机器人辅助皮质骨螺钉与椎弓根螺钉固定后路腰椎椎间融合术治疗合并骨质疏松腰椎管狭窄症的早期疗效比较

Comparison of the short-term efficacies between robot-assisted cortical bone screw and pedicle screw fixations in posterior lumbar interbody fusion for patients with osteoporotic lumbar spinal stenosis

中文关键词:  腰椎管狭窄症  骨科机器人  皮质骨轨迹螺钉  椎弓根螺钉  后路腰椎椎间融合术  骨质疏松

英文关键词:Lumbar Spinal Stenosis  TiRobot system  Cortical bone trajectory screws  Pedicle screws  Posterior lumbar interbody fusion  Osteoporosis

中文摘要:

  【摘要】 目的：比较机器人辅助下皮质骨轨迹螺钉（cortical bone trajectory screw，CBTS）固定和传统椎弓根螺钉（traditional pedicle screw，TPS）固定后路腰椎椎间融合术（posterior lumbar interbody fusion，PLIF）治疗合并骨质疏松腰椎管狭窄症患者的早期疗效和安全性。方法：回顾性分析2018年9月~2021年6月在我院接受机器人辅助下后路腰椎椎间融合内固定术治疗的113例患者临床资料，根据内固定方式分为两组：55例采用CBTS固定的患者纳入CBTS组，58例采用TPS固定的患者纳入TPS组，统计并比较两组患者的一般资料[年龄、性别比、身高、体重、体重指数（body mass index，BMI）、髋关节骨密度]、手术相关资料（手术时间、手术切口长度、术中出血量）、围术期指标（术后住院时间、手术并发症、螺钉松动率、邻近椎小关节侵犯率、术前及术后血糖）以及术前和术后随访时的疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry 功能障碍指数（Oswestry disability index，ODI）。结果：两组患者的年龄、性别比、身高、体重、BMI和髋关节骨密度均无统计学异（P>0.05）。两组手术时间、术后住院时间、手术并发症、术前VAS评分和ODI、术后1个月和6个月时的ODI均无统计学差异（P>0.05）；CBTS组术中出血量、手术切口长度和术后6个月时的VAS评分均显著小于TPS组（500mL vs 600mL，P=0.007；8cm vs 10cm，P=0.006；2分 vs 3分，P<0.001）。两组间术前血糖及术后1d血糖无统计学差异(P>0.05)，术后1周CBTS组显著低于TPS组（4.75mmol/L vs 5.57mmol/L，P=0.041）。末次随访时CBTS组螺钉松动率和邻近椎小关节侵犯率均显著低于TPS组（1.68% vs 4.52%，P=0.044和13.83% vs 26.53%，P=0.029）。结论：对于合并骨质疏松的腰椎管狭窄症患者，机器人辅助下CBTS固定PLIF比TPS固定PLIF的创伤更小，术后早期康复更快，螺钉相关并发症更少。

英文摘要:

  【Abstract】 Objectives: To compare the short-term effectiveness and safety between robot-assisted cortical bone trajectory screw(CBTS) and traditional pedicle screw(TPS) fixations in posterior lumbar interbody fusion(PLIF) for lumbar spinal stenosis with osteoporosis. Methods: We retrospectively analyzed the clinical data of 113 patients who underwent robot-assisted PLIF and internal fixation in our hospital between September, 2018 and June, 2021. The patients were divided into two groups according to the internal fixation method. 55 patients fixed with CBTS were included in the CBTS group, and 58 patients fixed with TPS were included in the TPS group. The general data[age, sex ratio, height, weight, body mass index(BMI), hip bone mineral density(BMD)], surgical related data(operative time, incision length, intraoperative blood loss), perioperative indicators(postoperative length of hospital stay, surgical complications, screw loosening rate, adjacent facet joint violation rate, preoperative and postoperative blood glucose), and visual analogue scale(VAS) score of pain and Oswestry disability index(ODI) before and after surgery were recorded and compared. Results: There was no significant difference in age, sex ratio, height, weight, BMI and hip BMD between the two groups(P>0.05). There was no significant difference in operative time, postoperative length of hospital stay, surgical complications, preoperative VAS score and ODI, and ODI at 1 month and 6 months after operation between the two groups(P>0.05). The intraoperative blood loss, length of incision and VAS score at 6 months after operation in the CBTS group were significantly lower than those in the TPS group(500mL vs 600mL, P=0.007; 8cm vs 10cm, P=0.006; 2 vs 3, P<0.001). There was no significant difference in blood glucose before operation and 1 day after operation between the two groups(P>0.05), while at 1 week after operation, the CBTS group was significantly lower than the TPS group(4.75mmol/L vs 5.57mmol/L, P=0.041). At the final follow-up, the rates of screw loosening and adjacent facet joint violation in CBTS group were significantly lower than those in TPS group(1.68% vs 4.52%, P=0.044 and 13.83% vs 26.53%, P=0.029). Conclusions: For patients with lumbar spinal stenosis combined with osteoporosis, PLIF with robot-assisted CBTS fixation is less in surgical trauma, faster in early postoperative recovery, and fewer in screw-related complications than with TPS fixation.