机器人与徒手侧方椎体间融合椎弓钉固定的比较

Robotic versus freehand lateral lumbar interbody fusion with posterior pedicle screw fixation

[目的]探讨机器人与徒手侧方腰椎椎间融合术治疗腰椎退行性疾病(lumbar degenerative diseases,LDD)的临床疗效。[方法]回顾性分析2019年1月-2022年1月四川省人民医院骨科治疗的LDD患者的临床资料,根据医患沟通结果,22例采用机器人辅助单一体位侧位腰椎椎间融合术(机器人组),21例应用传统双体位腰椎椎间融合术(徒手组)。比较两组围手术期、随访期及影像结果。[结果]两组患者均顺利完成手术,机器人组的手术时间[(136.0±18.6)min vs(149.4±22.0)min,P=0.036]、术中出血量[(124.9±16.5)ml vs(138.2±20.3)ml,P=0.023]、术中透视次数[(11.6±3.7)次vs(40.0±8.1)次,P<0.001]显著少于徒手组。随访时间平均(11.3±3.8)个月,两组完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组患者腰痛以及腿痛VAS评分、ODI评分显著降低(P<0.05)。相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,两组椎弓根螺钉置钉准确性的差异无统计学意义(P>0.05)。与术前相比,两组椎管面积、侧隐窝矢状径、腰椎前凸角均显著增加(P<0.05),相应时间点,两组上述影像指标的差异均无统计学意义(P>0.05)。[结论]机器人辅助与徒手侧位腰椎椎间融合术都是治疗LDD的有效方法。但是机器人组可减少手术时间、降低术中出血量以及术中透视次数,具有良好的临床应用价值。

[Objective]To investigate the clinical efficacy of robotic versus freehand lateral lumbar interbody fusion(LLIF)with posterior pedicle screw fixation for the treatment of lumbar degenerative diseases(LDD).[Methods]A retrospective study was conducted on 43 patients who underwent LLID for LDDs in our hospital from January 2019 to January 2022.According to preoperative doctor-patient communication,22 patients underwent robot-assisted single lateral position LLIF and pedicle screw fixation(the robot group),while other 21 patients underwent traditional LLIF with changing position and freehand technique(the freehand group).The documents regarding to perioperative period,follow-up and images were compared between the two groups.[Results]All patients in both groups had operation performed successfully.The robot group proved significantly superior to the freehand group in terms of operation time[(136.0±18.6)min vs(149.4±22.0)min,P=0.036],intraoperative blood loss[(124.9±16.5)ml vs(138.2±20.3)ml,P=0.023],intraoperative fluoroscopy times[(11.6±3.7)times vs(40.0±8.1)times,P<0.001].The mean follow-up time was of(11.3±3.8)months,and there was no significant difference in time to regain full weight-bearing activity between the two groups(P>0.05).The VAS scores of low back pain and leg pain,as well as ODI score significantly decreased over time in both groups(P<0.05),which were not statistically significant between the two groups at any corresponding time points(P>0.05).As for imaging,there was no significant difference in the accuracy of pedicle screw placement between the two groups(P>0.05).Compared with those preoperatively results,the spinal canal area,sagittal diameter of lateral recess and lumbar lordosis angle significantly improved in both groups postoperatively(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).[Conclusion]Both robot-assisted and freehand lateral lumbar interbody fusion are effective for the treatment of LDD.However,the robot technique does reduce the operation time,intraoperative blood loss and intraoperative fluoroscopy times,and has good clinical application value.