国产全膝关节置换术辅助机器人系统的尸体实验研究  

A cadaveric experimental study on domestic robot-assisted total knee arthroplasty

作　　者：柴伟 谢杰[2] 张晓岗[3] 何川[4] 延廷芳 刘立 张瑗 周宗科[7] 胡懿郃[2] 曹力[3] 陈继营 唐佩福 CHAI Wei;XIE Jie;ZHANG Xiaogang;HE Chuan;YAN Tingfang;LIU Li;ZHANG Yuan;ZHOU Zongke;HU Yihe;CAO Li;CHEN Jiying;TANG Peifu(Department of Orthopedics,the First Medical Center of Chinese PLA General Hospital,Beijing,100853,P.R.China;Department of Orthopedics,Xiangya Hospital Central South University,Changsha Hunan,410008,P.R.China;Department of Orthopedics,First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang,830011,P.R.China;Department of Orthopedics,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200025,P.R.China;Yuanhua Technology Limited,Shenzhen Guangdong,518000,P.R.China;Department of Orthopedics,Xinqiao Hospital,Affiliated Hospital of Army Medical University,Chongqing,400037,P.R.China;Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]中国人民解放军总医院第一医学中心骨科,北京100853 [2]中南大学湘雅医院骨科,长沙410008 [3]新疆医科大学第一附属医院关节外科,乌鲁木齐830011 [4]上海交通大学医学院附属瑞金医院骨科,上海200025 [5]元化智能科技(深圳)有限公司,广东深圳518000 [6]陆军军医大学附属新桥医院骨科,重庆400037 [7]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2021年第4期409-413,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：北京市自然科学基金-海淀原始创新联合基金资助项目(L182063);解放军总医院医疗大数据及人工智能研发项目(2019MBD-041);陆军军医大学临床医学创新技术项目(2018JSLC0035);重庆市技术创新与应用示范项目(CTSC2018jscx-msybX0051)。

摘　　要：目的通过尸体实验验证骨圣元化全膝关节置换术辅助系统(YUANHUA-TKA)的操作性能、精准性及安全性,以进一步优化系统,为其临床应用提供依据。方法6具单侧成年下肢尸体标本,实验前行CT三维扫描,然后使用YUANHUA-TKA系统术前软件进行分割,获取股骨及胫骨三维模型,从而规划假体植入物型号以及截骨量和截骨角度[包括下肢力线角(hip-knee-ankle angle,HKA)以及冠状面股骨组件角(frontal femoral component,FFC)和胫骨组件角(frontal tibia component,FTC)],其中将HKA理想值设为180°,冠状面FFC和FTC理想值设为90°。实验者可在截骨前根据术中情况进一步确认截骨计划,然后在YUANHUA-TKA系统辅助下完成各平面截骨后,安装假体。最后摄下肢标本髋关节、膝关节、踝关节正位X线片并拼接为下肢全长X线片,测量HKA、FFC和FTC。结果实验过程中YUANHUA-TKA系统运行稳定。术中观察股骨和胫骨各个截面平整,未出现韧带损伤等问题。术后实测值HKA为177.1°~179.7°,FFC为87.9°~91.4°,FTC为87.3°~91.4°,与术前规划的理想值比较,误差均在±3°之内。结论YUANHUA-TKA系统能辅助术者按照术前规划进行精准截骨,对全膝关节置换术有良好辅助作用。Objective To simulate and validate the performance, accuracy, and safety of the Yuanhua roboticassisted total knee arthroplasty system(YUANHUA-TKA) through cadaver-based experiment, thus optimizing the robotic system for the future human clinical application. Methods Six unilateral adult cadaver specimens of the lower limbs were scanned by three-dimensional CT before the experiment, and then the three-dimensional models of femur and tibia were obtained by using the preoperative software of YUANHUA-TKA system, so as to plan the type of prosthesis implant, the osteotomy volume and osteotomy angles [hip-knee-ankle angle(HKA), coronal frontal femoral component(FFC) and frontal tibial component(FTC)], the ideal value of HKA was set to 180°, and of FFC and FTC were set to 90°,respectively. The operator could further confirm the osteotomy plan according to the intraoperative situation before osteotomy, and then install the prosthesis after completing the osteotomy in each plane with the assistance of YUANHUA-TKA system. At last, the X-ray films of hip joint, knee joint, and ankle joint were taken and stitched into the full length X-ray film of the lower limb, and HKA, coronal FFC and FTC were measured. Results During the experiment, YUANHUA-TKA system ran stably. All sections of femur and tibia were smooth and no ligament injury was found. After operation, the HKA was 177.1°-179.7°, FFC was 87.9°-91.4°, and FTC was 87.3°-91.4°, which were within ±3°from the ideal values of preoperative planning. Conclusion The YUANHUA-TKA system can assist the surgeon to carry out precise osteotomy according to the preoperative planned value, which has a good auxiliary effect for total knee arthroplasty. It is expected to assist joint surgeons to improve the surgical accuracy in clinical application.

关 键 词：全膝关节置换术 手术机器人 尸体实验 

分 类 号：R687.4[医药卫生—骨科学]