机器人辅助TESSYS治疗腰椎间盘突出症的回顾性研究

Robot-assisted transforaminal endoscopic surgery for Transforaminal Endoscopic Spinal System（YESSYS）in patients with lumbar disc herniation: a retrospective study.

摘要:

目的:本研究旨在探讨骨科机器人辅助经椎间孔脊柱内镜系统(TESSYS)治疗腰椎间盘突出症的安全性及临床效果。方法:对北京市中关村医院收治的腰椎间盘突出症患者进行回顾性分析,选取C臂组(2022年6月至2023年12月,共48例)以及TiRobot组(2023年1月至2023年6月,共50例),总计98例患者作为研究对象。记录两组患者的定位时间、穿刺次数、建立工作通道时间、手术操作时间、术中出血量,以及术前和术后1个月、3个月、6个月、12个月的视觉模拟评分法(VAS)评分和Oswestry功能障碍指数(ODI)。末次随访采用改良MacNab标准评估手术疗效,记录并发症。运用SPSS 26软件对所有数据进行统计分析。结果:本研究对98例患者进行随访,随访时间均超过12个月,两组患者均顺利完成手术。TiRobot组定位时间长于C臂组,穿刺次数少于C臂组,建立工作通道时间短于C臂组,术中出血量少于C臂组,差异具有统计学意义(P＜0.05)。两组患者术后1个月、3个月、6个月、12个月的VAS评分、ODI评分与术前相比均显著降低(P＜0.05)。两组术后3个月、6个月、12个月的VAS评分、ODI评分较术后1个月显著降低(P＜0.05)。术后1个月、3个月、6个月,TiRobot组的VAS评分、ODI评分显著低于C臂组(P＜0.05)。末次随访时改良MacNab评分结果显示:TiRobot组优良率为94.0%；C臂组优良率为91.7%,两组差异无统计学意义(P＞0.05)。并发症发生率方面,两组术后随访12个月均未出现感染、血肿等并发症。TiRobot组并发症发生率为2%(复发1例),C臂组并发症发生率为6%(复发2例,神经鞘膜撕裂1例)。结论:机器人辅助技术可进一步提高TESSYS的精准度与安全性，加速患者早中期康复，并保障远期疗效稳定，为脊柱内镜技术向智能化、精准化、微创化方向发展奠定了基础。

Abstract:

Objective:This study aimed to assess the safety and clinical effectiveness of robot-assisted transforaminal endoscopic spine surgery (TESSYS) in treating lumbar disc herniation. Methods:A retrospective cohort study was conducted involving 98 patients with lumbar disc herniation who were admitted to Zhongguancun Hospital in Beijing. Participants were divided into two groups: the C-arm group (n = 48), treated from June 2022 to December 2023, and the TiRobot group (n = 50), treated from January 2023 to June 2023. Key metrics measured included positioning time, number of puncture attempts, time to establish the working channel, operation duration, intraoperative blood loss, and pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at 1, 3, 6, and 12 months. Surgical outcomes were evaluated using the modified MacNab criteria at the final follow-up, and any postoperative complications were recorded. Data analysis was performed using SPSS version 26. Results: All 98 patients completed at least 12 months of follow-up without any intraoperative failures. Compared to the C-arm group, the TiRobot group required significantly more time for positioning (P < 0.05) but achieved fewer puncture attempts, a faster establishment of the working channel, and reduced blood loss (P < 0.05). Both groups demonstrated significant postoperative reductions in VAS and ODI scores at all follow-up points compared to baseline (P < 0.05), with further improvements seen between the 1-month assessment and later evaluations (P < 0.05). The TiRobot group showed better pain and functional scores at 1, 3, and 6 months postoperatively (P < 0.05). The final modified MacNab ratings revealed comparable success rates (94.0% for TiRobot vs. 91.7% for C-arm, P > 0.05). No infections or hematomas were reported in either group. The complication rates were 2% (1 recurrence) for the TiRobot group and 6% (2 recurrences, 1 dural tear) for the C-arm group. Conclusion: Robot-assisted technology can further enhance the precision and safety of TESSYS, accelerate early to mid-term patient recovery, and ensure stable long-term outcomes. This lays the foundation for the advancement of spinal endoscopic techniques toward intelligent, precise, and minimally invasive approaches.