骨科机器人辅助颈椎椎弓根螺钉内固定  

Robot-assisted cervical pedicle screw fixation

作　　者：何达 郎昭 He Da;Lang Zhao(Department of Spine Surgery,Beijing Jishuitan Hospital,Capital Medical University(National Center for Orthopaedics),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

出　　处：《中华骨科杂志》2024年第15期1056-1060,共5页Chinese Journal of Orthopaedics

摘　　要：颈椎椎弓根螺钉内固定系统具有良好的生物力学性能,在颈椎矫形及融合手术中发挥着重要作用。但颈椎区域解剖结构的复杂性导致了较高的手术风险,主要包括椎动脉、神经根和脊髓不同程度的损伤。骨科机器人辅助颈椎椎弓根螺钉内固定技术是一种创新的外科手术技术,其工作原理主要包括空间映射、图像配准以及规划执行,从而使机器人可以完成从图像处理、螺钉轨迹规划到机械臂运动控制的整个过程。既往研究表明使用骨科机器人辅助可以提高颈椎手术的准确性和安全性。机器人辅助颈椎椎弓根螺钉内固定手术的适应证包括需要颈椎稳定性重建及畸形矫正的病例。禁忌证主要包括颈椎后部结构感染、外伤或肿瘤导致的椎弓根和椎体损伤,以及椎弓根缺如、椎弓根直径过细等解剖结构异常。术前需要根据X线及椎体断层CT等影像学资料进行手术规划,确定内固定范围,并识别异常解剖结构。根据手术需要及软组织张力选择常规正中切口或双侧经皮切口。准确注册及图像获取后,在机器人工作站上进行螺钉规划;然后在机器人引导下放置套管,并置入导针及螺钉。操作时应时刻关注机械臂的精确性问题,遇到定位偏差较大时不能盲目操作,需仔细查找原因。骨科机器人辅助颈椎椎弓根螺钉内固定技术具有准确性、稳定性和可重复性高的优势,可以克服传统手术的局限性,提高手术效果。The cervical pedicle screw fixation system is distinguished for its biomechanical stability,playing an essential role in corrective and fusion surgeries of the cervical spine.Nevertheless,the complex anatomy of the cervical region increases surgical risks,primarily the potential injury to vertebral arteries,nerve roots,and the spinal cord.Robot-assisted technology in cervical pedicle screw fixation emerges as an innovative technique,encompassing spatial mapping,image registration,and execution planning.These processes enable the robot to oversee the entire procedure from image analysis and trajectory planning of screws to robotic arm movement control.Current research underscores that robot assistance enhances precision and safety in cervical spine surgeries.Indications for such robot-assisted surgeries extend to stability reconstruction and deformity correction within the cervical spine.Conversely,contraindications include infections in posterior cervical structures,trauma-induced or tumor-related injuries to the pedicle and vertebral body,and anatomical anomalies such as absent or very narrow pedicles.X-ray and CT imaging are essential preoperative steps to ascertain the fixation level and identify atypical anatomical structures.Depending on the disease and soft tissue tension,either a conventional midline incision or bilateral percutaneous incisions can be chosen.Following image acquisition and registration,the workstation facilitates screw planning.Under robotic guidance,insertion of the sleeve proceeds,followed by guide pins and screws placement.During the operation,constant attention should be paid to the precision of the robotic arm.In cases of significant positional deviation,operations should be stopped,and the causes should be carefully investigated.Robot-assisted cervical pedicle screw fixation is distinguished by its precision,stability,and reproducibility,surpassing the limitations of conventional surgery and bolstering surgical outcomes.As a novel application in spinal surgery robotics,this technolog

关 键 词：颈椎 机器人手术 椎弓根钉 教育 医学 继续 

分 类 号：R687.3[医药卫生—骨科学]