机器人辅助腰神经根穿刺的实验研究  

Research on robot-assisted puncture of lumbar nerve root

作　　者：王乃堃 王然[2] 韩影[2] 孙维维 马超[2] 黄莹[2] 王士冲 何健[3] 骆敏舟 杨孝平 陆丽娟 WANG Nai-kun;WANG Ran;HAN Ying;SUN Weiwei;MA Chao;HUANG Ying;WANG Shi-chong;HE Jian;LUO Min-zhou;YANG Xiao-ping;LU Li-juan(Nanjing Drum Tower Clinical College of Xuzhou Medical University,Nanjing 210008,Jiangsu,China;Department of Pain Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China;Department of Radiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China;Institute of Intelligent Manufacturing Technology,Jiangsu Industrial Technology Research Institute,Nanjing 210042,Jiangsu,China;Nanjing University,Nanjing 210093,Jiangsu,China)

机构地区：[1]徐州医科大学鼓楼临床学院,江苏南京210008 [2]南京大学医学院附属鼓楼医院疼痛科,江苏南京210008 [3]南京大学医学院附属鼓楼医院影像科,江苏南京210008 [4]江苏省产业技术研究院智能制造技术研究所,江苏南京210042 [5]南京大学,江苏南京210093

出　　处：《生物医学工程与临床》2020年第4期363-368,共6页Biomedical Engineering and Clinical Medicine

基　　金：江苏省重点研发计划(社会发展)(BE2017603,BE2017675)。

摘　　要：目的探讨基于CT数据的穿刺机器人辅助选择性腰神经根穿刺的精准性及可行性。方法选择6个人体腰椎模型(骨骼材质为石膏,其余为硅胶)。自主研发设计的穿刺机器人(由机械臂、成像设备、空间定位系统及工作站四个部分及相应的软件组成)。采用穿刺机器人或栅格定位器辅助行腰椎双侧L4神经根穿刺。根据辅助方式不同分为实验组及对照组。实验组由6名无穿刺经验的研究生采用穿刺机器人辅助穿刺,对照组由3名不同年资的医师采用栅格定位器辅助穿刺。根据医师穿刺经验差异,对照组分为3个亚组:C1组为低年资(穿刺经验2年)医师,C2组为中年资(穿刺经验8年)医师,C3组为高年资(穿刺经验15年)医师。实验组及对照组对6个模型每侧神经根进行5次穿刺操作,每次穿刺后CT扫描验证,没有到位时需重新调整穿刺,直至到达目标位置。比较实验组与对照组的操作时间、到达目标所需要的穿刺次数及一次穿次成功率。结果实验组与C1组、C2组相比,操作时间缩短[(503.75±93.68)s vs(590.52±102.09)s、(545.28±103.97)s](P<0.05),穿刺次数减少(P<0.05),一次穿刺成功率提高(93.33%vs 16.67%、41.67%)(P<0.0001);实验组与C3组相比,穿刺次数减少(P<0.05),一次穿刺成功率提高(93.33%vs 68.33%)(P<0.0001),操作时间差异无统计学意义(P>0.05)。C2组与C1组相比,操作时间缩短(P<0.05),穿刺次数减少(P<0.05),一次穿刺成功率提高(P<0.01);C3组与C2组相比,操作时间缩短(P<0.05),穿刺次数减少(P<0.05),一次穿刺成功率提高(P<0.01)。随着医师穿刺经验的增加到机器人,一次穿刺成功率呈现上升的趋势。结论机器人辅助选择性腰神经根穿刺可以缩短操作时间、减少穿刺次数、提高一次性穿刺成功率,有助于提升穿刺精准性和穿刺者穿刺水平,具有较高的临床应用价值。Objective To investigate the accuracy and feasibility of CT-based robot-assisted selective lumbar nerve root puncture.Methods A total of 6 human lumbar spine models were selected,and self-developed and designed puncture robot or grid positioner were used to assist bilateral L4 nerve root puncture of lumbar spine.The bilateral L4 nerve roots of 6 human lumbar spine models were punctured and divided into experimental group and control group according to different auxiliary methods.The experimental group was used robot-assisted puncture by 6 graduate students without puncture experience,and control group was used grid locator-assisted puncture by 3 doctors with different experiences.According to difference puncture experience level,the control group was divided into 3 subgroups:C1 was low-seniority(puncture experience 2-year)group,C2 was median-seniority(puncture experience 8-year)group and C3 was high-seniority(puncture experience 15-year)group.The experimental group and control subgroup performed 5 puncture operations on each nerve root of 6 models.The CT scan was verified after each puncture,and readjusted puncture until reached target position.The operation time,target puncture numbers and one-time success rate were compared between experimental group and control group.Results Compared with C1 group and C2 group,operation time of experimental group was shortened[(503.75±93.68)seconds vs(590.52±102.09)seconds,(545.28±103.97)seconds](P<0.05),and puncture numbers was decreased(P<0.05),The success rate of one-time puncture was increased(93.33%vs 16.67%,41.67%)(P<0.0001).Compared with C3 group,puncture numbers was reduced in experimental group(P<0.05),and one-time success rate was increased(93.33%vs 68.33%)(P<0.0001),and there was no statistically significant difference in operation time(P>0.05).Compared with C1 group,operation time of C2 group was shortened(P<0.05),puncture number was reduced(P<0.05),and one-time success rate was increased(P<0.01).Compared with C2 group,operation time of C3 group was shortened(P<

关 键 词：机器人 栅格定位器 腰神经根 腰椎穿刺 辅助穿刺 

分 类 号：R318.6[医药卫生—生物医学工程] R614[医药卫生—基础医学]