中出血量少的优点,但存在费用高及对患者辐射大的问题。

Objective To evaluate the efficacy of robot-assisted full-endoscopic transforaminal lumbar interbody fusion(Endo-TLIF)in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis.Methods The clinical data of 17 lumbar spondylolisthesis patients underwent robot-assisted Endo-TLIF treatment in Gansu Provincial Hospital from January 2020 to January 2022 were retrospectively collected.The postoperative hospital stay and complications were recorded.The accuracy of pedicle screw placement and the time of single screw placement were calculated.The clinical efficacy was evaluated by modified MacNab and lumbar interbody fusion was evaluated by Suk method.The related scores were recorded before operation,1 month after operation and at the last follow-up.Results There were(126.45±17.28)min in duration of surgery,(90.00±11.25)mL in intraoperative blood loss,(4.10±0.95)times in intraoperative X-ray fluoroscopy,and(3.54±0.37)days in postoperative hospital stay.The accuracy of pedicle screw placement was 97.06%,and average pedicle screw placement time was 9.75 min.At the last follow-up,all patients were evaluated to have good lumbar interbody fusion,with the excellent and good rate was 94.12%.One month after operation and at the last follow-up,the visual analogue scale(VAS)score was lower than that before operation,while the total score of Japanese Orthopaedic Association(JOA)was significantly higher than that before operation(P<0.05).No dura mater injury,nerve tissue injury,screw loosening and fracture were found in all patients.Conclusion Robot-assisted Endo-TLIF in the treatment of grade Ⅰ and Ⅱ lumbar spondylolisthesis has good efficacy,and has the advantages of accurate pedicle screw placement,less trauma,short operation time,and less intraoperative blood loss,but there are problems of high cost and high radiation to patients.