[1]付松,邵诗泽,王龙强,等.Quadrant系统下椎间融合辅助机器人治疗老年单节段腰椎退变的临床研究[J].中华老年骨科与康复电子杂志,2017,(02):70-76.[doi:10.3877/cma.j.issn.2096-0263.2017.02.002]
　Fu Song,Shao Shize,Wang Longqiang,et al.Clinical research on interbody fusion assisted by Quadrant systemand robot in the treatment of single segment lumbar degenerative[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2017,(02):70-76.[doi:10.3877/cma.j.issn.2096-0263.2017.02.002]
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Quadrant系统下椎间融合辅助机器人治疗老年单节段腰椎退变的临床研究()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2017年02期
页码:
70-76
栏目:
论著
出版日期:
2017-03-25

文章信息/Info

Title:
Clinical research on interbody fusion assisted by Quadrant systemand robot in the treatment of single segment lumbar degenerative
作者:
付松 1; 邵诗泽 1; 王龙强 1; 王亚楠 1; 侯海涛 1; 刘海军 1; 王欢 1; 黄相鹏 1; 朱洪英 1; 吕仁花 2
264400 威海，山东省文登整骨医院脊柱脊髓科 1；264400 威海市中心医院神经内科 2
Author(s):
Fu Song1;  Shao Shize1;  Wang Longqiang1;  Wang Yanan1;  Hou Haitao1;  Liu Haijun1;  Wang Huan1;  Huang Xiangpeng1;  Zhu Hongying1;  Lyu Renhua2
1Department of Spinal Cord, Shandong Wendeng Orthopeadic Hospital, Weihai 264400, China; 2Department of Neurosurgery, The Affiliated Weihai Central Hospital, 264400, China
关键词:
微创手术;  腰椎;  老年人;  机器人
Keywords:
Minimally invasive surgical procedures;  Lumbar vertebrae;  Aged;  Robot
DOI:
10.3877/cma.j.issn.2096-0263.2017.02.002
文献标志码:
A
摘要:
目的 比较 Quadrant通道下减压、椎间融合辅助机器人经皮置入椎弓根螺钉和传统后路开放手术治疗老年单节段腰椎退变性疾病的临床疗效及影像学情况。方法 前瞻性收集 2014年 8月至 2015年 1月手术治疗单节段腰椎退变性疾病患者 50例，随机分为经通道减压、融合辅助机器人经皮置钉组（机器人组）及传统后路开放手术组（开放组）。机器人组 24例，通过机器人进行术前规划，机器人臂经皮置入椎弓根螺钉，在 Mast Quadrant通道辅助下进行减压、椎间融合。开放组 26例，采用传统的后路开放手术。观察两组患者术中出血量、手术时间、术中及术后并发症发生情况，分别于术后 3周、1、6、 12个月随访并比较两组患者的疼痛视觉模拟评分（VAS），Oswestry功能障碍指数（ODI）及 MRI上测量的多裂肌面积及萎缩比，并通过 CT观察术后 12个月的椎间融合情况。结果 所有患者均获得满意随访，随访时间 12～15 个月，平均（12.9±0.4）个月。机器人组手术时间为 99.7（20.1）min，开放组为 101.6（31.7）min，差异无统计学意义（Z=-0.197，P＞0.05）。机器人组患者的术中出血量和术后引流量分别为207.9（59.8）ml、90.6（45.6）ml少于开放组[297.5（80.1）ml、180.6（78.4）ml]，差异具有统计学意义（Z=1.517，P＜0.05；Z=2.168，P＜0.05）。两组患者术前及术后各个时间点的ODI、VAS评分随着随访时间的延长，均明显降低。术后 12个月机器人组多裂肌的萎缩比（[ 6.2±1.1）%]低于开放手术组（[ 17.1±2.1）%]，差异具有统计学意义（c2=0.008，P<0.001）。CT显示术后12个月椎间均达到骨性愈合，未见内固定相关并发症。结论 经通道减压、融合辅助机器人经皮置钉和传统的后路开放手术治疗单节段腰椎退变性疾病均能取得较好的临床疗效，但经通道减压、融合辅助机器人经皮置钉术对局部肌肉的创伤较小，更有利于恢复。
Abstract:
Objectives To compare the clinical effect and imaging changes between robot assisted percutaneous pedicle screws insertion via interbody fusion and decompression under quadrant system and conventional posterior open surgery in senile lumbar degenerative patients with single segment. Methods A prospective study was performed in 50 lumbar degenerative patients involved one level segment from August 2014 to January 2015, they were divided into robot group and open surgery group randomly. Preoperative plans and percutaneous pedicle screw insertion of twenty- four patients in robot group were achieved by robot, decompression and interbody fusion were carried out under Quadrant Mast channel. Twenty-six patients in open surgery group underwent traditional open surgery. The intraoperative blood loss, duration of operation, intraoperative and postoperative complications were comparied between two groups. The amount and ratio of muscle atrophy were measured by MRI, visual analogue scale (VAS) and oswestry disability index (ODI) were observed at 3 weeks, 1, 6, 12 months postoperatively. The lumbar interbody fusion were observed through CT images at 12 months postoperatively. Results All cases were well followed- up with a times pan of 12- 15 months (12.9±0.4) months on the average). The operation time in the robot group was 99.7 (20.1) min compared to 101.6(31.7) min in open surgery group, there was no significant difference between two groups (Z=0.197, P> 0.05). In the robot group, the median intraoperative blood loss and postoperativee suction drainage were 207.9 (59.8)ml and90.6(45.6)ml,whichweresignificantlylowerthantheopensurgerygroup[297.5(80.1)ml and180.6 (78.4)ml)],with statistical significance(Z=1.517, P<0.05; Z=2.168, P<0.05).ODI andVAS scores of both groups decreased significantly over time.The muscle atrophy oratio in robot group [(6.2±1.1)%] was significantly lower than that in open group [(17.1±2.1)%] at 12 months postoperatively with statistically significant differences (c2=0.008, P<0.001). CT scan showed interval bone healing at 12 months follow- up in two groups, and no internal fixation related complications were found. Conclusion Both robot assisted percutaneous pedicle screws insertion via a channel decompression and fusion and conventional posterior open surgery can achieve excellent clinical efficacy in lumbar degenerative diseases with single segment. But less local muscle injury and better recovery were observed using robot assisted percutaneous pedicle screws insertion via a channel decompression and fusion.

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备注/Memo

备注/Memo:
基金项目：威海市科技发展计划项目（2011-2-94-2）
更新日期/Last Update: 2017-04-01