机器人辅助侧块开槽技术在颈椎后路单开门椎管扩大椎板成形术中的实用性

关键词：颈椎  颈椎病  减压术，外科  机器人

Keywords:Cervical vertebrae  Cervical spondylosis  Decompression,surgical  Robots

摘要：

      目的 探讨骨科手术机器人辅助侧块开槽技术在颈椎后路单开门椎管扩大椎板成形术中的实用性。方法 回顾性分析2021年6月—2024年6月采用颈椎后路单开门椎管扩大椎板成形术治疗的159例颈椎退行性疾病患者资料，其中59例采用常规技术（常规组），72例采用侧块开槽技术（侧块组），28例采用手术机器人辅助侧块开槽技术（机器人组），记录3组患者的手术时间、术中出血量、术后引流量及并发症发生情况。于术前、术后即刻、术后2个月、术后12个月及末次随访时采用视觉模拟量表（VAS）评分评估颈部疼痛程度，采用颈椎功能障碍指数（NDI）评估颈椎功能，采用日本骨科学会（JOA）评分评估神经功能状况；在颈椎侧位X线片上测量C_2~7 Cobb角，在颈椎横断面CT上测量椎管横截面积并计算椎管横截面积增加率。结果 所有手术顺利完成，患者随访12 ~ 48（24.39±10.66）个月。机器人组手术时间、术中出血量高于常规组和侧块组，差异均有统计学意义（P < 0.05）；常规组与侧块组手术时间、术中出血量组间差异均无统计学意义（P > 0.05）。3组术后引流量差异均无统计学意义（P > 0.05）。3组术后2个月、术后12个月及末次随访时的颈痛VAS评分较术前改善，3组术后各随访时间点的NDI、JOA评分较术前改善，差异均有统计学意义（P < 0.05）；3组术后各随访时间点VAS评分、NDI组间差异均无统计学意义（P > 0.05）；侧块组和机器人组术后各随访时间点的JOA评分较常规组改善更明显，差异均有统计学意义（P < 0.05）。3组各随访时间点的C_2~7 Cobb角组间差异均无统计学意义（P > 0.05）。侧块组和机器人组术后各随访时间点的椎管横截面积增加率优于常规组，差异均有统计学意义（P < 0.05）。结论 与常规技术相比，侧块开槽技术可明显扩大骨性椎管横截面积、改善术后神经功能。机器人辅助侧块开槽技术会增加手术时间和术中出血量，且并不能增加骨性椎管横截面积及提高术后神经功能改善情况，不建议常规使用。

Abstract:

      Objective To explore the practicality of the robot-assisted lateral mass grooving technique in posterior cervical single-door laminoplasty. Methods From June 2021 to June 2024，the data of 159 patients with cervical degenerative diseases who underwent posterior cervical single-door laminoplasty were analyzed retrospectively. Among them，59 underwent the conventional technique（conventional group），72 received the lateral mass grooving technique（lateral mass group），and 28 did the robot-assisted lateral mass grooving technique（robot group）. The operation time，intraoperative blood loss，postoperative drainage volume，and complications of the 3 groups were recorded. At pre-operation，immediately post-operation，postoperative 2 months，postoperative 12 months and the final follow-up，the intensity of neck pain was evaluated using the visual analogue scale（VAS） score，and cervical function was assessed using the neck disability index（NDI），and the neurological function was assessed using the Japanese Orthopaedic Association（JOA） score；the C₂-₇ Cobb angle was measured on lateral cervical roentgenographs，and the spinal canal cross-sectional area was measured on cervical CT scans and the increase rate of the spinal canal cross-sectional area was calculated. Results All the surgeries were successfully completed. The patients were followed up for 12 - 48（24.39±10.66） months. The operation time and intraoperative blood loss of the robot group were higher than those of the conventional and lateral mass groups，and the differences were statistically significant（P < 0.05）；and there were no statistically significant differences in operation time and intraoperative blood loss between the conventional group and the lateral mass group（P > 0.05）. There was no statistically significant difference in postoperative drainage volume between the 3 groups（P > 0.05）. The VAS scores at postoperative 2，12 months and the final follow-up in the 3 groups were all improved compared with those at pre-operation，and the NDI and JOA scores at each follow-up time point after the operation in the 3 groups were also improved compared with those at pre-operation，and the differences were statistically significant（P < 0.05）. There were no statistically significant difference in the VAS scores and NDI between the 3 groups at each follow-up time point（P > 0.05）. The JOA scores at each follow-up time point after the operation in the lateral mass group and the robot group were improved more significantly than those in the conventional group，and the differences were statistically significant（P < 0.05）. There was no statistically significant difference in the C₂-₇ Cobb angle between the 3 groups at each follow-up time point（P > 0.05）. The increase rates of the spinal canal cross-sectional area at each follow-up time point after the operation in the lateral mass group and the robot group were better than those in the conventional group，and the differences were statistically significant（P < 0.05）. Conclusions Compared with conventional technique，the lateral mass guttering technique could significantly expand the spinal canal cross-sectional area，and improve the recovery of postoperative neurological function. While robot-assisted lateral mass guttering technique will increase the operation time and intraoperative blood loss，but can not increase the spinal canal cross-sectional area or improve the recovery of postoperative neurological function. Therefore，it is not recommended for routine use.