俯卧位机器人辅助脊柱外科手术中呼吸运动导致椎体位移评估与测量  

Measurement and evaluation of respiration induced vertebral movement in robot-assisted spine surgery

作　　者：刘亚军[1] 曾成[1] 范明星[1] 赵经纬[1] 吕艳伟[2] 田伟[1] LIU Ya-jun ZENG Cheng FAN Ming-xing ZHAO Jing-wei LV Yan-wei TIAN Wei(Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035 [2]北京积水潭医院临床统计与流行病学研究室,北京100035

出　　处：《临床军医杂志》2016年第10期1015-1018,共4页Clinical Journal of Medical Officers

基　　金：北京市卫生系统高层次卫生技术人才培养计划(215领军人才项目);北京市科技新星计划课题(2007B023);北京市科技计划课题(Z131107002213162);扬帆计划重点医学专业发展计划(ZL2014)

摘　　要：目的探讨俯卧位机器人辅助脊柱外科全麻手术中由呼吸引起的椎体位置改变,为抵消呼吸引起的椎体运动造成的影响及提高机器人手术的精确度提供支持。方法在手术室内,采用光学示踪系统固定于俯卧位全麻患者的背部,以追踪C3、C7、T7、T12、L4及S1椎体的位移。结果根据全周期的高峰值-低峰值计算各节段活动度,T7(2.26 mm)、T12(2.27 mm)以及L4(1.61 mm)的活动度显著高于其余节段。前后方向的活动度显著高于左右及上下的活动度。结论机器人辅助脊柱外科手术中,患者的呼吸运动会造成显著的椎体位移,影响主要集中在下胸段及腰段椎体。现有的机器人系统需要根据对呼吸模式的观察,调整定位时机。Objective To explore the respiration induced spinal body movement during the robot-assisted spine surgery,and to analyze the influence of the movements on the screw placement accuracy. Methods An optical tracker was used to track the motion during the surgery. The tracker was attached on back of patients. The motion changes of C3,C7,T7,T12,L4,and S1 levels were monitored with patients under general anaesthesia. Results Motion was calculated from peak to peak. The average motion on T7（ 2. 26 mm）,T12（ 2. 27 mm） and L4（ 1. 61 mm） was greater than other levels. The motion in anterior and posterior was greater than either superior and inferior or left and right directions. Conclusion Respiration during robot-assisted spine surgery causes significant vertebral body motion. This type of motion is significant in lower thoracic and lumbar segments. The robotic system may need to adjust the time of manipulation according to the specific respiratory pattern of patients.

关 键 词：机器人辅助手术 脊柱外科 呼吸运动 

分 类 号：R687[医药卫生—骨科学]