组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2024, Vol. 20 ›› Issue (3): 300-.

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脊柱机器人辅助系统在MIS-TLIF手术中的临床应用价值

  

  • 出版日期:2024-06-01 发布日期:2024-07-05

Clinical application value of spinal robot assisted system in MIS-TLIF surgery

  • Online:2024-06-01 Published:2024-07-05

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摘要：

目的　研究脊柱机器人辅助系统在微创经椎间孔椎间融合术（MIS-TLIF）中的临床应用价值。方法 选取2019 年 3 月至 2022 年 11 月收治的因腰椎退行性疾病而接受手术治疗的 78 例患者，根据不同手术方式分为传统 MISTLIF组（A组，41例）与机器人 MIS-TLIF组（B组，37例）。比较两组围手术期指标（术中出血量、手术时间、切口长度和透视次数），术后CT检查结果（螺钉置钉准确度、螺钉外展角），功能恢复情况：疼痛视觉模拟评分（VAS）、日本矫正外科学会（JOA）评分，以及围手术期并发症情况。结果 B组的手术时间、术中出血量、透视次数均少于A组，切口长度短于A 组（P＜0.05）。A 组植入 164 枚螺钉，B 组植入 148 枚，B 组可接受螺钉显著多于 A 组（P＜0.05）。A 组螺钉外展角为18.12 °±7.50 °，B 组为 23.56 °±6.64 °，B 组外展角度大于 A 组（P＜0.05）。术后 1 个月时，两组 VAS 评分均较术前下降，JOA评分上升（P＜0.05），但两组间比较差异无统计学意义（P＞0.05）。两组均未发生血管、神经等严重并发症情况；A组3例定位错误、2例硬膜囊撕裂，经对应治疗均恢复；B组无早期并发症。B组早期并发症发生率低于A组（P＜0.05）。结论　脊柱机器人辅助系统能缩短MIS-TLIF手术时间、减少患者术中出血量，提高椎弓根螺钉置入的准确度，具有较高的临床应用价值。

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Abstract:

Objective To study the clinical application value of spinal robot assisted system in minimally invasive transforaminal fusion （MIS-TLIF） surgery. Methods From March 2019 to November 2022，78 patients who underwent surgical treatment for lumbar degenerative diseases were divided into traditional MIS-TLIF group （group A，41 cases） and robotic MIS-TLIF group （group B，37 cases） according to different surgical methods. Perioperative indicators （intraoperative bleeding， surgical time， incision length， and fluoroscopy frequency）， postoperative CT findings （screw placement accuracy，screw abduction angle）， functional recovery （VAS， JOA scores）， and perioperative complications were compared between the two groups. Results The intraoperative bleeding volume and fluoroscopy frequency in Group B were less than those in Group A， and the operative time and incision length were shorter than those in Group A （P<0.05） . A total of 164 screws were implanted in Group A，148 in Group B. The acceptable screws in Group B were significantly higher than those in Group A （P< 0.05） . The abduction angle of screws in Group A was 18.12°±7.50°， and that in Group B was 23.56°±6.64°. The abduction angle in Group B was greater than that in Group A （P<0.05） . One month after surgery， the VAS score of the two groupsdecreased compared to that before surgery， while the JOA score increased （P<0.05）.However， there was no statistically significant difference between the two groups （P>0.05）.There were no serious complications such as blood vessels and nerves in both groups； In group A，3 patient had a positioning error and 2 patient had a dural sac tear， all of which recovered after corresponding treatment； Group B had no early complications. The incidence of early complications in Group B was lower than  that in Group A （P<0.05）.Conclusion The spinal robot assisted system can shorten the operation time of MIS-TLIF，reduce intraoperative bleeding， and improve the accuracy of pedicle screw placement. It has high clinical application value.

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