中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (12): 1855-1862.doi: 10.12307/2024.025

• 数字化骨科 digital orthopedics • 上一篇    下一篇

机器人辅助微创腰椎后路融合治疗腰椎退行性疾病

李  亭1，2，廖文鳌1，3，钟文杰1，4，刘希麟1，王  飞1，胡  豇1   

  1. 1四川省医学科学院·四川省人民医院骨科，四川省成都市   610072；2成都医学院研究生院，四川省成都市   610500；3电子科技大学研究生院，四川省成都市   611731；4成都体育学院研究院，四川省成都市   610041
  • 收稿日期:2023-01-13 接受日期:2023-03-21 出版日期:2024-04-28 发布日期:2023-08-22
  • 通讯作者: 刘希麟，博士，主治医师，四川省医学科学院·四川省人民医院骨科，四川省成都市 610072
  • 作者简介:李亭，男，1995年生，四川省眉山市人，汉族，成都医学院在读硕士，主要从事脊柱外科方向研究。
  • 基金资助:
    四川省科技计划项目(2021YFS0383)；项目负责人：刘希麟

Robot-assisted minimally invasive transforaminal lumbar interbody fusion in treatment of lumbar degenerative diseases

Li Ting1, 2, Liao Wenao1, 3, Zhong Wenjie1, 4, Liu Xilin1, Wang Fei1, Hu Jiang1   

  1. 1Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China; 2Department of Postgraduate, Chengdu Medical College, Chengdu 610500, Sichuan Province, China; 3Department of Postgraduate, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China; 4Department of Postgraduate, Chengdu Sport University, Chengdu 610041, Sichuan Province, China
  • Received:2023-01-13 Accepted:2023-03-21 Online:2024-04-28 Published:2023-08-22
  • Contact: Liu Xilin, MD, Attending physician, Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
  • About author:Li Ting, Master candidate, Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China; Department of Postgraduate, Chengdu Medical College, Chengdu 610500, Sichuan Province, China
  • Supported by:
    Key Project of Sichuan Science and Technology Department, No. 2021YFS0383 (to LXL)

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摘要：


文题释义：

骨科机器人辅助手术：由主机、机械臂、手术计划与控制软件、光学跟踪系统、主控台车和导航定位组成，主要用于脊柱外科、创伤骨科以及关节外科。确认手术路径以后，通过导航技术和机械臂运动控制技术，准确地运动到手术处，精度误差在亚毫米级。
单边双通道内镜下微创腰椎融合术：通过建立一个操作通道和一个观察通道两个相互独立的通道，能够显著提高手术操作灵活性和工作效率。并且操作自由，其内镜放大和水介质的特点使视野更加清晰，目前常用于腰椎间盘退行性疾病、腰椎管狭窄、腰椎峡部裂伴轻度腰椎滑脱症等多种脊柱疾病。


背景：微创手术目前发展迅速，机器人辅助下的微创经椎间孔腰椎椎间融合与机器人辅助下单边双通道内镜下微创腰椎融合是治疗腰椎退行性疾病的重要后路微创手术方法，但是何种术式更具有优势，值得探讨。

目的：比较不同机器人辅助微创腰椎后路融合手术的临床疗效以及影像学检查，探讨机器人辅助微创腰椎后路融合技术在腰椎退行性疾病中的临床应用价值。
方法：回顾分析2018年1月至2022年6月于四川省医学科学院·四川省人民医院骨科就诊的83例腰椎退行性疾病患者的临床资料，其中27例应用机器人辅助下微创经椎间孔腰椎椎间融合治疗(A组)，30例应用机器人辅助单边双通道内镜下微创腰椎融合治疗(B组)，另选择26例传统微创经椎间孔腰椎椎间融合患者作为对照组(C组)。3组患者的性别、年龄、体质量指数、手术节段分布及术前疼痛目测类比评分及Oswestry功能障碍指数等一般资料比较差异均无显著性意义(P > 0.05)。比较3组患者手术时间、术中出血量、手术并发症、辐射次数、辐射剂量以及辐射时间。以Gertzbein-Robbins分级标准判断经皮螺钉的精度；评估手术后疼痛目测类比评分及Oswestry功能障碍指数；以Macnab标准评估手术方案的优良率。

结果与结论：①A组手术时间短于B、C组(P < 0.05)，但是B组与C组之间差异无显著性意义(P > 0.05)；B组术中失血量明显少于A组，A组少于C组，差异均有显著性意义(P < 0.05)；②C组的辐照次数、辐照剂量及辐射时间明显高于A、B组(P < 0.05)；③3组患者术后疼痛目测类比评分及Oswestry功能障碍指数均较术前显著改善(P < 0.05)，但术后1 d及术后6个月，3组之间差异无显著性意义(P > 0.05)；④术后影像学检查显示，A、B组的置钉精度优于C组(P < 0.05)；⑤Macnab手术优良率在3组间差异无显著性意义(P > 0.05)；⑥在并发症上，3组之间差异无显著性意义(P > 0.05)；⑦结果说明机器人辅助下微创经椎间孔腰椎椎间融合、机器人辅助单边双通道内镜下微创腰椎融合都是治疗腰椎退行性疾病的有效方法；相较于传统微创经椎间孔腰椎椎间融合治疗，机器人辅助下的腰椎微创融合手术效率高，术中辐射更少，内固定精度更高，具有良好的临床应用价值。

https://orcid.org/0000-0002-6662-5375(李亭)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 机器人手术, 单边双通道脊柱内镜手术, 经椎间孔腰椎椎间融合, 腰椎退行性疾病, 置钉精度

Abstract: BACKGROUND: Minimally invasive surgery is developing rapidly. Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases. However, it is worth discussing which operation method is more advantageous. 
OBJECTIVE: To compare the clinical efficacy and imaging examination between different operation groups, and discuss the clinical application value of robot-assisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases. 
METHODS: Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. Of them, 27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment (group A); 30 patients received robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion treatment (group B), and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group (group C). There were no significant differences in gender, age, body mass index, surgical segment, preoperative visual analog scale score and Oswestry Disability Index among the three groups (P > 0.05). The operation time, intraoperative blood loss, complications, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency were compared among the three groups. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screw. Visual analog scale and Oswestry Disability Index scores were evaluated after surgery. The excellent and good rate of the three surgical options was evaluated using Macnab’s criteria. 
RESULTS AND CONCLUSION: (1) The operation time of group A was significantly shorter than that of groups B and C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). The intraoperative blood loss in group B was significantly less than that in group A, and that in group A was significantly less than that in group C (P < 0.05). (2) The fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency of group C were significantly higher than those of groups A and B (P < 0.05). (3) Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation (P < 0.05), but there was no significant difference among the three groups 1 day and 6 months after surgery (P > 0.05). (4) Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C (P < 0.05). (5) There was no significant difference in the excellent and good rate of MacNab criteria among the three groups (P > 0.05). (6) There was no significant difference in complications among the three groups (P > 0.05). (7) The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases. Compared with traditional minimally invasive transforaminal lumbar interbody fusion, robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency, less intraoperative radiation and higher internal fixation accuracy, which has a good clinical application value.

Key words: robot surgery, unilateral biportal endoscopic surgery, transforaminal lumbar interbody fusion, lumbar degenerative disease, screw placement accuracy

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