机器人与徒手侧方椎体间融合椎弓钉固定的比较(开放获取)
作者:
作者单位:

1.四川省医学科学院·四川省人民医院骨科,四川成都 610072 ;2.电子科技大学研究生院,四川成都 611731 ;3.成都体育学院研究院,四川成都 610041

作者简介:

李亭,住院医师,研究方向:脊柱外科,(电子信箱)litingsrh1225@163.com

中图分类号:

R687

基金项目:

四川省科技计划项目(编号:2021YFS0383;2022YFS0100)


(Open Access) Robotic versus freehand lateral lumbar interbody fusion with posterior pedicle screw fixation
Author:
Affiliation:

1.Department of Orthopedics, Sichuan Academy of Medical Sciences &Sichuan Provincial People's Hospital, Chengdu 610072 , Sichuan, China ; 2.Postgraduate Institute, University of Electronics Science andTechnology of China, Chengdu 611731 , Sichuan, China ; 3.Postgraduate Institute, Chengdu Sport University, Chengdu 610041 , Sichuan,China

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    摘要:

    [目的] 探讨机器人与徒手侧方腰椎椎间融合术治疗腰椎退行性疾病(lumbar degenerative diseases, LDD) 的临床疗效。[方法] 回顾性分析2019 年1 月—2022 年1 月四川省人民医院骨科治疗的LDD 患者的临床资料,根据医患沟通结果,22例采用机器人辅助单一体位侧位腰椎椎间融合术(机器人组),21 例应用传统双体位腰椎椎间融合术(徒手组)。比较两组围手术期、随访期及影像结果。[结果] 两组患者均顺利完成手术,机器人组的手术时间[(136.0±18.6) min vs (149.4±22.0) min, P=0.036]、术中出血量[(124.9±16.5) ml vs (138.2±20.3) ml, P=0.023]、术中透视次数[(11.6±3.7) 次vs (40.0±8.1) 次, P<0.001] 显著少于徒手组。随访时间平均(11.3±3.8) 个月,两组完全负重活动时间的差异无统计学意义(P>0.05)。随时间推移,两组患者腰痛以及腿痛VAS 评分、ODI 评分显著降低(P<0.05)。相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,两组椎弓根螺钉置钉准确性的差异无统计学意义(P>0.05)。与术前相比,两组椎管面积、侧隐窝矢状径、腰椎前凸角均显著增加(P<0.05),相应时间点,两组上述影像指标的差异均无统计学意义(P>0.05)。[结论] 机器人辅助与徒手侧位腰椎椎间融合术都是治疗LDD 的有效方法。但是机器人组可减少手术时间、降低术中出血量以及术中透视次数,具有良好的临床应用价值。

    Abstract:

    [Objective] To investigate the clinical efficacy of robotic versus freehand lateral lumbar interbody fusion (LLIF) with poste-rior pedicle screw fixation for the treatment of lumbar degenerative diseases (LDD). [Methods] A retrospective study was conducted on 43patients who underwent LLID for LDDs in our hospital from January 2019 to January 2022. According to preoperative doctor-patient com-munication, 22 patients underwent robot-assisted single lateral position LLIF and pedicle screw fixation (the robot group), while other 21patients underwent traditional LLIF with changing position and freehand technique (the freehand group). The documents regarding to peri-operative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had operation per-formed successfully. The robot group proved significantly superior to the freehand group in terms of operation time [(136.0±18.6) min vs(149.4±22.0) min, P=0.036], intraoperative blood loss [(124.9±16.5) ml vs (138.2±20.3) ml, P=0.023], intraoperative fluoroscopy times[(11.6±3.7) times vs (40.0±8.1) times, P<0.001]. The mean follow-up time was of (11.3±3.8) months, and there was no significant differencein time to regain full weight-bearing activity between the two groups (P>0.05). The VAS scores of low back pain and leg pain, as well asODI score significantly decreased over time in both groups (P<0.05), which were not statistically significant between the two groups at anycorresponding time points (P>0.05). As for imaging, there was no significant difference in the accuracy of pedicle screw placement betweenthe two groups (P>0.05). Compared with those preoperatively results, the spinal canal area, sagittal diameter of lateral recess and lumbar lor-dosis angle significantly improved in both groups postoperatively (P<0.05), whereas which were not statistically significant between the twogroups at any time points accordingly (P>0.05). [Conclusion] Both robot-assisted and freehand lateral lumbar interbody fusion are effective

