机构地区:[1]第三军医大学新桥医院骨科,重庆400037 [2]中国科学院沈阳自动化研究所,机器人学国家重点实验室,沈阳110015
出 处:《中国矫形外科杂志》2013年第3期275-279,共5页Orthopedic Journal of China
基 金:国家科技支撑计划课题(2012BAI14B02);军队临床高新技术重大项目(2010gxjs072);国家科技支撑计划课题(2012BAI14B02);军队临床高新技术重大项目(2010gxjs072);机器人学国家重点实验室开放课题资助项目(2011-001)
摘 要:[目的]探讨术前计划在脊柱微创手术机器人椎弓根螺钉钻孔中的应用价值,总结应用经验,优化系统的结构设计。[方法]实验牛脊骨标本16具,随机分为两组。术前对实验组牛脊骨标本(8具)拟进钉平面进行横断面CT扫描,测量左右椎弓根螺钉术前计划进钉角度、进钉点与棘突的间距,术中应用C型臂标定牛脊柱标本各个椎体与机械臂钻头的相对位置,应用脊柱微创手术机械人系统按照术前计划进行椎弓根螺钉置入前的钻孔操作。对照组牛脊骨标本(8具)术中直接在C型臂X线透视下应用脊柱微创手术机器人进行椎弓根螺钉的钻孔操作。记录系统连接平均建立时间,每个钻孔平均操作时间,透视次数及累计透视时间。术后行CT扫描,评估两组克氏针的位置情况。[结果]系统连接建立时间平均为(351.7±24.9)s。实验组与对照组每个钻孔操作平均时间为(89.5±6.1)s与(447.5±90.7)s,术中X线平均透视时间为(2.9±0.8)s和(11.5±3.8)s,平均透视累计时间为(2.9±1.0)s和(11.1±3.2)s。各指标差异均存在明显统计学意义(P=0.000,t=-11.143;P=0.000,t=-6.243;P=0.000,t=-7.002)。术后CT评估,实验组克氏针完全位于椎弓根内68枚,手术操作成功率达到85.0%。对照组克氏针完全位于椎弓根内63枚,手术操作成功率达到78.8%。两组准确率差异无明显统计学意义(x2=1.053,P=0.412)。[结论]通过术前计划,应用脊柱微创手术机器人系统进行椎弓根螺钉钻孔操作,手术时间、X线累计透视时间都明显缩短,术前计划在脊柱微创手术机器人椎弓根螺钉钻孔操作中具有重要的临床应用价值。目前脊柱微创手术机器人的研制仍然处于初级阶段,值得进行更加深入的研究完善。[ Objective] To evaluate and investigate the clinical value of the drilling for pedicle screw placement on cattle lumbar spine through preoperative plan by using spinal minimal invasive robot system, summarize the experience, optimize the design of the system. [ Methods ] Sixteen cattle lumbar spines were randomly divided into two groups. Preoperative computed to- mographie (CT) scan of 8 lumbar spines in experimental group (EG) in axial plane were captured for each vertebra from the CT film, the surgeon planed the entry point and trajectory of the screws. Intraoperative fluoroscopic X -rays was used to locate the relative position of the robotic arm and the speeiman. On the basis of preoperative CT scan and introoperative fluoroscopic data, we aligned the robot to the desired entry point and trajectory, as dictated by the surgeon's preoperative plan. The other 8 cattle lumbar spines in contral group (CG) were drilled the pedicle hole in operation under the guidance of introperative C - arm fluoroscopy. Sixteen cattle lumbar spines were inserted 160 K - wires by using the spinal minimal invasive robot system. The time for system registration and pedicle drilling, fluoroscopic times and the radiation exposure time were measured and recorded. Postoperative CT scans were used to assess the position of the K - wires. [ Results ] Assisted by spinal minimal invasive robot system, the av- erage time for system registration was (351.7 ±24. 9) s, the time for procedure of drilling one K - wire in EG and CG was respectively (89. 5 ± 6. 1 ) s and (447.5 ± 90. 7 ) s , fluoroscopic for the procesure was respectively ( 2. 9 ± 0. 8) times and ( 11.5 ± 3.8 ) times, the radiation exposure time was respectively (2. 9 ± 1.0) s and ( 11.1 ± 3.2) s , there were significant difference between the two grom)s (P = 0. 000. t = - 11. 143 : P = 0. 000. t= -6. 243; P =0. 000, t = -7. 002) . Overall, only twelve ( 15.0% ) of the 80 screws in EG violated the pedicle wall. Four screw
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