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
Objective: Explore the feasibility and clinical efficacy of using unilateral biportal endoscopy for the treatment of Type II/III lumbar brucellar spondylitis. Methods: A retrospective study of the clinical data of 20 ...Objective: Explore the feasibility and clinical efficacy of using unilateral biportal endoscopy for the treatment of Type II/III lumbar brucellar spondylitis. Methods: A retrospective study of the clinical data of 20 patients with Type II/III lumbar brucellar spondylitis admitted to the First Affiliated Hospital of Hebei North University from January 2020 to May 2022, including 15 males and 5 females, aged 41 - 60 years old, average age (48.11 ± 7.28) years old. After admission, the patient can isolate brucella through metagenomic Next-Generation Sequencing (mNGS), meeting the tertiary diagnostic criteria. Preoperative conventional drug treatment, unilateral biportal endoscopic minimally invasive surgery was performed when nutrition was improved, perioperative control of various indexes was stable, and erythrocyte sedimentation was declining. It was completed under an endoscope. The lesion was cleared, spinal nerve compression was relieved, interbody fusion was performed, and the spine was fixed by a percutaneous pedicle screw. Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were analyzed at 1 month, 3 months, 6 months and the last follow-up. At the final follow-up of all patients, the clinical efficacy criteria and the Bridwell grading criteria were used to evaluate the recovery and intervertebral bone graft fusion, respectively. Results: All patients’ lower back and leg pain was relieved the next day after surgery. At a follow-up of one month after surgery, both systemic and local symptoms significantly improved. At the last follow-up, clinical symptoms disappeared and there was no tenderness or percussion pain in the local area. With the passage of time, 1 month, 3 months, 6 months after the operation, and the last follow-up are all evaluation indicators compared with those before the operation. No matter VAS, JOA, ODI score, or ESR, CRP is significantly improved compared with preoperative (P All 20 cases in this group reached the BS clinical cure standard, and the excellent rate of intervertebral bone graft fusion was 95%. Conclusion: On the basis of .展开更多
Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outc...Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.展开更多
目的探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系。方法对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效。随访时间12~38个月。男35个,女26个,年龄19~81岁,平均年龄54.4...目的探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系。方法对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效。随访时间12~38个月。男35个,女26个,年龄19~81岁,平均年龄54.4岁。手术节段均为单节段,共61节段。记录患者围手术期及手术并发症情况;随访以末次随访为终止时间。采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和改良MacNab标准评价临床疗效;手术前后行腰椎CT三维重建检查,观察并测量关节突关节切除内侧角(β角);椎间盘类型按照分类定位系统MSU(Michgan State University)基于MRI横断位分A、B、C区,依据区域定位法FSU(Functional Spine Unit)基于MRI或CT横断位、矢状位分级1~4级;统计采用配对t检验,及方差分析。结果61例患者均顺利完成手术。其中行腰椎间盘突出手术61例,其中合并中央管狭窄29例,合并侧隐窝狭窄54例。术中出现硬膜囊撕裂2例。术后出现短暂性下肢麻木3例,类脊髓综合征1例,感染1例。患者术后随访(12~38)个月。术后随访时,患者腿部VAS、ODI较术前明显下降(P值均<0.05)。术后末次随访时依据改良MacNab标准,优良率为65.6%(40/61)。腰椎三维CT影像学方面,测量β角均小于90°,平均值83.59°,范围(66.72°~89.32°)。基于MSU分区,A区37例,B区15例,C区9例;基于FSU位置分级,分别为1级1例,2级25例,3级2例,合并1和2级26例,2和3级4例,1和2、3级3例。方差分析显示术后满意度与椎间盘分区及分级、β角无关,与术后疼痛及功能障碍指数相关。结论单侧双通道脊柱内镜治疗退行性腰椎疾病术后疗效可能与术后β角及椎间盘分区、分级无关。分级、分区越复杂,手术难度越大,早期开展这项技术遇到的困难可能越多。展开更多
