基于5G技术的机器人辅助远程胸腰椎内固定手术的应用效果  

Effectiveness of 5G-based robot-assisted remote thoracolumbar internal fixation surgery

作　　者：何达 张琦 赵经纬 范明星 刘波 蒋协远 He Da;Zhang Qi;Zhao Jingwei;Fan Mingxing;Liu Bo;Jiang Xieyuan(Department of Spine Surgery,Beijing Jishuitan Hospital,Capital Medical University(National Center for Orthopaedics),Beijing 100035,China;Research Unit of Intelligent Orthopaedics,Chinese Academy of Medical Sciences,Beijing 100035,China;Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co.,Ltd,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院(国家骨科医学中心)脊柱外科,北京100035 [2]中国医学科学院智能骨科创新单元,北京100035 [3]北京积水潭骨科机器人工程研究中心有限公司,北京100035

出　　处：《中华骨科杂志》2024年第15期995-1001,共7页Chinese Journal of Orthopaedics

基　　金：首都卫生发展科研专项项目(首发2024-2-2076);中国医学科学院医学与健康科技创新工程项目(2021-I2M-5-007);骨科手术机器人北京市工程研究中心骨科手术机器人临床应用研究项目(2023OSR-GCZX202202)。

摘　　要：目的评估基于5G技术的机器人辅助远程胸腰椎内固定手术的应用效果,探讨该技术在临床应用中的可行性和优缺点。方法采用回顾性病例系列研究,研究对象为2021年4至12月接受机器人辅助远程胸腰椎内固定手术的61例患者。采用以北京积水潭医院为中心构建的骨科机器人远程手术系统,并应用5G移动通信技术进行网络传输,操控异地的骨科手术机器人辅助完成螺钉置入。共有10家医院参与了远程手术,远程操作中心与手术现场的平均距离为1617 km/例,最远距离超过3000 km。采用Gertzbein-Robbins分级标准评估椎弓根螺钉置入的准确性,通过分析螺钉位置的优秀率与临床可接受率、术中通信、并发症等指标评价手术效果,并与参与医院完成的本地机器人辅助胸腰椎内固定手术进行对照分析。结果所有患者的远程手术均顺利完成,手术时间为(92±32)min,共置入354枚胸腰椎椎弓根螺钉,螺钉位置的优秀率为89.8%,临床可接受率为97.5%。61例患者均获得随访,随访时间(18.9±1.9)个月(范围16~24个月)。术前疼痛视觉模拟评分(visual analogue scale,VAS)评分为(5.74±1.30)分,出院时改善至(2.30±0.90)分,差异有统计学意义(t=11.002,P<0.001)。6例胸腰椎退行性疾病患者术后跛行及疼痛症状均明显缓解。55例胸腰椎骨折患者术前伤椎前缘高度比为62.78%±12.60%,术后恢复至85.36%±8.35%,差异有统计学意义(t=16.977,P<0.001)。末次随访时骨折均愈合。围手术期未出现血管、神经损伤或感染等并发症,无机器人使用相关的并发症。5G网络确保了手术过程中机器人控制信号、图像和音频信号的稳定传输,未观察到信号延迟或通信故障。参与医院1(汕头新圣骨科医院)远程与本地机器人辅助手术螺钉位置的优秀率(90.2%和93.8%,χ^(2)=0.169,P=0.681)和临床可接受率(99.0%和100.0%,P=1.000)相似,参与医院2(贵州省人民医院)远程与本地机器ObjectiveTo assess the effectiveness and viability of 5G-enabled robot-assisted thoracolumbar internal fixation surgery,scrutinizing its benefits and potential limitations in a clinical setting.MethodsThis retrospective case series study analyzed 61 patients who underwent robot-assisted remote thoracolumbar internal fixation surgery between April and December 2021.The orthopaedic robotic telesurgery system,centered at Beijing Jishuitan Hospital and utilizing 5G technology for network transmission,was used to assist in screw placement.The surgeries,distributed across ten hospitals and executed over an average distance of 1617 km(maximum exceeding 3000 km),were appraised by examining the accuracy of screw placement,intraoperative communication efficacy,complication rates,among other metrics,and benchmarked against traditional local procedures.ResultsTelesurgery was completed successfully in all patients,averaging 92±32 minutes per operation.Out of 354 screws placed,89.8%were positioned perfectly and 97.5%were deemed clinically acceptable.The 61 patients,followed-up for an average of 18.9±1.9 months,exhibited significant postoperative improvement in pain.The preoperative visual analogue scale(VAS)pain score was 5.74±1.30 and improved to 2.30±0.90 at discharge,a statistically significant difference(t=11.002,P<0.001).6 patients with thoracolumbar degenerative spine disease showed significant relief of claudication and pain symptoms postoperatively.55 patients with thoracolumbar spine fractures had a preoperative height ratio of 62.78%±12.60%at the anterior margin of the injured vertebrae,which recovered to 85.36%±8.35%postoperatively,a statistically significant difference(t=16.977,P<0.001).All fractures were healed at final follow-up.No perioperative complications,such as vascular or nerve injuries or infections,occurred.Additionally,there were no complications related to the use of the robot.The 5G network ensured stable transmission of robotic control signals,images,and audio signals during the procedure,with

关 键 词：胸椎 腰椎 机器人手术 椎弓根钉 远程手术 第五代移动通信技术 

分 类 号：R687.3[医药卫生—骨科学]