摘要
目的 比较机器人辅助与透视辅助微创经椎间孔腰椎椎体间融合术(minimally invasive transforaminal lum-bar interbody fusion,MIS-TLIF)的临床疗效.方法 回顾性分析2020年5月至2021年9月南京医科大学第一附属医院接受机器人辅助MIS-TLIF(机器人辅助组)治疗的腰椎退变性疾病患者27例,男9例、女18例,年龄(61.00±9.11)岁(范围41～71岁).选择同期接受透视辅助MIS-TLIF(透视辅助组)的患者27例作对照,男16例、女11例,年龄(56.70±11.97)岁(范围32～76岁).记录手术时间、术中出血量、辐射暴露时间、术后引流量、住院时间、疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、椎弓根钉置钉准确率及术后并发症情况.采用拟合对数曲线基于手术量和手术时间绘制机器人辅助组的学习曲线.结果 所有患者均顺利完成手术并获得随访,随访时间为(15.44±3.89)个月(范围12～24个月).机器人辅助组手术时间、引流量、住院天数分别为(181.44±36.43)min、(43.70±22.04)ml、(5.04±1.40)d,小于透视辅助组的(223.22±59.40)min、(74.63±71.86)ml、(6.59±3.04)d,差异有统计学意义(P＜0.05).机器人辐射暴露时间为(77.78±9.81)s,大于透视辅助组的(63.78±17.70)s(t=3.595,P=0.001).两组患者腰椎VAS评分手术前后比较的差异均有统计学意义(P＜0.05),术后3天和末次随访均小于术前.机器人辅助组术后第3天VAS评分为(2.52±0.98)分,小于透视辅助组的(3.07±0.87)分(t=0.294,P=0.032).两组均置入椎弓根螺钉108枚,机器人辅助组置钉准确率为93.5％(101/108),大于透视辅助组的77.8％(84/108),差异有统计学意义(x2=11.821,P=0.008).通过拟合对数曲线描述机器人辅助组术者的手术数量与手术时间的关系,结果显示手术时间随手术量增加而下降,前10例的手术时间波动较大,经过10例手术后手术时间逐渐缩短且趋于稳定.结论 机器人辅助MIS-TLIF可提高椎弓根螺钉的置钉准确率,改善术后早期疼痛,学习曲线短.
Abstract
Objective To compare the clinical efficacy of robotic-assisted and fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF).Methods A total of 27 patients with lumbar degenerative disease receiving ro-bot-assisted MIS-TLIF(robot-assisted group)treatment in the First Affiliated Hospital of Nanjing Medical University from May 2020 to September 2021 were retrospectively analyzed,including 9 males and 18 females,aged 61.00±9.11 years(range,41-71 years).Twenty-seven patients who received fluoroscopic-assisted MIS-TLIF(fluoroscopic-assisted group)during the same period were se-lected as controls,including 16 males and 11 females,aged 56.70±11.97 years(range,32-76 years).Operation time,intraoperative bleeding,radiation exposure time,postoperative drainage,hospitalization time,visual analogue scale(VAS)for pain,Oswestry dis-ability index(ODI),accuracy of pedicle screw placement,and postoperative complications were recorded.The learning curve of the robot-assisted group was drawn based on the amount of surgery and the operation time by fitting the logarithmic curve.Results All patients successfully completed the operation and were followed up for 15.44±3.89 months(range,12-24 months).The operation time,drainage volume,and hospitalization time in the robot-assisted group were 181.44±36.43 min,43.70±22.04 ml,and 5.04±1.40 d,respectively,which were smaller than 223.22±59.40 min,74.63±71.86 ml,6.59±3.04 d in the fluoroscopy-assisted group,and the differences were statistically significant(P＜0.05).The radiation exposure time in robot-assisted group was 77.78±9.81 s,which was larger than fluoroscopy-assisted group(63.78±17.70 s).There were statistically significant differences in lumbar VAS scores be-tween the two groups before and after surgery(P＜0.05),3 days after operation and the last follow-up was smaller than those before operation.The VAS score on postoperative day 3 in the robot-assisted group was 2.52±0.98,which was less than 3.07±0.87 in the fluoroscopically-assisted group(t=0.294,P=0.032).In both groups,108 pedicle screws were placed,and the accuracy of nail place-ment in the robot-assisted group was 93.5％(101/108),which was greater than that in the fluoroscopically-assisted group 77.8％(84/108),and the difference was statistically significant(x2=11.821,P=0.008).By fitting a logarithmic curve to describe the rela-tionship between the number of operations and the operation time of the robotic-assisted group of operators,the results showed that the operation time decreased with the increase of the number of operations,and the operation time fluctuated greatly in the first 10 cases,and then gradually shortened and stabilized after 10 operations.Conclusion Robot-assisted MIS-TLIF can improve the ac-curacy of pedicle screw placement,improve the early postoperative pain and shorten the learning curve.
维普
万方数据