    参考文献
    [1] Du J,Yang J,Yan L,et al.Intraoperative anti-inflammatory drugscombined with no drainage after MIS-TLIF in the treatment of recurrent lumbar disc herniation:an RCT [J].J Orthop Surg Res,2021,16(1):20.DOI:10.1186/s13018-020-02155-x.
    [2] 曾忠友,吴宏飞,宋永兴,等.腰椎退行性疾病两种融合术的并发症比较[J].中国矫形外科杂志,2024,32(3):193-198.DOI:10.3977/j.issn.1005-8478.2024.03.01.Zeng ZY,Wu HF,Song YX,et al.Comparison of complications oftwo fusion surgeries for lumbar degenerative diseases [J].Orthopedic Journal of China,2024,32(3):193-198.DOI:10.3977/j.issn.1005-8478.2024.03.01.
    [3] Macki M,Hamilton T,Haddad YW,et al.Expandable Cage Technology-Transforaminal,Anterior,and Lateral Lumbar InterbodyFusion [J].Oper Neurosurg(Hagerstown),2021,21(Suppl 1):S69-s80.DOI:10.1093/ons/opaa342.
    [4] 潘谕浩,万趸,邓轩赓,等.两种微创融合术治疗腰退行性疾病比较[J].中国矫形外科杂志,2023,31(17):1555-1560.DOI:10.3977/j.issn.1005-8478.2023.17.04.Pan YH,Wan D,Deng XG,et al.Comparison of two minimally invasive fusion surgery for lumbar degenerative disease [J].Orthopedic Journal of China,2023,31(17):1555-1560.DOI:10.3977/j.issn.1005-8478.2023.17.04.
    [5] Heo DH,Eum JH,Jo JY,et al.Modified far lateral endoscopictransforaminal lumbar interbody fusion using a biportal endoscopicapproach:technical report and preliminary results [J].Acta Neurochir(Wien),2021,163(4):1205-1209.DOI:10.1007/s00701-021-04758-7.
    [6] Taba HA,Williams SK.Lateral lumbar interbody fusion [J].Neurosurg Clin N Am,2020,31(1):33-42.DOI:10.1016/j.nec.2019.08.004.
    [7] Verma K,Boniello A,Rihn J.Emerging techniques for posteriorfixation of the lumbar spine [J].J Am Acad Orthop Surg,2016,24(6):357-364.DOI:10.5435/JAAOS-D-14-00378.
    [8] Pimenta L,Pokorny G,Amaral R,et al.Single-position pronetranspsoas lateral interbody fusion including L4L5:early postoperative outcomes [J].World Neurosurg,2021,149:e664-e668.DOI:10.1016/j.wneu.2021.01.118.
    [9] 李亭,刘希麟,王飞,等.机器人辅助微创经椎间孔腰椎椎间融合治疗腰椎退行性疾病:置钉精度及其安全性[J].中国组织工程研究,2022,26(36):5812-5818.DOI:10.12307/2022.974.Li T,Liu XL,Wang F,et al.Robot-assisted minimally invasivetransforaminal lumbar interbody fusion in the treatment of lumbardegenerative diseases:accuracy and safety of screw placement [J].Chinese Journal of Tissue Engineering Research,2022,26(36):5812-5818.DOI:10.12307/2022.974.
    [10] Zhang J,Liu TF,Shan H,et al.Decompression using minimally invasive surgery for lumbar spinal stenosis associated with degenerative spondylolisthesis:a review [J].Pain Ther,2021,10(2):941-59.DOI:10.1007/s40122-021-00293-6.
    [11] 胡向阳,胡可君,朱慧强,等.内镜与开放后路椎间融合术治疗腰椎退行疾病[J].中国矫形外科杂志,2023,31(7):607-612.DOI:10.3977/j.issn.1005-8478.2023.07.06.Hu XY,Hu KJ,Zhu HQ,et al.Endoscopic versus open posteriorlumbar interbody fusion for lumbar degenerative diseases [J].Orthopedic Journal of China,2023,31(7):607-612.DOI:10.3977/j.issn.1005-8478.2023.07.06.
    [12] Pimenta L,Turner AW,Dooley ZA,et al.Biomechanics of lateralinterbody spacers:going wider for going stiffer [J].Sci World J,2012,2012:381814.DOI:10.1100/2012/381814.
    [13] Lykissas MG,Cho W,Aichmair A,et al.Is there any relation between the amount of curve correction and postoperative neurological deficit or pain in patients undergoing stand-alone lateral lumbar interbody fusion [J].Spine,2013,38(19):1656-1662.DOI:10.1097/BRS.0b013e31829cf269.
