双平面骨科机器人辅助骶髂关节螺钉置人系统精度测试及尸体应用的研究

Appfication of bi-planar navigation robot system for insertion of sacroiliac screws

目的测试双平面骨科机器人辅助骶髂关节螺钉置入系统的定位精度，探讨应用双平面骨科机器人系统辅助骶髂关节螺钉置入的临床可行性。方法本研究包括系统定位精度实验和尸体应用实验两部分内容。①在导航机器人的底板上固定两根尖克氏针，测量其尖端的坐标真值。应用机器人导航系统得到其坐标的计算值，然后计算测量真值与计算值之间的距离作为系统的定位误差。实验共测量10组数据，得出精度结果。②在原有对4具尸体骨盆标本置入12枚骶髂关节螺钉实验的基础上，对一具新鲜成年男性尸体进行机器人辅助骶髂关节螺钉置入的临床模拟手术，在其一侧S1椎体内置入2枚螺钉。通过透视和CT图像来评价螺钉的置入位置，同时记录手术时间和透视次数，作为临床评价指标。结果通过定位精度实验，本系统的定位精度在2mm以内，可以满足临床应用的需要。术中导针置入位置与规划螺钉位置有极佳的一致性。术后的透视及CT图像显示，2枚骶髂关节螺钉均位于S1“安全区”内。从采集图像完成到螺钉置入的手术操作时间：第一枚螺钉用时10’36″第二枚螺钉用时6’48”。置入2枚螺钉（包括术中和术后验证）共透视11次。结论本系统能够精确而高效地辅助骶髂关节螺钉置入，并且在提供精确导航的同时，大大减少了术中对患者和手术人员的辐射伤害。

Objective To investigate the feasibility and accuracy of applying the bi-planar navigation robot system for insertion of sacroiliac screws. Methods The actual positions of the tips of 2 Kirschner wires fixed on the motherboard of the system were measured. To evaluate the accuracy, the actual positions and the virtual positions adopted by the system were compared in 10 groups of data. Assisted by the bi-planar navigation robot system, 2 sacroiliac screws were inserted to the S1 vertebral body of one fresh mankind cadaver in a simulated surgical setup. The locations of the 2 screws were evaluated on the view of fluoroscopy and CT. The duration of operation and the fluoroscopic times between image acquisition and screw insertion were recorded. Results The discrepancies between the actual positions and the virtual positions were all within 2 mm. The actual positions of the guide-wire and the planning positions of the screw were perfect consistent on the fluoroscopic view. The 2 screws were inserted into the safe area of the S1 vertebrae. The operation duration for the first screw was 10＇36＂, and for the second was 6＇48＂. The fluoroscopic times during the whole operation were 11. Conclusions The bi-planar navigation robot system can provide precise and effective navigation for insertion of sacroiliac screws, decreasing the radiation exposure to the patient and the staff significantly.