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
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.
文摘目的:观察单侧双通道内镜下腰椎融合术(unilateralbiportal endoscopic transforaminal lumbarinter-bodyfusion,UBE-TLIF)术后的隐性失血情况,并对其相关危险因素进行分析。方法:回顾性分析2020年1月~2021年6月在我院行UBE-TLIF治疗的59例腰椎退行性疾病患者的临床资料,收集患者一般资料如年龄、性别、体质指数(bodymass index,BMI)、学习曲线、疾病类型以及是否合并有高血压、糖尿病;手术相关资料如病变节段、手术时间、显性失血量、美国麻醉师协会麻醉分级(American Society of Anesthesiologists,ASA);实验室检查如凝血酶原时间、活化部分凝血活酶时间、血小板计数、纤维蛋白原、血红蛋白(hemoglobin,Hb)和红细胞压积(hematocrit,Hct)。根据Gross公式计算总失血量,并由此计算患者的术后隐性失血量,采用单因素方差分析和Pearson相关性检验探讨患者的特征与术后隐性失血之间的相关性,采用多元线性回归分析确定术后隐性失血的独立危险因素,构建危险因素的受试者工作特征(receiver operating characteristic,ROC)曲线以分析危险因素的预测价值。结果:手术时间为128.22±22.88min,总失血量为607.32±186.78ml,隐性失血量为393.83±173.42ml,占总失血量的(62.13±11.73)%。术后Hb、Hct均较术前明显降低(P<0.05)。单因素方差分析中性别、高血压、糖尿病、手术节段、疾病类型与隐性失血无明显相关性(P>0.05),学习曲线和ASA分级与隐性失血具有相关性(P<0.001)。Pearson相关性分析显示,年龄、BMI、凝血酶原时间、活化部分凝血活酶时间、血小板计数与隐性失血无相关性(P>0.05),手术时间、纤维蛋白原与隐性失血具有相关性(P<0.001)。多元线性回归分析显示,手术时间(B=2.236,P<0.01)学习曲线(B=-109.781,P<0.01)、ASA分级(B=77.589,P<0.01)和纤维蛋白原(B=81.762,P<0.01)是隐性失血的独立危险因素。ROC曲线显示手术时间预测严重隐性失血的ROC曲线下面积(areaundercurve,AUC)为0.813(95%CI:0.688~0.938,P<0.001),最佳截点为139.5min;纤维蛋白原的AUC为0.794(95%CI:0.654~0.934,P<0.001),最佳截点为2.65g/L。结论:UBE-TLIF治疗腰椎退行性疾病存在较大的术后隐性失血,手术时间、学习曲线、ASA分级和纤维蛋白原是术后隐性失血的独立危险因素。
