机器人辅助脊柱内镜下腰椎椎间融合术治疗单节段腰椎管狭窄症的临床疗效

Clinical efficacy of robot-assisted spinal endoscopic lumbar interbody fusion for the treatment of single-segment lumbar spinal stenosis

中文关键词:  骨科机器人  单侧双通道脊柱内镜融合术  腰椎椎管狭窄症  临床疗效

英文关键词:Orthopedic robot  Unilateral biportal endoscopic spinal fusion  Lumbar spinal stenosis  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨骨科机器人辅助（Robot-assisted，RA）脊柱内镜下单侧双通道腰椎椎间融合术（unilateral biportal endoscopic lumbar interbody fusion，UBE-LIF）在单节段腰椎管狭窄症（lumbar spinal stenosis，LSS）治疗中的临床疗效。方法：回顾性分析佛山市中医院脊柱科于2023年8月～2024年2月收治的90例LSS患者临床资料，分为观察组（42例，采用RA-UBE-LIF）与对照组（48例，UBE-LIF）。收集患者年龄、性别、病程及病变节段等基本人口学与临床资料；比较两组患者透视次数、手术时间、术中出血量、术后引流量、住院时间、置钉准确率（Gertzbein标准）以及并发症发生情况；采用疼痛视觉模拟评分（visual analogue score，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）量化评估患者术前及术后1周、3个月和6个月的腰痛、腿痛改善程度和腰椎功能恢复情况。结果：所有患者均顺利完成手术并接受了随访，随访时间范围为6～12个月。观察组的透视次数（4.40±0.83 vs 9.92±1.62）、术中出血量（90.76±13.27mL vs 121.21±16.75mL）、术后引流量（75.93±14.43mL vs 93.02±17.04mL）、住院时间（4.43±1.52d vs 7.19±1.79d）均小于对照组（P＜0.05），两组手术时间（118.24±8.91min vs 120.67±10.43min）比较无显著性差异（P＞0.05）。观察组RA经皮置钉准确率为97.62%，与对照组（89.58%）相比有显著性差异（P＜0.05）。观察组的并发症发生率为2.38%，与对照组（6.25%）相比无显著性差异（P＞0.05）。两组患者术后各时间点的腰痛、腿痛VAS评分与ODI均较前一时间点显著下降（P＜0.05）；术前两组无显著差异（P＞0.05），术后各时间点（1周、3个月、6个月）观察组VAS评分与ODI改善均优于对照组（P＜0.05）。结论：RA-UBE-LIF治疗LSS手术精准安全、疗效满意。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of robot-assisted(RA) unilateral biportal endoscopic lumbar interbody fusion(UBE-LIF) in the treatment of single-level lumbar spinal stenosis(LSS). Methods: A retrospective analysis was conducted on the clinical data of 90 patients with LSS admitted to the Spine Department of Foshan Hospital of Traditional Chinese Medicine from August 2023 to February 2024. The patients were divided into an observation group(42 patients, treated with RA-UBE-LIF) and a control group(48 patients, treated with UBE-LIF). The patients′ baseline information and clinical data were collected, including age, gender, duration of illness, and lesion segments. The number of fluoroscopic exposures, operative time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, screw placement accuracy(based on the Gertzbein criteria), and the occurrence of complications were compared between the two groups. The visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to quantitatively assess the improvement in back and leg pain and the recovery of lumbar function in patients before surgery and at 1 week, 3 months, and 6 months postoperatively. Results: All the patients successfully completed the surgery and were followed up for a period ranging from 6 to 12 months. Compared with the control group, the observation group had significantly fewer fluoroscopic exposures(4.40±0.83 vs 9.92±1.62), less intraoperative blood loss(90.76±13.27mL vs 121.21±16.75mL), postoperative drainage volume(75.93±14.43mL vs 93.02±17.04mL), and length of hospital stay(4.43±1.52d vs 7.19±1.79d)(all P<0.05). There was no significant difference in operative time between the two groups(118.24±8.91min vs 120.67±10.43min)(P>0.05). The accuracy rate of RA percutaneous screw placement in the observation group was 97.62%, which was significantly different from that of the control group(89.58%)(P<0.05). The complication rate in the observation group was 2.38%, which was not significantly different from that of the control group(6.25%)(P>0.05). The VAS scores for back and leg pain and ODI of both groups at each postoperative time point were significantly lower than those at the previous time point(P<0.05). There were no significant differences between the two groups preoperatively(P>0.05), but the improvements in VAS scores and ODI at each postoperative time point(1 week, 3 months, 6 months) were better in the observation group compared to the control group(P<0.05). Conclusions: Orthopedic RA-UBE-LIF for the treatment of LSS is accurate and safe, which has satisfactory therapeutic effects.