无框架脊柱导航手术机器人腰椎弓根标准轴位引导置针  

Frameless Spinal Navigation Surgery Robot Guide-wire Placement in the lumbar spine with pedicle standard axis view

作　　者：张春霖[1] 赵玉果[2] 张昌盛[1] 王铮[1] 崔峰[1] 

机构地区：[1]郑州大学第一附属医院骨科,河南省郑州市450052 [2]南阳市中心医院骨科,河南省南阳市473000

出　　处：《中国组织工程研究与临床康复》2010年第35期6466-6470,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：腰椎弓根螺钉内固定具有很好的生物力学效果,是目前脊柱外科常用的技术。各种各样的经椎弓根引导置入方法,包括计算机辅助导航等,均存在一定的失误率,误置会导致严重后果。目的：采用自主研发的无框架脊柱导航手术机器人,在椎弓根标准轴位透视引导下置入导针,以期为临床探索一种精准度更高、操作更为简便的经椎弓根穿刺或置入方法。方法：取6具干燥腰椎体标本（L1~L5）,置针前用CT扫描并三维重建后,测量椎弓根中心轴线与椎体自身矢状面的夹角α,以及它与椎体上终板前后缘连线所在平面的夹角β。术中C臂机透视确定腰椎骨标准正位像后,依据α与β角度将其向目标侧椎弓根旋转,进行椎弓根标准轴位投照,遥操作机器人,令导针沿椎弓根近圆环状投影的中心置入。置针后摄椎体侧位像、轴位像观察导针的位置,并行CT扫描测量针道α及β角。结果与结论：60个椎弓根均成功置入导针,置针后椎体X射线侧位像、轴位像及CT扫描横断面图像显示导针位于椎弓根中心,均未见导针接触或穿破椎弓根骨皮质。提示椎弓根标准轴位投照引导下无框架脊柱导航手术机器人置针,是一种精准度高、可靠安全的新方法,操作简便,并能减少或避免射线暴露。BACKGROUND： Pedicle screw fixation, as a commonly used technique, can provide super bio-mechanical effect. Various guiding methods have been employed including computer aided surgery navigation system （CASNS）. However, none of them can ensure absolute accuracy, and malpositioning may result in disastrous consequence. OBJECTIVE： To perform pedicle guide-wire placement with pedicle standard axis view （PSAV） using Frameless Spinal Navigation Surgery Robot （FSNSR） so as to explore a high accurate and easily tackled transpedicular placement technique. METHODS： A total of 6 human lumbar spines vertebras （L1 to L5） were used. All specimens underwent pre-intervention CT scanning, and the angle （α） between pedicle centre axis and vertebra body sagittal plane （m plane） and the angle （β） between the axis and superior surface of vertebra body （s plane） were measured, respectively. During the operation, a standard posterior-anterior fluoroscopic image of target vertebra was obtained; the PSAV was acquired via C-arm rotation according to α and β; the guide-wire was inserted into the centre of approximate circular projection of pedicle by teleoperating FSNSR. After surgery, each vertebra underwent vertebra body axial and lateral radiographs as well as CT scans to assess guide-wire trajectory and excursion between post/preoperative α and β. RESULTS AND CONCLUSION： A total of 60 guide-wires were successfully inserted. All guide-wires were confirmed in the core of the pedicle by axial and lateral X-ray, as well as CT scanning. None of the guide-wire trajectory was found to contract or perforate the pedicle wall. FSNSR guide-wire placement with PSAV is a novel, safe and accurate transpedicular placement technique, which can reduce or prevent radiation exposure.

关 键 词：导航 置针 脊柱 无框架 机器人 腰椎椎弓根 椎弓根标准轴位 

分 类 号：R318[医药卫生—生物医学工程]