[通过机器人辅助和经椎间孔扩张微创入路治疗胸腰椎结核]。

Q3 Medicine
Qunlong Pan, Haiming Yu, Yizhong Li, Xiaoyu He, Jinnan Shi
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引用次数: 0

摘要

目的方法:回顾性分析2017年1月至2022年5月收治的40例符合入选标准的胸腰椎结核患者的临床资料:回顾性分析2017年1月至2022年5月期间收治的符合入选标准的40例胸腰椎结核患者的临床资料。其中,15例采用机器人辅助微创入路经椎间孔扩张入路进行病灶清除、植骨、内固定治疗(机器人组),25例采用传统经椎间孔后入路进行病灶清除、椎间植骨治疗(传统组)。两组患者在性别、年龄、病变节段、术前美国脊柱损伤协会(ASIA)分级、Cobb角、视觉模拟量表(VAS)评分、红细胞沉降率(ESR)和C反应蛋白(CRP)等基线数据方面无明显差异(P>0.05)。记录并比较两组患者的手术时间、术中出血量、住院时间、术后卧床时间、并发症、术前和术后1周的血沉和CRP、术后3天的血清白蛋白水平、术前和术后6个月的神经功能VAS评分和ASIA分级、植入物融合情况、融合时间、病灶的Cobb角、X光片和CT观察到的Cobb角消失情况等结果指标。计算并比较手术前后 ESR、CRP 和 VAS 评分(变化值)的差异:与传统组相比,机器人组的手术时间和术中出血量明显减少,术后 3 天的血清白蛋白水平明显升高(PP>0.05)。传统组有 2 例切口愈合不良,而机器人组未发生并发症,两组并发症发生率差异无学意义(P>0.05)。两组的血沉和 CRP 变化值差异有学意义(PP>0.05)。两组患者手术前后的 Cobb 角差异有学意义(PPPP>0.05)。两组患者术后均未出现或加重脊髓神经功能损伤。两组术后6个月的ASIA分级与术前相比差异有学意义(PP>0.05):与传统的后路开放手术相比,采用机器人辅助下经椎间孔微创入路进行病灶清除和植骨内固定治疗胸腰椎结核,可缩短手术时间,减少术中出血,最大限度地减少手术创伤,疗效确切。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Treatment of thoracolumbar tuberculosis with robot-assisted and minimally invasive access via transforaminal expansion approach].

Objective: To investigate the feasibility and effectiveness of robot-assisted posterior minimally invasive access in treatment of thoracolumbar tuberculosis via transforaminal expansion approach.

Methods: A clinical data of 40 patients with thoracolumbar tuberculosis admitted between January 2017 and May 2022 and met the selection criteria was retrospectively analyzed. Among them, 15 cases were treated with robot-assisted and minimally invasive access via transforaminal expansion approach for lesion removal, bone graft, and internal fixation (robotic group), and 25 cases were treated with traditional transforaminal posterior approach for lesion removal and intervertebral bone grafting (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05) in terms of gender, age, lesion segment, and preoperative American Spinal Injury Association (ASIA) grading, Cobb angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). The outcome indicators were recorded and compared between the two groups, including operation time, intraoperative bleeding volume, hospital stay, postoperative bedtime, complications, ESR and CRP before operation and at 1 week after operation, the level of serum albumin at 3 days after operation, VAS score and ASIA grading of neurological function before operation and at 6 months after operation, the implant fusion, fusion time, Cobb angle of the lesion, and the loss of Cobb angle observed by X-ray films and CT. The differences of ESR, CRP, and VAS score (change values) between pre- and post-operation were calculated and compared.

Results: Compared with the traditional group, the operation time and intraoperative bleeding volume in the robotic group were significantly lower and the serum albumin level at 3 days after operation was significantly higher ( P<0.05); the postoperative bedtime and the length of hospital stay were also shorter, but the difference was not significant ( P>0.05). There were 2 cases of poor incision healing in the traditional group, but no complication occurred in the robotic group, and the difference in the incidence of complication between the two groups was not significant ( P>0.05). There were significant differences in the change values of ESR and CRP between the two groups ( P<0.05). All Patients were followed up, and the follow-up time was 12-18 months (mean, 13.0 months) in the traditional group and 12-16 months (mean, 13.0 months) in the robotic group. Imaging review showed that all bone grafts fused, and the difference in fusion time between the two groups was not significant ( P>0.05). The difference in Cobb angle between the pre- and post-operation in the two groups was significant ( P<0.05); and the Cobb angle loss was significant more in the traditional group than in the robotic group ( P<0.05). The VAS scores of the two groups significantly decreased at 6 months after operation when compared with those before operation ( P<0.05); the difference in the change values of VAS scores between the two groups was not significant ( P>0.05). There was no occurrence or aggravation of spinal cord neurological impairment in the two groups after operation. There was a significant difference in ASIA grading between the two groups at 6 months after operation compared to that before operation ( P<0.05), while there was no significant difference between the two groups ( P>0.05).

Conclusion: Compared with traditional posterior open operation, the use of robot-assisted minimally invasive access via transforaminal approach for lesion removal and bone grafting internal fixation in the treatment of thoracolumbar tuberculosis can reduce the operation time and intraoperative bleeding, minimizes surgical trauma, and obtain definite effectiveness.

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中国修复重建外科杂志
中国修复重建外科杂志 Medicine-Medicine (all)
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