BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perfo...BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.展开更多
背景:单边双通道内镜下腰椎椎间融合作为新颖的微创技术已被广泛应用于腰椎退行性疾病的治疗,但融合器沉降作为一种术后并发症仍无法完全避免。目的:通过有限元模型分析单边双通道内镜下腰椎椎间融合技术的生物力学特点,以及在不同高度...背景:单边双通道内镜下腰椎椎间融合作为新颖的微创技术已被广泛应用于腰椎退行性疾病的治疗,但融合器沉降作为一种术后并发症仍无法完全避免。目的:通过有限元模型分析单边双通道内镜下腰椎椎间融合技术的生物力学特点,以及在不同高度融合器和骨质疏松条件下融合器沉降的风险。方法:基于健康成年男性志愿者的CT数据构建了L_(4)-L_(5)椎体有限元模型,依据单边双通道内镜下腰椎椎间融合手术方式,依次构建置入8,10,12 mm 3种不同高度融合器的模型,每种高度融合器模型分为骨质正常和骨质疏松两种情况。在L_(4)上表面施加500 N的随动载荷和10 Nm的力矩,模拟前屈、后伸、左侧弯、右侧弯、左旋转、右旋转运动,观察并分析不同工况下各种模型的相对活动度、椎弓根钉-杆系统应力及终板应力。结果与结论:(1)在相同运动状态下,6种椎间融合模型的相对活动度均明显低于正常腰椎模型;6种椎间融合模型前屈运动下的相对活动度最大,后伸运动下的相对活动度最小;在相同骨质与运动状态下,随着融合器高度的增加,椎间融合模型的相对活动度减少;(2)在相同骨质与运动状态下,随着融合器高度的增加,椎间融合模型的椎弓根钉-杆系统应力减小;6种椎间融合模型侧弯运动下的椎弓根钉-杆系统应力最大,前屈和后伸运动下的椎弓根钉-杆系统应力最小;当融合器高度相同时,骨质疏松模型椎弓根钉-杆系统应力均大于骨质正常模型;(3)在相同骨质与运动状态下,随着融合器高度的增加,椎间融合模型的L_(4)下终板(或L_(5)上终板)最大应力增加;当融合器高度相同时,骨质疏松模型的L_(4)下终板(或L_(5)上终板)最大应力稍大于骨质正常模型;在相同运动状态下,6种椎间融合模型的L_(4)下终板最大应力均大于L_(5)上终板;6种椎间融合模型前屈运动下的L_(4)下终板(或L_(5)上终板)最大应力最大,后伸运动下的L_(4)下终板(或L_(5)上终板)最大应力最小;(4)结果显示,融合器选择并不是越高越好,而是需要适度撑开,在保证节段稳定性的同时避免融合器过高导致融合器沉降的风险增加。展开更多
基金Supported by National Natural Science Foundation of China(Regional Program),No.82060879,No.82360947Gansu Province Key Talent Project,No.2024-4+2 种基金Natural Science Foundation of Gansu Province,No.20JR10RA356Gansu Provincial Joint Research Fund,No.23JRRA1534National Administration of Traditional Chinese Medicine High Level Key Discipline Construction Project of Traditional Chinese Medicine(Traditional Chinese Orthopedics and Traumatology Science),No.203.
文摘BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.
文摘背景:单边双通道内镜下腰椎椎间融合作为新颖的微创技术已被广泛应用于腰椎退行性疾病的治疗,但融合器沉降作为一种术后并发症仍无法完全避免。目的:通过有限元模型分析单边双通道内镜下腰椎椎间融合技术的生物力学特点,以及在不同高度融合器和骨质疏松条件下融合器沉降的风险。方法:基于健康成年男性志愿者的CT数据构建了L_(4)-L_(5)椎体有限元模型,依据单边双通道内镜下腰椎椎间融合手术方式,依次构建置入8,10,12 mm 3种不同高度融合器的模型,每种高度融合器模型分为骨质正常和骨质疏松两种情况。在L_(4)上表面施加500 N的随动载荷和10 Nm的力矩,模拟前屈、后伸、左侧弯、右侧弯、左旋转、右旋转运动,观察并分析不同工况下各种模型的相对活动度、椎弓根钉-杆系统应力及终板应力。结果与结论:(1)在相同运动状态下,6种椎间融合模型的相对活动度均明显低于正常腰椎模型;6种椎间融合模型前屈运动下的相对活动度最大,后伸运动下的相对活动度最小;在相同骨质与运动状态下,随着融合器高度的增加,椎间融合模型的相对活动度减少;(2)在相同骨质与运动状态下,随着融合器高度的增加,椎间融合模型的椎弓根钉-杆系统应力减小;6种椎间融合模型侧弯运动下的椎弓根钉-杆系统应力最大,前屈和后伸运动下的椎弓根钉-杆系统应力最小;当融合器高度相同时,骨质疏松模型椎弓根钉-杆系统应力均大于骨质正常模型;(3)在相同骨质与运动状态下,随着融合器高度的增加,椎间融合模型的L_(4)下终板(或L_(5)上终板)最大应力增加;当融合器高度相同时,骨质疏松模型的L_(4)下终板(或L_(5)上终板)最大应力稍大于骨质正常模型;在相同运动状态下,6种椎间融合模型的L_(4)下终板最大应力均大于L_(5)上终板;6种椎间融合模型前屈运动下的L_(4)下终板(或L_(5)上终板)最大应力最大,后伸运动下的L_(4)下终板(或L_(5)上终板)最大应力最小;(4)结果显示,融合器选择并不是越高越好,而是需要适度撑开,在保证节段稳定性的同时避免融合器过高导致融合器沉降的风险增加。
文摘[目的]评价单侧双通道内镜下经椎间孔腰椎间融合术(unilateral biportal endoscopic transforaminal lumbar interbody fusion, UBE-TLIF)治疗复发性腰椎间盘突出症(recurrent lumbar disc herniation, RLDH)的临床疗效。[方法]回顾性分析2022年1月—2023年12月本院收治的38例RLDH患者的临床资料。依据术前医患沟通结果,18例行UBE-TLIF翻修术,另外20例行开放后路腰椎间融合(posterior lumbar interbody fusion, PLIF)翻修术。评价比较临床及影像资料。[结果]两组患者均顺利完成手术,无神经损伤等并发症。BE-TLIF组在手术时间[(138.3±15.4) min vs (154.8±14.6) min, P=0.002]、术中出血量[(186.1±41.0) ml vs (230.5±55.8) ml, P=0.009]、下地时间[(2.4±0.6) d vs (5.9±1.0) d, P<0.001]、住院时间[(8.1±2.3) d vs (12.4±2.9) d, P<0.001]均显著优于PLIF组。随访时间平均(5.4±1.1)个月,UBE-TLIF组在术后1 d腰痛VAS评分[(2.2±0.7) vs (3.1±0.8), P=0.002]、ODI评分[(36.7±3.4) vs (57.0±3.9), P<0.001]和JOA评分[(11.2±2.4) vs (9.2±2.5), P=0.018]均显著优于PLIF组,但是,末次随访时,两组间上述指标的差异均无统计学意义(P>0.05)。[结论] UBE-TLIF组早期功能恢复优于PLIF组,并具有手术时间短、术中出血量少、下地时间早、住院时间短等优势。