    [14] Phillips FM,Isaacs RE,Rodgers WB,et al.Adult degenerative scoliosis treated with XLIF:clinical and radiographical results of aprospective multicenter study with 24-month follow-up [J].Spine,2013,38(21):1853-1861.DOI:10.1097/BRS.0b013e3182a43f0b.
    [15] Nuss S,Leary OP,Zheng B,et al.Instrumentation choice and earlyradiographic outcome following lateral lumbar interbody fusion(LLIF):Lateral instrumentation versus posterior pedicle screw fixation [J].N Am Spine Soc J,2022,12:100176.DOI:10.1016/j.xnsj.2022.100176.
    [16] Ashayeri K,Leon C,Tigchelaar S,et al.Single position lateral decubitus anterior lumbar interbody fusion(ALIF)and posterior fusion reduces complications and improves perioperative outcomescompared with traditional anterior-posterior lumbar fusion [J].Spine J,2022,22(3):419-428.DOI:10.1016/j.spinee.2021.09.009.
    [17] Lamartina C,Berjano P.Prone single-position extreme lateral interbody fusion(Pro-XLIF):preliminary results [J].Eur Spine J,2020,29(Suppl 1):6-13.DOI:10.1007/s00586-020-06303-z.
    [18] Buckland AJ,Ashayeri K,Leon C,et al.Single position circumferential fusion improves operative efficiency,reduces complicationsand length of stay compared with traditional circumferential fusion[J].Spine J,2021,21(5):810-820.DOI:10.1016/j.spinee.2020.11.002.
    [19] Jacob KC,Patel MR,Ribot MA,et al.Single-level TLIF versusLLIF at L4-5:a comparison of patient-reported outcomes and recovery ratios [J].J Am Acad Orthop Surg,2022,30(4):e495-e505.DOI:10.5435/JAAOS-D-21-00772.
    [20] Chung HW,Lee HD,Jeon CH,et al.Comparison of surgical outcomes between oblique lateral interbody fusion(OLIF)and anteriorlumbar interbody fusion(ALIF)[J].Clin Neurol Neurosurg,2021,209:106901.DOI:10.1016/j.clineuro.2021.106901.
    [21] 李亭,廖文鳌,钟文杰,等.机器人辅助微创腰椎后路融合治疗腰椎退行性疾病[J].中国组织工程研究,2024,28(12):1855-1862.DOI:10.12307/2024.025.Li T,Liao WA,Zhong WJ,et al.Robot assisted minimally invasiveposterior lumbar fusion for the treatment of lumbar degenerative diseases [J].Chinese Journal of Tissue Engineering Research,2024,28(12):1855-1862.DOI:10.12307/2024.025.
    [22] Luengo-Matos S,Sánchez-Gómez LM,Hijas-Gómez AI,et al.Efficacy and safety of robotic spine surgery:systematic review andmeta-analysis [J].J Orthop Traumatol,2022,23(1):49.DOI:10.1186/s10195-022-00669-0.
    [23] Fu W,Tong J,Liu G,et al.Robot-assisted technique vs conventional freehand technique in spine surgery:A meta-analysis [J].Int J Clin Pract,2021,75(5):e13964.DOI:10.1111/ijcp.13964.
    [24] Hyun SJ,Kim KJ,Jahng TA,et al.Minimally invasive robotic versus open fluoroscopic-guided spinal instrumented fusions:a randomized controlled trial [J].Spine,2017,42(6):353-358.DOI:10.1097/BRS.0000000000001778.
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李亭,廖文鳌,钟文杰,等. 机器人与徒手侧方椎体间融合椎弓钉固定的比较(开放获取)[J]. 中国矫形外科杂志, 2024, 32 (20): 1825-1831. DOI:10.20184/j. cnki. Issn1005-8478.100698.
LI Ting, LIAO Wen- ao, ZHONG Wen-jie, et al. (Open Access) Robotic versus freehand lateral lumbar interbody fusion with posterior pedicle screw fixation[J]. Orthopedic Journal of China , 2024, 32 (20): 1825-1831. DOI:10.20184/j. cnki. Issn1005-8478.100698.

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  • 收稿日期:September 28,2023
  • 最后修改日期:May 28,2024
  • 在线发布日期: October 21,2024