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机器人辅助微创经椎间孔腰椎体间融合术治疗退行性腰椎脊柱疾病的有效性和安全性:系统评价和荟萃分析。

Effectiveness and safety of robot-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases: a systematic review and meta-analysis.

机构信息

Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, Jilin, China.

出版信息

J Robot Surg. 2024 Jan 17;18(1):37. doi: 10.1007/s11701-023-01768-8.

Abstract

Robot-assisted (RA) technology has been widely used in spine surgery. This analysis aimed to compare the effectiveness and safety of RA minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and fluoroscopy-assisted (FA) MIS-TLIF for degenerative lumbar spinal diseases (DLSD). PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure were systematically searched, and the outcomes included surgical parameters [operation time, blood loss, number of fluoroscopic, accuracy of pedicle screw position, superior facet joint violation (FJV)], and clinical indexes (Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, clinical efficacy, hospital stays, complications). Eleven articles involving 1066 patients were included. RA group produced better results than the FA group in operation time (WMD = - 6.59; 95% CI - 12.79 to - 0.40; P = 0.04), blood loss (WMD = - 34.81; 95% CI - 50.55 to - 19.08; P < 0.0001), number of fluoroscopic (WMD = - 18.24; 95% CI - 30.63 to - 5.85; P = 0.004), accuracy of pedicle screw position: Grade A (OR = 3.16; 95% CI 2.36-4.23; P < 0.00001), Grade B (OR = 0.39; 95% CI 0.28-0.54; P < 0.00001), Grade C (OR = 0.27; 95% CI 0.13-0.54; P = 0.0002), and Grade D (OR = 0.17; 95% CI 0.03-0.98; P = 0.05), FJV: Grade 0 (OR = 3.27; 95% CI 1.34-8.02; P = 0.010), Grade 1 (OR = 0.24; 95% CI 0.16-0.38; P < 0.00001), Grade 2 (OR = 0.24; 95% CI 0.12-0.51; P = 0.0002), and Grade 3 (OR = 0.26; 95% CI 0.07-0.93; P = 0.04). But no significant differences in VAS score, ODI, JOA score, clinical efficacy, hospital stays, and complications. These results demonstrate a significant improvement in the intraoperative course of the RA technique. However, RA-MIS-TLIF has not yet demonstrated significant advantages in terms of postoperative symptom relief and functional improvement. Future research and clinical practice should further explore the efficacy of this technique to optimize outcomes and quality of life for patients with DLSD. The study was registered in the PROSPERO (CRD42023454405).

摘要

机器人辅助(RA)技术已广泛应用于脊柱外科。本分析旨在比较 RA 微创经椎间孔腰椎体间融合术(MIS-TLIF)和透视辅助(FA)MIS-TLIF 治疗退行性腰椎脊柱疾病(DLSD)的有效性和安全性。系统检索了 PubMed、Web of Science、Cochrane 图书馆和中国国家知识基础设施数据库,并将手术参数[手术时间、失血量、透视次数、椎弓根螺钉位置准确性、上关节突侵犯(FJV)]和临床指标[视觉模拟评分(VAS)、Oswestry 残疾指数(ODI)、日本矫形协会(JOA)评分、临床疗效、住院时间、并发症]纳入研究。共纳入 11 篇文章,涉及 1066 例患者。RA 组在手术时间(WMD=-6.59;95%CI-12.79 至-0.40;P=0.04)、失血量(WMD=-34.81;95%CI-50.55 至-19.08;P<0.0001)、透视次数(WMD=-18.24;95%CI-30.63 至-5.85;P=0.004)、椎弓根螺钉位置准确性方面优于 FA 组:A 级(OR=3.16;95%CI 2.36-4.23;P<0.00001)、B 级(OR=0.39;95%CI 0.28-0.54;P<0.00001)、C 级(OR=0.27;95%CI 0.13-0.54;P=0.0002)和 D 级(OR=0.17;95%CI 0.03-0.98;P=0.05)、FJV:0 级(OR=3.27;95%CI 1.34-8.02;P=0.010)、1 级(OR=0.24;95%CI 0.16-0.38;P<0.00001)、2 级(OR=0.24;95%CI 0.12-0.51;P=0.0002)和 3 级(OR=0.26;95%CI 0.07-0.93;P=0.04)方面也有更好的结果。但在 VAS 评分、ODI、JOA 评分、临床疗效、住院时间和并发症方面无显著差异。这些结果表明 RA 技术在手术过程中有显著改善。然而,RA-MIS-TLIF 在术后症状缓解和功能改善方面尚未显示出明显优势。未来的研究和临床实践应进一步探索该技术的疗效,以优化退行性腰椎脊柱疾病患者的治疗效果和生活质量。本研究已在 PROSPERO(CRD42023454405)注册。

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