骨科机器人导航在单侧双通道内镜下手术治疗单节段腰椎管狭窄症中的应用

Application of orthopedic robot-assisted navigation in unilateral biportal endoscopy for single-level lumbar spinal stenosis

中文关键词:  腰椎管狭窄  单侧双通道脊柱内镜  骨科机器人导航

英文关键词:Lumbar spinal stenosis  Unilateral biportal endoscopy  Orthopedic robot-assisted navigation

中文摘要:

  【摘要】 目的：评估骨科机器人导航在单侧双通道内镜下经椎间孔腰椎间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）治疗腰椎管狭窄症中的应用价值。方法：回顾性分析2024年1月~2025年3月在广东省第二中医院手术治疗的35例单节段腰椎管狭窄症患者临床资料，其中18例应用骨科机器人导航辅助UBE-TLIF治疗（机器人组），男性8例，女性10例，年龄56.89±7.95岁；17例应用传统UBE-TLIF治疗（传统组），男性9例，女性8例，年龄58.82±8.68岁。两组患者性别、年龄、病变节段、合并基础病、病程、骨密度分级、椎间盘突出程度MSU分级分区等基线资料均无显著性差异（P>0.05），比较两组手术时间、置钉时间、透视次数、术中出血量、置钉准确率（Gertzbein-Robbins分级标准A级置钉比例）和小关节侵犯情况。术前和术后1周、1个月、3个月、6个月及末次随访时采用疼痛视觉模拟量表（visual analogue scale，VAS）评分及Oswestry功能障碍指数（Oswestry disability index，ODI）评估。结果：所有患者均顺利完成手术，两组手术时间无统计学差异（156.72±14.22min vs 161.29±14.20min，P>0.05），机器人组透视次数较传统组显著性减少（7.11±1.45次 vs 23.00±2.42次，P<0.05），置钉时间较传统组显著性缩短（35.72±3.10min vs 46.00±6.32min，P<0.05）。机器人组的置钉准确率优于传统组（98.6% vs 88.2%，P<0.05）；小关节侵犯等级机器人组0级62枚（86.1%），1级7枚（9.7%），2级3枚（4.2%）；传统组0级47枚（69.1%），1级12枚（17.6%），2级9枚（13.2%）；两组间比较有统计学差异（P<0.05）。两组术后各时间点的VAS评分及ODI均较术前显著性改善（P<0.05），两组间相同时间点比较均无显著性差异（P>0.05）。结论：在单节段腰椎管狭窄症手术治疗中，相较于传统UBE-TLIF，机器人导航辅助UBE-TLIF的置钉效率更高，术中辐射更少，置钉精度更高。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical value of orthopedic robot-assisted navigation in unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF) for the treatment of lumbar spinal stenosis. Methods: A retrospective analysis was performed on the clinical data of 35 patients with single level lumbar spinal stenosis who underwent surgery at the Second Traditional Chinese Medicine Hospital of Guangdong Province from January 2024 to March 2025. Among them, 18 patients(robot group) received orthopedic robot-assisted UBE-TLIF(8 males, 10 females; mean age 56.89±7.95 years), and 17 patients(conventional group) underwent conventional UBE-TLIF(9 males, 8 females; mean age 58.82±8.68 years). There were no significant differences between the two groups in baseline characteristics, including sex, age, involved segment, comorbidities, disease duration, bone mineral density grade, and MSU grading and zoning system for disc herniation(P>0.05). The following parameters were compared, including operative time, screw placement time, fluoroscopy frequency, intraoperative blood loss, screw placement accuracy(proportion of grade A screws according to the Gertzbein-Robbins classification), and facet joint violation. Clinical outcomes were assessed using the visual analogue scale(VAS) and the Oswestry disability index(ODI) preoperatively and at 1 week, 1 month, 3 months, 6 months, and the final follow-up postoperatively. Results: All surgeries were completed successfully. No significant difference was found in operative time between the two groups(156.72±14.22min vs 161.29±14.20min, P>0.05). Compared with the conventional group, the robot group had significantly fewer fluoroscopic exposures(7.11±1.45 vs 23.00±2.42, P<0.05) and significantly shorter screw placement time(35.72±3.10min vs 46.00±6.32min, P<0.05). The screw placement accuracy rate in the robot group was significantly higher than that in the conventional group(98.6% vs 88.2%, P<0.05). Regarding facet joint violation, in the robot group, 62 screws(86.1%) were of grade 0, 7(9.7%) of grade 1, and 3(4.2%) of grade 2; And in the conventional group, 47 screws(69.1%) were of grade 0, 12(17.6%) of grade 1, and 9(13.2%) of grade 2. There was a statistically significant difference between the two groups(P<0.05). Both groups showed significant improvements in VAS and ODI scores at all postoperative time points compared with baseline(P<0.05), but there were no significant intergroup differences at any corresponding time point(P<0.05). Conclusions: In the surgical treatment of single level lumbar spinal stenosis, robot navigation assisted UBE-TLIF is higher in screw placement efficiency, less in intraoperative radiation exposure, and greater in screw accuracy compared with conventional UBE-TLIF.