机器人/导航辅助下椎弓根螺钉植入在脊柱畸形矫正中的应用  

Robotics/navigation-assisted pedicle screw implantation in spinal deformity correction surgery

作　　者：刘新宇[1] 李冬来 赵文龙 王政 李超[1] 王连雷 原所茂[1] 田永昊[1] LIU Xinyu;LI Donglai;ZHAO Wenlong;WANG Zheng;LI Chao;WANG Lianlei;YUAN Suomao;TIAN Yonghao(Department of Orthopedics,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Orthopedics,The Third Hospital of Jinan,Jinan 250132,Shandong,China)

机构地区：[1]山东大学齐鲁医院骨科,山东济南250012 [2]济南市第三人民医院骨科,山东济南250132

出　　处：《山东大学学报（医学版）》2023年第3期21-28,共8页Journal of Shandong University:Health Sciences

基　　金：国家自然科学基金(81874022,82172483,82102522)。

摘　　要：手术机器人和导航系统是技术进步的成果,为脊柱外科的精准置钉带来了新的机遇。脊柱区解剖复杂,与许多重要的血管、神经毗邻,椎体旋转和变异、椎弓根狭窄、脊柱侧后凸等一系列的脊柱畸形对脊柱手术操作的精确度提出了更高的要求。传统脊柱手术十分依赖于术者的经验和术中判断,不能监测螺钉植入过程,所以螺钉误置率较高;机器人和导航系统在手术过程中可以提供实时的三维影像,协助脊柱外科医生及时调整螺钉位置和方向,提高了置钉的安全性和准确性,减小手术创伤和辐射暴露。然而,前期设备投入成本高昂、外科医生的学习曲线漫长以及患者的辐射暴露较多等问题仍然不可忽视。尽管远期矫形效果缺乏研究以及术中辐射暴露水平的不确定性,但机器人和导航系统已经影响了脊柱畸形矫治手术的方式和发展进程。Surgical robotics and navigation systems are the results of technological advances that start a new approach for accurate insertion of the pedicle screw in spine surgery.The anatomical complexity of the spinal region and its proximity to many important blood vessels and nerves,spinal deformities such as vertebral body rotation and variation,narrow pedicle,kyphosis and scoliosis place higher demands on the accuracy of spine surgery.Free-hand placement of pedicle screws relies heavily on operators'experience and intraoperative judgment,but does not allow surgeons to monitor the process of insertion.As a result,the misplacement rate is high.The robotic and navigation systems can provide real-time,three-dimensional images during the operation.Thus,they can assist surgeons in adjusting screws promptly,improving the safety and accuracy of the operation and reducing surgical incision and radiation exposure.However,the expensive equipment costs,long learning curve and high radiation exposure for patients cannot be ignored.Despite the lack of research on long-term outcomes and the uncertainty of intraoperative radiation exposure,robotic and navigation systems have influenced the development of spinal deformity correction surgery.

关 键 词：机器人 导航 脊柱畸形 辐射暴露 置钉准确性 

分 类 号：R687.1[医药卫生—骨科学]