机器人辅助单边双通道内镜行腰椎减压融合内固定术的回顾性研究

Robot-assisted unilateral biportal endoscopy for lumbar decompression， fusion，and internal fixation： A retrospective study

摘要:

目的 通过与经皮脊柱内镜下腰椎减压融合内固定术进行比较，探讨机器人辅助单侧双通道内镜在腰椎减压融合内固定术中的运用及优势。方法 回顾性分析2021年2月至2022年6月甘肃省中医院脊柱疾病诊疗中心收治的26例需行腰椎减压融合术的患者，根据手术方式分为机器人辅助单侧双通道内镜行腰椎减压融合内固定术（Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion，R-ULIF）、经皮脊柱内镜辅助下腰椎减压融合内固定术（endoscopic lumbar interbody fusion，Endo-LIF）2组，R-ULIF组采用R-ULIF，Endo-LIF组采用Endo-LIF。分析并比较2组患者一般资料、2组透视次数、手术时间、出血量、术后住院时间、置钉优良率、融合率、并发症发生率、术后疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数评分（oswestry dysfunction index，ODI）、MacNab标准疗效评价等指标。结果 所有患者均顺利完成手术。R-ULIF组13例，其中男6例，女7例，年龄（53.92±9.86）岁；病程33.0（6.1，81.0）个月，手术时间（187.85±10.18） min，透视次数（7.92±0.95）次，术中出血量（54.54±4.72） mL，术后住院时间（3.92±0.86） d，置钉准确率98.1%（51/52），融合率92.3%，无并发症发生（0%）；Endo-LIF组13例，其中男5例，女8例，年龄（52.38±10.89）岁；病程48.0（6.0，120.0）个月，手术时间（175.15±23.81） min，透视次数（13.77±1.48）次，术中出血量（104.31±6.81） mL，术后住院时间（5.23±1.01） d，置钉准确率76.9%（40/52），融合率84.6%，1例男性患者发生了硬膜撕裂，1例女性患者发生了融合器下沉，并发症发生率为15%。2组患者相比，R-ULIF组透视次数、术中出血量、术后住院时间小于Endo-LIF组（P<0.05）。2组患者的VAS评分和ODI评分在各时间点均明显降低（P<0.05）；R-ULIF组患者术后1个月和3个月时ODI评分优于Endo-LIF组（P=0.017/P=0.047），在术前、术后1周组间差异无统计学意义（P>0.05）。术后6个月采用 MacNab标准评价疗效，R-ULIF组获优9例、良2例、中1例、差1例，优良率84.6%；Endo-LIF组获优7例、良3例、中2例，差1例，优良率76.9%。结论 机器人辅助单边双通道内镜行腰椎减压融合术治疗腰椎间盘突出合并腰椎失稳，短期内临床疗效安全可靠，置钉成功率高，辐射暴露少，术中出血量少，患者住院时间少，值得临床推广。

Abstract:

Objective To investigate the application and advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression，fusion，and internal fixation by comparing it with percutaneous spinal endoscopy.Methods A retrospective analysis was performed for 26 patients who were admitted to Center for Diagnosis and Treatment of Spinal Diseases，Gansu Provincial Hospital of Traditional Chinese Medicine，from February 2021 to June 2022 and needed to undergo lumbar decompression and fusion，and according to the surgical procedure，they were divided into R-ULIF group and Endo-LIF group. The patients in the R-ULIF group were treated with robot-assisted unilateral biportal endoscopy for lumbar interbody fusion（R-ULIF），and those in the Endo-LIF group were treated with percutaneous spinal endoscopic lumbar interbody fusion（Endo-LIF）. The two groups were analyzed and compared in terms of general data，fluoroscopy frequency，time of operation，bleeding volume，length of postoperative hospital stay，excellent and good rate of screw placement，fusion rate，the incidence rate of complications，visual analogue scale（VAS） score for postoperative pain，oswestry dysfunction index（ODI） score，and MacNab efficacy evaluation standard.Results All patients completed the operation successfully. There were 13 patients（6 male patients and 7 female patients） in the R-ULIF group，with an age of （53.92±9.86） years，a course of disease of 33.0（6.1，81.0） weeks，a time of operation of （187.85±10.18） minutes，a fluoroscopy frequency of （7.92±0.95） times，an intraoperative blood loss of （54.54±4.72） mL，a length of postoperative hospital stay of 3.92±0.86 days，an accuracy rate of screw placement of 98.1%（51/52），and a fusion rate of 92.3%，and no complication was observed（0%）； there were 13 patients（5 male patients and 8 female patients） in the Endo-LIF group，with an age of 52.38±10.89 years，a course of disease of 48.0（6.0，120.0） weeks，a time of operation of （175.15±23.81） minutes，a fluoroscopy frequency of 13.77±1.48 times，an intraoperative blood loss of （104.31±6.81） mL，a length of postoperative hospital stay of （5.23±1.01） days，an accuracy rate of screw placement of 76.92%（40/52），and a fusion rate of 84.6%，and the incidence rate of complications was 15%（one male patient had dural tear and one female patient had fusion cage sinking）. Compared with the Endo-LIF group，the R-ULIF group had significantly lower fluoroscopy frequency and intraoperative blood loss and a significantly shorter length of postoperative hospital stay（P<0.05）. Both groups had significant reductions in VAS score and ODI score at each time point（P<0.05），and the R-ULIF group had a better ODI score than the Endo-LIF group at 1 and 3 months after surgery（P=0.017 and 0.047），while there was no significant difference between the groups before surgery and at 1 week after surgery（P>0.05）. Based on the MacNab efficacy evaluation standard at 6 months after surgery，there were 9 cases with excellent efficacy，2 cases with good efficacy，1 case with moderate efficacy，and 1 case with poor efficacy in the R-ULIF group，with an excellent and good rate of 84.6%；in the Endo-LIF group，there were 7 cases with excellent efficacy，3 cases with good efficacy，2 cases with moderate efficacy，and 1 case with poor efficacy，with an excellent and good rate of 76.9%.Conclusion Robot-assisted unilateral biportal endoscopy for lumbar decompression，fusion，and internal fixation has a safe and reliable short-term clinical in the treatment of lumbar disc herniation combined with lumbar instability，with a high success rate of screw placement，low radiation exposure，low intraoperative blood loss，and a short length of hospital stay，and therefore，it holds promise for clinical application. In the treatment of lumbar disc herniation combined with lumbar instability.