Objective: To compare the clinical effects of robot-assisted minimally invasive transforaminal lumbar interbody fusion (TLIF) and traditional open TLIF in the treatment of lumbar spondylolisthesis. Methods: A total of 41 patients with lumbar spondylolisthesis accepted surgical treatment in Department of Spinal Surgery of Beijing Jishuitan Hospital From July 2015 to April 2016 were retrospectively analyzed. There were 16 cases accepted robot-assisted minimally invasive TLIF and 25 accepted traditional open TLIF. The operation time, X-ray radiation exposure time, perioperative bleeding, drainage volume, time of hospitalization, time for pain relief, time for ambulatory recovery, visual analogue scale (VAS), Oswestry disability index (ODI) and complications were compared. T test and χ(2) were used to analyze data. Results: There were no significant difference in gender, age, numbers, degrees, pre-operative VAS and ODI in spondylolisthesis (all P>0.05). Compared with traditional open TLIF group, the robot-assisted minimally invasive TLIF group had less perioperative bleeding ((187.5±18.4) ml vs. (332.1±23.5) ml), less drainage volume ((103.1±15.6) ml vs. (261.3±19.8) ml), shorter hospitalization ((7.8±1.9) days vs. (10.0±1.6) days), shorter time for pain relief ((2.8±1.0) days vs. (5.2±1.1) days), shorter time for ambulatory recovery ((1.7±0.9) days vs. (2.9±1.3) days) and less VAS of the third day postoperatively (2.2±0.9 vs. 4.2±2.4) (t=2.762-16.738, all P<0.05), but need more operation time ((151.3±12.3) minutes vs. (102.2±7.1) minutes) and more X-ray radiation exposure ((26.1±3.3) seconds vs. (5.5±2.1) seconds) (t=6.125, 15.168, both P<0.01). In both groups ODI was significantly lower in final follow-up than that of the pre-operation (t=12.215, 14.036, P<0.01). Intervertebral disc height of the final follow-up in both groups were significantly larger than that of the preoperation (robot-assisted minimally invasive TLIF group: (11.8 ± 2.8) mm vs. (7.5 ± 1.9) mm, traditional open TLIF group: (12.7 ± 2.5) mm vs. (7.9±2.0) mm), and so was the lumbar lordosis angle (robot-assisted minimally invasive TLIF group: (48.7±9.2)°vs. (39.6±7.9)°, traditional open TLIF group: (50.1±10.8)°vs. (41.4±8.8)°), the lordosis angle of the slippage segment (robot-assisted minimally invasive TLIF group: (18.7±5.6)°vs. (10.9±3.8)°, traditional open TLIF group: (17.6±6.1)°vs.(8.7±3.2)°) (t=4.128-16.738, all P<0.01). Slippage rate of the final follow-up in both groups were significantly smaller than those of the pre-operation (robot-assisted minimally invasive TLIF group: (5.3±2.3) % vs. (27.8±7.2) %, traditional open TLIF group: (6.6±2.8) % vs. (29.1±9.5) %) (t=11.410, 18.504, both P<0.01). There was no difference of the upper data between two groups (t=0.106-1.227, P>0.05). The results of the post-operative CT showed that the pedicle screws in the robot-assisted minimally invasive TLIF group were more precisely placed than traditional open TLIF group (χ(2)=4.247, P=0.039). The mean follow-up time was 8 months (ranging from 3 to 12 months). There were no significant difference in outcomes between the two groups (χ(2)=0.366, P=0.545). Conclusions: In the treatment of lumbar spondylolisthesis, Robot-assisted minimally invasive TLIF can lead to less perioperative bleeding, less post-operative pain, and quicker recovery than traditional open TLIF surgery, but it needs more operation time and radiation exposure.
目的： 比较机器人引导下微创经椎间孔腰椎椎体间融合术(TLIF)与传统开放TLIF治疗Ⅰ、Ⅱ度单节段腰椎滑脱症的疗效。 方法： 回顾性分析2015年7月至2016年4月于北京积水潭医院脊柱外科接受手术的41例Ⅰ、Ⅱ度单节段腰椎滑脱症患者，机器人微创组16例，开放手术组25例。比较两组患者的手术时间、术中射线暴露时间、术中出血量、术后引流量、住院时间、疼痛缓解时间、自主翻身时间、自主下床活动时间、手术前后的腰痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和并发症情况。计量资料组间比较采用独立样本t检验，计数资料组间比较采用χ(2)检验。 结果： 两组患者的性别、年龄、滑脱节段和滑脱程度、术前VAS和ODI差异无统计学意义(P值均>0.05)。与开放手术组相比，机器人微创组的手术时间[(151.3±12.3)min比(102.2±7.1)min]和术中射线暴露时间[(26.1±3.3)s比(5.5±2.1)s]均较长，差异有统计学意义(t＝6.125、15.168，P值均<0.01)；机器人微创组的术中出血量[(187.5±18.4)ml比(332.1±23.5)ml]和术后引流量[(103.1±15.6)ml比(261.3±19.8)ml]均较少，住院时间[(7.8±1.9)d比(10.0±1.6)d]、疼痛缓解时间[(2.8±1.0)d比(5.2±1.1)d]、自主翻身时间[(1.3±0.5)d比(2.2±0.8)d]、自主下床活动时间[(1.7±0.9)d比(2.9±1.3)d]均较短，差异均有统计学意义(t＝4.587～13.153，P值均<0.01)。与术前相比，机器人微创组和开放手术组末次随访时椎间隙高度[机器人微创组：(11.8±2.8)mm比(7.5±1.9)mm；开放手术组：(12.7±2.5)mm比(7.9±2.0)mm]、腰椎前凸角[机器人微创组：(48.7±9.2)°比(39.6±7.9)°；开放手术组：(50.1±10.8)°比(41.4±8.8)°]、滑脱节段前凸角[机器人微创组：(18.7±5.6)°比(10.9±3.8)°；开放手术组：(17.6±6.1)°比(8.7±3.2)°]均增大(t＝4.128～16.738，P值均<0.01)，滑脱率减小[机器人微创组：(5.3±2.3)%比(27.8±7.2)%；开放手术组：(6.6±2.8)%比(29.1±9.5)%](t＝11.410、18.504，P值均<0.01)，但是两组间差异无统计学意义(t＝0.106～1.227，P值均>0.05)。机器人微创组的置钉准确性高于开放手术组(χ(2) ＝4.247，P＝0.039)。41例患者均获得随访，随访时间3～12个月，平均8个月。与开放手术组相比，机器人微创组患者术后3 d、3个月和末次随访时VAS均降低，仅术后3 d时差异有统计学意义(2.2±0.9比4.2±2.4)(t＝2.762，P＝0.006)。与术前相比，两组患者术后3 d、3个月和末次随访时VAS均降低(t＝7.193～16.765，P值均<0.01)、末次随访时ODI降低(t＝12.215、14.036，P<0.01)。两组间疗效差异无统计学意义(χ(2)＝0.366，P＝0.545)。 结论： 与传统开放TLIF手术相比，机器人引导下微创TLIF手术治疗腰椎滑脱症术中出血较少，术后疼痛轻、引流量少、恢复快，置入螺钉更加精确，但手术时间和射线暴露时间长。.
Keywords: Robotics; Spondylolysis; Surgical procedures, minimally invasive; transforaminal lumbar interbody fusion.