目的:探讨机器人辅助系统在经椎间孔镜治疗腰椎间盘突出症伴腰椎不稳的安全性和有效性。
方法:自2021年10月至2023年3月,对26例单节段腰椎间盘突出症合并腰椎不稳的患者采用机器人辅助系统经椎间孔镜治疗。操作时间,术中失血,切口长度,术后引流量,术后下床活动时间,记录术后住院时间。观察并比较手术前后的椎间隙高度和腰椎前凸角度。使用视觉模拟量表(VAS)评估疼痛水平。采用Oswestry残疾指数(ODI)评价临床疗效。通过BrantiganSteffee标准评估椎间融合。
结果:所有患者均顺利完成手术,手术时间105~109min,平均(150.8±24.1)min。术中出血量35~88ml,平均(55.5±16.4)ml。切口长度1.4~3.5cm,平均(2.3±0.8)cm。术后引流量15~40ml,平均(28.5±7.8)ml。术后下床活动时间15~30h,平均(22.8±4.5)h,术后住院时间3~7d,平均(4.2±1.3)d,共随访26例。病程12~16个月,平均(14.0±1.3)个月。1周时的VAS和ODI[(2.96±0.72)点,(41.63±4.79)%]和12个月[(1.27±0.60)分,(13.11±2.45)%]与术前[(6.69±0.93)分,(59.12±5.92)%],P<0.01。12个月时椎间隙高度(11.95±1.47)mm和腰椎前凸(57.46±7.59)°与术前[(6.67±1.20)mm,(44.08±7.79)°],P<0.01。手术后12个月,所有患者均无椎弓根螺钉断裂或融合器脱位,椎间融合成功了.根据Brantigan-Steffee分类,D级17例,E级9例。
结论:机器人辅助系统经椎间孔镜治疗单节段腰椎间盘突出症伴腰椎不稳,提高了手术的准确性和安全性。早期随访临床效果准确。
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.
CONCLUSIONS: 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.