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目的总结机器人经皮置入椎弓根螺钉辅助Quadrant通道下减压、椎间融合治疗腰椎滑脱症的手术技巧并分析其短期疗效。方法 2014年6月—2015年3月,山东省文登整骨医院脊柱脊髓科手术治疗腰椎滑脱症患者39例。利用机器人进行术前规划,安放机器人机械臂,按照术前规划经皮置入椎弓根螺钉,在Mast Quadrant通道辅助下行减压、椎间融合术。记录手术时间、置钉时间、术中出血量、术后引流量,统计螺钉置入准确率及术中、术后的并发症发生情况。术后2周及1、6、12个月进行随访,随访指标包括Oswestry功能障碍指数(ODI)、疼痛视觉模拟量表(VAS)评分、反映滑脱程度的Taillard指数、滑脱间隙的椎间隙高度以及椎间融合情况。结果 39例患者手术均顺利完成,其中36例获得随访。术中出血量为(266.8±61.6)m L,手术时间为(115.3±32.8)min,机器人经皮置入单枚螺钉时间为(1.4±0.6)min,术后引流量为(196.4±69.5)m L。术后随访,各个时间点VAS评分、ODI、Taillard指数较术前降低,滑脱间隙的椎间隙高度较术前增高,差异均有统计学意义(P<0.05)。术后12个月随访时CT显示椎间均达到骨性愈合,未见椎间融合器移位、内固定断裂等并发症。结论机器人经皮置钉辅助Quadrant通道下减压、椎间融合术操作安全、简单,置钉准确率高,容易掌握,对于腰椎滑脱症具有较好的临床疗效。
Objective To summarize the surgical techniques of decompression and interbody fusion of intervertebral fusion in the treatment of lumbar spondylosis by robot percutaneous pedicle screw fixation and to analyze its short-term curative effect. Methods From June 2014 to March 2015, 39 patients with spondylolisthesis were treated by spine and spinal cord surgery in Wendeng Osteopathy Hospital of Shandong Province. Preoperative planning using robots, placement of robotic arms, percutaneous placement of pedicle screws according to preoperative planning, assisted decompression and interbody fusion at the Mast Quadrant channel. Record the operation time, nailing time, intraoperative blood loss, postoperative drainage, statistical accuracy of screw placement and intraoperative and postoperative complications. Follow-up was performed at 2 weeks and 1, 6 and 12 months after operation. The follow-up indexes included Oswestry Disability Index (ODI), pain visual analog scale (VAS) score, Taillard index reflecting the degree of slippage, intervertebral height Intervertebral fusion situation. Results All the 39 cases were successfully performed, of which 36 cases were followed up. The intraoperative blood loss was (266.8 ± 61.6) m L and the operation time was (115.3 ± 32.8) min. The duration of percutaneous transluminal screw insertion was (1.4 ± 0.6) min and the amount of postoperative drainage was (196.4 ± 69.5) m L. After operation, the VAS score, ODI and Taillard index decreased at each time point, and the intervertebral height of the intervertebral space was significantly higher than that before operation (P <0.05). At 12 months after operation, CT showed that the intervertebral all reached the bony union without any dislocation of the intervertebral cage and internal fixation fracture. Conclusion The percutaneous pinning of the robot aids the decompression of the Quadrant channel, and the operation of interbody fusion is safe, simple and accurate. It is easy to grasp and has good clinical curative effect on lumbar spondylolisthesis.