目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(6...目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(62.62±4.01)岁。记录患者基本信息及围手术期相关指标,并在术后1个月、6个月进行随访,记录术前术后改良日本骨科协会评分(modified Japanese orthopaedic association score,mJOA)、美国脊髓损伤协会(American spinal injury association,ASIA)感觉评分(ASIA sense score,ASS)和双下肢运动评分(ASIA motor score,AMS)变化情况。以mJOA评分计算术后6个月随访时的改善率(recover rate,RR)及优良率,对RR与性别、年龄、术前mJOA评分、影像学分型及病程进行相关性分析。结果平均手术时间为(108.46±16.12)min,平均出血量(23.46±7.47)mL,平均住院时间(6.08±0.86)d。术后随访时间为6~35个月,平均(16.77±9.33)个月,术后1个月及6个月随访时,mJOA、ASS、AMS评分均优于术前(P<0.05),平均RR为(55.69±19.73)%,优良率为69.23%。RR与术前病程呈负相关(P<0.001),与术前mJOA评分呈正相关(P=0.029),与性别、年龄、影像学分型均无明显相关性(P>0.05)。结论Delta大通道脊柱内镜技术治疗胸椎黄韧带骨化症安全可靠,具有术后恢复快、创伤小、出血量少等优势,短期效果良好。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Objective: Explore the feasibility and clinical efficacy of using unilateral biportal endoscopy for the treatment of Type II/III lumbar brucellar spondylitis. Methods: A retrospective study of the clinical data of 20 patients with Type II/III lumbar brucellar spondylitis admitted to the First Affiliated Hospital of Hebei North University from January 2020 to May 2022, including 15 males and 5 females, aged 41 - 60 years old, average age (48.11 ± 7.28) years old. After admission, the patient can isolate brucella through metagenomic Next-Generation Sequencing (mNGS), meeting the tertiary diagnostic criteria. Preoperative conventional drug treatment, unilateral biportal endoscopic minimally invasive surgery was performed when nutrition was improved, perioperative control of various indexes was stable, and erythrocyte sedimentation was declining. It was completed under an endoscope. The lesion was cleared, spinal nerve compression was relieved, interbody fusion was performed, and the spine was fixed by a percutaneous pedicle screw. Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Visual Analogue Scale (VAS), Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were analyzed at 1 month, 3 months, 6 months and the last follow-up. At the final follow-up of all patients, the clinical efficacy criteria and the Bridwell grading criteria were used to evaluate the recovery and intervertebral bone graft fusion, respectively. Results: All patients’ lower back and leg pain was relieved the next day after surgery. At a follow-up of one month after surgery, both systemic and local symptoms significantly improved. At the last follow-up, clinical symptoms disappeared and there was no tenderness or percussion pain in the local area. With the passage of time, 1 month, 3 months, 6 months after the operation, and the last follow-up are all evaluation indicators compared with those before the operation. No matter VAS, JOA, ODI score, or ESR, CRP is significantly improved compared with preoperative (P All 20 cases in this group reached the BS clinical cure standard, and the excellent rate of intervertebral bone graft fusion was 95%. Conclusion: On the basis of .
文摘Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.
文摘目的探讨单侧双通道脊柱内镜(UBE)治疗退行性腰椎疾病(DLD)术后疗效与影响因素关系。方法对2021年2月至2023年3月收治本科室的61例DLD患者进行回顾性分析,评价其术后疗效。随访时间12~38个月。男35个,女26个,年龄19~81岁,平均年龄54.4岁。手术节段均为单节段,共61节段。记录患者围手术期及手术并发症情况;随访以末次随访为终止时间。采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和改良MacNab标准评价临床疗效;手术前后行腰椎CT三维重建检查,观察并测量关节突关节切除内侧角(β角);椎间盘类型按照分类定位系统MSU(Michgan State University)基于MRI横断位分A、B、C区,依据区域定位法FSU(Functional Spine Unit)基于MRI或CT横断位、矢状位分级1~4级;统计采用配对t检验,及方差分析。结果61例患者均顺利完成手术。其中行腰椎间盘突出手术61例,其中合并中央管狭窄29例,合并侧隐窝狭窄54例。术中出现硬膜囊撕裂2例。术后出现短暂性下肢麻木3例,类脊髓综合征1例,感染1例。患者术后随访(12~38)个月。术后随访时,患者腿部VAS、ODI较术前明显下降(P值均<0.05)。术后末次随访时依据改良MacNab标准,优良率为65.6%(40/61)。腰椎三维CT影像学方面,测量β角均小于90°,平均值83.59°,范围(66.72°~89.32°)。基于MSU分区,A区37例,B区15例,C区9例;基于FSU位置分级,分别为1级1例,2级25例,3级2例,合并1和2级26例,2和3级4例,1和2、3级3例。方差分析显示术后满意度与椎间盘分区及分级、β角无关,与术后疼痛及功能障碍指数相关。结论单侧双通道脊柱内镜治疗退行性腰椎疾病术后疗效可能与术后β角及椎间盘分区、分级无关。分级、分区越复杂,手术难度越大,早期开展这项技术遇到的困难可能越多。
文摘目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(62.62±4.01)岁。记录患者基本信息及围手术期相关指标,并在术后1个月、6个月进行随访,记录术前术后改良日本骨科协会评分(modified Japanese orthopaedic association score,mJOA)、美国脊髓损伤协会(American spinal injury association,ASIA)感觉评分(ASIA sense score,ASS)和双下肢运动评分(ASIA motor score,AMS)变化情况。以mJOA评分计算术后6个月随访时的改善率(recover rate,RR)及优良率,对RR与性别、年龄、术前mJOA评分、影像学分型及病程进行相关性分析。结果平均手术时间为(108.46±16.12)min,平均出血量(23.46±7.47)mL,平均住院时间(6.08±0.86)d。术后随访时间为6~35个月,平均(16.77±9.33)个月,术后1个月及6个月随访时,mJOA、ASS、AMS评分均优于术前(P<0.05),平均RR为(55.69±19.73)%,优良率为69.23%。RR与术前病程呈负相关(P<0.001),与术前mJOA评分呈正相关(P=0.029),与性别、年龄、影像学分型均无明显相关性(P>0.05)。结论Delta大通道脊柱内镜技术治疗胸椎黄韧带骨化症安全可靠,具有术后恢复快、创伤小、出血量少等优势,短期效果良好。
