北京生物醫(yī)學(xué)工程

骨科機(jī)器人輔助微創(chuàng)腰椎內(nèi)固定術(shù)臨床效果觀察

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

作者：黃潔韓冰劉稷軒施嶄高新雪閆碩王豫田偉

單位：北京積水潭醫(yī)院脊柱外科(北京 100035) 北京航空航天大學(xué)生物與醫(yī)學(xué)工程學(xué)院(北京 100191)

關(guān)鍵詞：骨科機(jī)器人；護(hù)理；腰椎內(nèi)固定術(shù)；椎弓根螺釘置入；位置精準(zhǔn)性；早期下地

分類號：R318

出版年·卷·期（頁碼）：2020·39·2（145-151）

摘要：

目的比較骨科機(jī)器人輔助微創(chuàng)腰椎內(nèi)固定術(shù)和傳統(tǒng)開放腰椎內(nèi)固定術(shù)的手術(shù)和護(hù)理效果差異，并從術(shù)后護(hù)理角度對患者術(shù)后早期下地時間進(jìn)行探討。方法本研究為前瞻性隨機(jī)對照研究，納入2019年4月1日至7月30日收入北京積水潭醫(yī)院脊柱外科行單節(jié)段腰椎手術(shù)的患者。采用隨機(jī)數(shù)表法將符合納排標(biāo)準(zhǔn)的患者分為機(jī)器人輔助微創(chuàng)內(nèi)固定術(shù)組和傳統(tǒng)開放內(nèi)固定術(shù)組。術(shù)后首次下地時間在機(jī)器人輔助微創(chuàng)腰椎內(nèi)固定術(shù)組縮短至術(shù)后4 h，而傳統(tǒng)開放腰椎內(nèi)固定術(shù)組患者仍保持術(shù)后24 h。評價指標(biāo)包括Gertzbein-Robbins螺釘分類標(biāo)準(zhǔn)、首次下地活動持續(xù)時長、圍手術(shù)期疼痛評分、手術(shù)時間、術(shù)中出血量、術(shù)后住院時間和術(shù)后并發(fā)癥等。結(jié)果本研究共納入患者60名，平均年齡(54.58±7.04)歲，其中男性患者33名(55%)。兩組患者在基線信息方面無顯著性差異。螺釘位置可接受率及優(yōu)良率方面，機(jī)器人輔助微創(chuàng)內(nèi)固定術(shù)組均優(yōu)于傳統(tǒng)開放內(nèi)固定術(shù)組。圍術(shù)期護(hù)理方面，術(shù)后4 h及術(shù)后24 h的疼痛評分采用視覺模擬評分法(visual analog scale, VAS)，機(jī)器人輔助微創(chuàng)內(nèi)固定術(shù)組顯著優(yōu)于傳統(tǒng)開放內(nèi)固定術(shù)組。此外，機(jī)器人輔助微創(chuàng)內(nèi)固定術(shù)組比傳統(tǒng)開放內(nèi)固定術(shù)組具有更長的首次下地活動持續(xù)時長。在手術(shù)時間、術(shù)中出血量和術(shù)后住院時間方面，機(jī)器人輔助微創(chuàng)內(nèi)固定術(shù)組也存在明顯優(yōu)勢。結(jié)論骨科機(jī)器人輔助微創(chuàng)腰椎內(nèi)固定術(shù)能夠提高椎弓根螺釘置入的精準(zhǔn)性。在護(hù)理方面，術(shù)后早期下地活動能夠提高患者圍手術(shù)期體驗，同時并不增加并發(fā)癥的發(fā)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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