| 骨科机器人辅助置钉下全内镜化经椎间孔腰椎椎间融合术治疗腰椎间盘突出症伴腰椎不稳 |
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投稿时间：2024-01-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 张凯 |
ZHANG Kai |
甘肃中医药大学第一临床医学院, 甘肃 兰州 730000 |
First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu, China |
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| 范喜荣 |
FAN Xi-rong |
甘肃中医药大学第一临床医学院, 甘肃 兰州 730000 |
First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu, China |
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| 赵常春 |
ZHAO Chang-chun |
甘肃中医药大学第一临床医学院, 甘肃 兰州 730000 |
First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu, China |
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| 许广慧 |
XU Guang-hui |
甘肃中医药大学第一临床医学院, 甘肃 兰州 730000 |
First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu, China |
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| 薛文 |
XUE Wen |
甘肃省人民医院脊柱外科, 甘肃 兰州 730000 |
Department of Orthopaedics, the People's Hospital of Gansu, Lanzhou 730000, Gansu, China |
xuewendoctor@sina.com |
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| 期刊信息：《中国骨伤》2024年，第37卷，第8期，第750-755页 |
| DOI：10.12200/j.issn.1003-0034.20230942 |
| 基金项目:甘肃省人民医院国家级科研培育计划重点科研基金(编号:2019-222);甘肃省自然科学基金(编号:23JRRA1280) |
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中文摘要:
目的：探讨骨科机器人辅助置钉下全内镜化经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎间盘突出症伴腰椎不稳的安全性和有效性。
方法：2021年10月至2023年3月收治26例单节段腰椎间盘突出症伴腰椎不稳患者,男14例,女12例,年龄47~73(58.5±8.1)岁,病程2~12(6.6±2.8)个月,手术节段L4,5 16例,L5S1 10例。采用骨科机器人辅助置钉下全内镜化TLIF治疗。观察记录手术时间、术中出血量、切口长度、术后引流量、术后下床活动时间、术后住院时间。观察比较术前、术后的椎间隙高度及腰椎前凸角。采用视觉模拟评分(visual analog scale,VAS)评价疼痛程度,Oswestry功能障碍指数(Oswestry disability index,ODI)评价临床疗效,Brantigan-Steffee标准评估椎间融合情况。
结果：26例患者均顺利完成手术,手术时间105~109(150.8±24.1) min,术中失血量35~88(55.5±16.4) ml,切口长度1.4~3.5(2.3±0.8) cm,术后引流量15~40(28.5±7.8) ml,术后下床活动时间15~30(22.8±4.5) h,术后住院时间3~7(4.2±1.3) d。26例患者术后获得随访,时间12~16(14.0±1.3)个月。VAS和ODI术后1周[2.96±0.72)分、(41.63±4.79)%]、术后12个月[1.27±0.60)分、(13.11±2.45)%]较术前[6.69±0.93)分、(59.12±5.92)%]改善(P<0.01);术后12个月椎间隙高度(11.95±1.47) mm和腰椎前凸角(57.46±7.59)°较术前[(6.67±1.20) mm、(44.08±7.79)°]改善(P<0.01)。术后12个月所有患者无椎弓根螺钉断裂及融合器的移位,椎间均成功融合。根据Brantigan-Steffee分级:D级17例,E级9例。
结论：骨科机器人辅助置钉下全内镜化TLIF对于腰椎间盘突出症伴腰椎不稳患者,提高了手术的精准度和安全性,早期随访临床效果确切。 |
| 【关键词】内窥镜 微创脊柱外科 经椎间孔腰椎椎间融合术 骨科机器人 腰椎间盘突出症 |
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| Orthopedic robot-assisted endoscopic transforaminal lumbar interbody fusion for lumbar disc herniation with lumbar instability |
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ABSTRACT
Objective To explore the safety and effectiveness of the robot-assisted system for transforaminal percutaneous endoscopic in the treatment of lumbar disc herniation with lumbar instability.
Methods From October 2021 to March 2023,26 patients with single-segment lumbar disc herniation and lumbar spinal instability were treated with robot-assisted system for transforaminal percutaneous endoscopic. The operation time,intraoperative blood loss,incision length,postoperative drainage volume,postoperative ambulation activity time,postoperative hospitalization time were record. The intervertebral space height and the lumbar lordosis angle before and after surgery were observed and compared. Pain level was evaluated using the visual analogue scale(VAS). The clinical efficacy was evaluated by Oswestry disability index(ODI). The interbody fusion was evaluated by Brantigan Steffee criteria.
Results All patients successfully completed the operation,the operation time ranged form 105 to 109 min with an average of (150.8±24.1) min. Intraoperative blood loss ranged form 35 to 88 ml with an average of (55.5±16.4) ml. Incision length ranged form 1.4 to 3.5 cm with an average of (2.3±0.8) cm. Postoperative drainage volume ranged form 15 to 40 ml with an average of (28.5±7.8) ml. Postoperative ambulation time ranged form 15 to 30 h with an average of (22.8±4.5) h. Postoperative hospitalization time was 3 to 7 d with an average of (4.2±1.3) d. Total of 26 patients were followed up,the duration ranged from 12 to 16 months with an average of (14.0±1.3) months. The VAS and ODI at 1 week[(2.96±0.72) points,(41.63±4.79)%] and 12 months[(1.27±0.60) points,(13.11±2.45)%] were significantly different from those before surgery[(6.69±0.93) points,(59.12±5.92)%],P<0.01. The height of the intervertebral space (11.95±1.47) mm and lumbar lordosis (57.46±7.59)° at 12 months were significantly different from those before surgery[(6.67±1.20) mm,(44.08±7.79)°],P<0.01. At 12 months after surgery,all patients had no pedicle screw rupture or dislocation of the fusion cage,and the intervertebral fusion was successful. According to Brantigan-Steffee classification,17 cases were grade D and 9 cases were grade E.
Conclusion Robot-assisted system for transforaminal percutaneous endoscopic for the treatment of single-segment lumbar disc herniation with lumbar instability improved the accuracy and safety of the operation,and the clinical effect of early follow-up is accurate. Minimally invasive spinal surgery; Transforaminal lumbar interbody fusion; Orthopaedic robot; Lumbar disc herniation |
| KEY WORDS Endoscopic Minimally invasive spinal surgery Transforaminal lumbar interbody fusion Orthopaedic robot Lumbar disc herniation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张凯,范喜荣,赵常春,许广慧,薛文.骨科机器人辅助置钉下全内镜化经椎间孔腰椎椎间融合术治疗腰椎间盘突出症伴腰椎不稳[J].中国骨伤,2024,37(8):750~755 |
| 英文格式: | ZHANG Kai,FAN Xi-rong,ZHAO Chang-chun,XU Guang-hui,XUE Wen.Orthopedic robot-assisted endoscopic transforaminal lumbar interbody fusion for lumbar disc herniation with lumbar instability[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(8):750~755 |
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