摘要
目的观察应用机器人辅助皮质骨螺钉固定技术治疗腰椎退行性疾病的临床效果和安全性。方法对2018年12月至2019年12月北京积水潭医院脊柱外科应用机器人辅助皮质骨螺钉固定融合手术治疗的腰椎退行性疾病患者64例的临床资料进行回顾性分析。其中男42例,女22例;年龄(66.4±14.6)(55~79)岁。包括腰椎管狭窄症36例,腰椎间盘突出症10例,腰椎滑脱症18例。记录手术的临床指标包括手术时间、出血量和引流量;通过CT影像采用Gertzbein和Robbins评分方法对皮质骨螺钉置钉精确性进行评价;采用疼痛视觉模拟评分(VAS)和日本矫形外科学会(JOA)评分对患者术前与术后疼痛程度和脊柱功能进行评价。结果共植入螺钉464枚,其中A级螺钉406枚(87.5%),B级螺钉44枚(9.5%),C级螺钉10枚(2.2%),D级螺钉4枚(0.8%),螺钉置钉优良率为97.0%。手术时间为(110.4±63.2)min,术中出血量(164.3±234.2)ml,术后引流量为(210.4±146.4)ml,住院时间为(5.4±2.4)d。JOA评分术前为(8.4±7.6)分,末次随访为(21.4±8.4)分;VAS评分术前为(8.1±6.8)分,末次随访为(3.2±4.2)分。2项指标术后与术前差异均有统计学意义(均P<0.01)。随访时间为(11.6±3.4)(10~14)个月,未见螺钉松动和断裂。结论应用机器人辅助皮质骨螺钉固定技术治疗腰椎退行性疾病可获得较高的螺钉置钉精确性和安全性,取得较好的临床效果。
Objective To evaluate the safety and clinical effect of robot-assisted cortical bone trajectory(CBT)screws fixation for lumbar degenerative diseases.Methods Clinical data of 64 patients underwent robot-assisted cortical screw fixation and fusion surgery due to lumbar degenerative diseases in Department of Spine Surgery,Beijing Jishuitan Hospital from December 2018 to December 2019 were retrospectively analyzed.Forty-two males and 22 females aged 66.4±14.6(55~79)were included.Of all cases,36 were lumbar spinal stenosis,10 were lumbar disc herniation and 18 were lumbar spondylolisthesis.Postoperative CT images were used to evaluate the accuracy of CBT screws according to the Gertzbein and Robbins scores.The clinical indicators of robot-assisted CBT screw fixation surgery including operating time,blood loss,drainage,visual analogue scale(VAS)scores and Japanese Orthopedic Association(JOA)scores were analyzed.Results A total of 464 screws including 406(87.5%)screws in grade A,44(9.5%)screws in grade B,10(2.2%)screws in grade C and 4(0.8%)screws in grade D were implanted.The follow-up time was(11.6±3.4)(10-14)months.The operation time was(110.4+63.2)min.The intraoperative blood loss was(164.3±234.2)ml.The postoperative drainage volume was(210.4±146.4)ml.The average hospital stay was(5.4±2.4)d.The JOA score increased from pre-operative(8.4±7.6)points to(21.4±8.4)points at the last follow-up.The VAS score reduced from pre-operative(8.1±6.8)points to(3.2±4.2)points at the last follow-up.During the follow-up period,no screw loosening or breakage occurred.Conclusion The robot-assisted CBT screw fixation has high accuracy and safety in the treatment of lumbar degenerative diseases and achieves satisfactory therapeutic effects.
作者
韩晓光
张琦
行勇刚
何达
赵经纬
范明星
Han Xiaoguang;Zhang Qi;Xing Yonggang;He Da;Zhao Jingwei;Fan Mingxing(Department of Spine Surgery, Beijing Jishuitan Hospital, the Fourth Clinical Medical Collage of Peking University, Beijing 100035, China)
出处
《骨科临床与研究杂志》
2021年第4期234-238,共5页
Journal Of Clinical Orthopedics And Research
基金
国家自然科学基金(U1713221)。
关键词
机器人手术
脊柱融合术
腰椎
治疗结果
Robotic surgical procedures
Spinal fusion
Lumbar vertebrae
Treatment outcome
