直接线性变换算法机器人辅助改良TESSYS手术治疗腰椎间盘突出症的疗效分析

Efficacy analysis of direct linear transformation algorithm robot-assisted modified TESSYS surgery for lumbar disc herniation

中文关键词:  腰椎间盘突出症  DLT算法  机器人辅助  椎间孔镜  穿刺  关节突成形

英文关键词:Lumbar intervertebral disc herniation  DLT algorithm  Robot  Intervertebral foraminoscopy  Puncture  Articular process formation

中文摘要:

  【摘要】 目的：比较直接线性变换（direct linear transformation，DLT）算法机器人辅助改良经椎间孔脊柱内镜系统（transforaminal endoscopic spine system，TESSYS）手术与常规改良TESSYS手术治疗腰椎间盘突出症的临床疗效，探讨DLT算法机器人辅助改良TESSYS手术的应用价值。方法：回顾性分析2022年6月~2023年6月在解放军总医院第八医学中心应用机器人辅助和常规改良TESSYS手术治疗的43例腰椎间盘突出症患者的资料，其中男性24例，女性19例，年龄15~89岁（51.44±19.14岁）。DLT算法机器人辅助改良TESSYS手术15例（机器人组）；常规方法行改良TESSYS手术28例（常规组）。两组患者年龄、性别、体重指数（body mass index，BMI）、手术节段、突出类型均无统计学差异（P＞0.05）。比较两组患者的穿刺次数、透视次数、关节突成形前时间、成形时间、手术时间，术前、术后1d和末次随访时的下肢疼痛视觉模拟量表（visual analogue scale，VAS）评分和Oswestry功能障碍指数（Oswestry disability index，ODI），末次随访时采用改良Macnab评分评估疗效。结果：所有患者均完成手术。常规组1例术中硬膜损伤，严密缝合术后未出现脑脊液漏，术后无明显症状，未出现血肿、神经损伤、感染等并发症。机器人组未见明显并发症，术后复查神经根减压充分。机器人组穿刺次数1.67±0.82次，常规组7.89±1.91次，差异有统计学意义（P＜0.05）；机器人组透视次数12.27±1.44次，常规组19.71±1.44次，差异有统计学意义（P＜0.05）。机器人组关节突成形前时间6.33±1.50mins，常规组16.21±4.61mins，差异有统计学意义（P＜0.05）；机器人组关节突成形时间16.60±2.53mins，常规组20.11±7.21mins，差异无统计学意义（P＞0.05）。机器人组手术时间71.27±11.33mins，常规组85.21±19.08mins，差异有统计学意义（P＜0.05）。机器人组术前、术后1d、末次随访时VAS评分分别为6.33±1.05分、2.73±1.39分、1.27±0.46分，常规组分别为6.21±0.96分、2.57±0.63分、1.43±0.57分，两组术后各时间点与术前比较均有显著性差异（P＜0.05），两组同时间点比较均无统计学差异（P>0.05）；机器人组术前、术后1d、末次随访时的ODI分别为（39.75±3.95）%、（16.92±5.04）%、（9.72±2.62）%，常规组分别为（41.86±3.74）%、（16.84±2.76）%、（9.21±2.77）%，两组术后各时间点与术前比较均有统计学差异（P＜0.05），两组同时间点比较均无统计学差异（P>0.05）。两组随访时间无统计学差异，末次随访时两组间改良Macnab优良率无统计学差异（机器人组93.3% vs 常规组92.9%，P>0.05）。结论：相较于常规改良TESSYS手术，局麻下DLT算法机器人辅助改良TESSYS手术治疗腰椎间盘突出症可减少穿刺次数、透视次数、成形前操作时间和手术操作时间。

英文摘要:

  【Abstract】 Objectives: To compare the clinical efficacy of direct linear transformation(DLT) algorithm robot-assisted modified transforaminal endoscopic spine system(TESSYS) with conventional modified TESSYS in the treatment of lumbar disc herniation, and to explore the application value of DLT algorithm robot-assisted modified TESSYS surgery. Methods: A retrospective analysis was conducted on the data of 43 patients with lumbar disc herniation who underwent modified TESSYS surgery assisted with robot and conventional techniques from June 2022 to June 2023 in the 8th Medical Center, PLA General Hospital. There were 24 males and 19 females, with an average age of 51.44±19.14(15-89)years. 15 cases were treated with DLT algorithm robot-assisted modified TESSYS surgery(robot group) and 28 cases underwent modified TESSYS surgery using conventional methods(conventional group). There were no significant differences in age, gender, body mass index(BMI), surgical segment, and type of protrusion between the two groups(P>0.05). The number of punctures, fluoroscopy times, time before articular process formation, formation time, operative time, and visual analogue scale(VAS) score and Oswestry disability index(ODI) before and after surgery and at the final follow-up between two groups of patients were compared. The efficacy was evaluated with the modified Macnab scores at the final follow-up. Results: All the patients completed the operations. In the conventional group, 1 case had intraoperative dural injury, no cerebrospinal fluid leakage after close suture, and no obvious postoperative symptoms, no hematoma, nerve injury, infection or other complications. In the robot group, no significant complications were observed, and postoperative decompression of nerve root was sufficient. The number of punctures was 1.67±0.82 times in the robot group and 7.89±1.91 times in the conventional group, with statistical difference(P<0.05). The number of fluoroscopy was 12.27±1.44 times in the robot group and 19.71±1.44 times in the conventional group, with statistical difference(P<0.05). The time before articular process formation of the robot group was significantly less than that of the conventional group(6.33±1.50min vs 16.21±4.61min, P<0.05). The formation time of articular process wasn′t significantly different between the robot group and conventional group(16.60±2.53min vs 20.11±7.21min, P>0.05). There was significant difference in operative time between the robot group and conventional group(71.27±11.33min vs 85.21±19.08min, P<0.05). The VAS scores were 6.33±1.05 points, 2.73±1.39 points and 1.27±0.46 points in the robot group and 6.21±0.96 points, 2.57±0.63 points and 1.43±0.57 points in the conventional group before surgery, on 1d after surgery and at the final follow-up, respectively. The VAS scores after operation improved significantly than before operation in both groups(P<0.05), and there were no significant differences between the two groups at the same time point(P>0.05). The ODI of the robot group before surgery, on 1d after surgery and at the final follow-up were (39.75±3.95)%, (16.92±5.04)% and (9.72±2.62)%, while those of the conventional group were (41.86±3.74)%, (16.84±2.76)% and (9.21±2.77)%, respectively. The postoperative ODI were statistically different from those before operation in both groups(P<0.05), but no statistical differences between the two groups was found at the same time point(P>0.05). There was no significant difference in the follow-up time between the two groups, and no significant difference was there in the excellent and good rate of modified Macnab classification at the final follow-up(93.3% in the robot group vs 92.9% in the conventional group, P<0.05). Conclusions: Compared with conventional modified TESSYS surgery, DLT algorithm robot-assisted modified TESSYS surgery under local anesthesia can reduce the number of puncture times, fluoroscopy times, operative time before articular process formation, and operative time in the treatment of lumbar disc herniation.