北京生物医学工程

骨科机器人辅助微创腰椎内固定术临床效果观察

Clinical effect for orthopaedic robot assisted minimally invasive lumbar internal fixation surgery

作者：黄洁韩冰刘稷轩施崭高新雪闫硕王豫田伟

单位：北京积水潭医院脊柱外科(北京 100035) 北京航空航天大学生物与医学工程学院(北京 100191)

关键词：骨科机器人；护理；腰椎内固定术；椎弓根螺钉置入；位置精准性；早期下地

分类号：R318

出版年·卷·期（页码）：2020·39·2（145-151）

摘要：

目的比较骨科机器人辅助微创腰椎内固定术和传统开放腰椎内固定术的手术和护理效果差异，并从术后护理角度对患者术后早期下地时间进行探讨。方法本研究为前瞻性随机对照研究，纳入2019年4月1日至7月30日收入北京积水潭医院脊柱外科行单节段腰椎手术的患者。采用随机数表法将符合纳排标准的患者分为机器人辅助微创内固定术组和传统开放内固定术组。术后首次下地时间在机器人辅助微创腰椎内固定术组缩短至术后4 h，而传统开放腰椎内固定术组患者仍保持术后24 h。评价指标包括Gertzbein-Robbins螺钉分类标准、首次下地活动持续时长、围手术期疼痛评分、手术时间、术中出血量、术后住院时间和术后并发症等。结果本研究共纳入患者60名，平均年龄(54.58±7.04)岁，其中男性患者33名(55%)。两组患者在基线信息方面无显著性差异。螺钉位置可接受率及优良率方面，机器人辅助微创内固定术组均优于传统开放内固定术组。围术期护理方面，术后4 h及术后24 h的疼痛评分采用视觉模拟评分法(visual analog scale, VAS)，机器人辅助微创内固定术组显著优于传统开放内固定术组。此外，机器人辅助微创内固定术组比传统开放内固定术组具有更长的首次下地活动持续时长。在手术时间、术中出血量和术后住院时间方面，机器人辅助微创内固定术组也存在明显优势。结论骨科机器人辅助微创腰椎内固定术能够提高椎弓根螺钉置入的精准性。在护理方面，术后早期下地活动能够提高患者围手术期体验，同时并不增加并发症的发生率。

Objective To compare the surgery and nursing effects between orthopaedic robot assisted minimally invasive lumbar internal fixation and conventional open lumbar internal fixation, and to explore the early ambulation time after surgery from the viewpoint of postoperative nursing. Methods This prospective randomized controlled trial enrolled patients underwent single-segment lumbar spine surgery in Spine Department of Jishuitan Hospital between April 1, 2019 and July 30, 2019. Patients were divided into robot assisted minimally invasive internal fixation group and traditional open internal fixation group according to the random number table. The first-time ambulation in robot assisted minimally invasive internal fixation group was 4 hours after surgery, while in traditional open internal fixation group was 24 hours after surgery. The results included the Gertzbein-Robbins screw classification criteria, the length of time for the first-time ambulation after surgery, the perioperative pain scores, the operation time, the intraoperative blood loss, the postoperative hospital stay and perioperative complications. Results A total of 60 patients were enrolled in this study, with an average age of (54.58 ± 7.04) years, including 33 (55%) male patients. There were no significant differences in baseline characteristics between these two groups. The robot assisted minimally invasive lumbar internal fixation group was superior to the conventional open lumbar internal fixation group in screw position acceptance rate. The pain scores of the robot assisted minimally invasive lumbar internal fixation group at 4 hours and 24 hours after surgery were significantly better than those of conventional open lumbar internal fixation group. At the same time, robot assisted minimally invasive lumbar internal fixation group had an earlier and longer duration of first-time ambulation after surgery. The robot assisted minimally invasive lumbar internal fixation group was significantly superior to the conventional open lumbar internal fixation group in terms of operation time, intraoperative blood loss and postoperative hospital stay. Conclusions Orthopaedic robot assisted minimally invasive lumbar internal fixation can improve the accuracy of pedicle screw placement. Early ambulation after surgery can improve the perioperative experience of patients without increasing incidence of complications.

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