机器人辅助股骨干骨折复位

Robotic assisted femoral shaft fracture reduction

背景:机器人的机械手具有精确的空间定位以及重复运动轨迹的能力,机械手辅助股骨干骨折复位带来的将是一种一次性,轻柔的,精确调节的,全新的精确复位过程,这种复位过程可以使骨折复位所导致的全身和局部反应降到最低,理论上是一种真正的微创的骨折复位。目的:介绍一种机器人辅助股骨骨折复位系统以及初步实验结果。方法:实验在德国汉诺威医学院完成。将不带软组织的成人正常股骨标本近端、远端以及机械臂上分别固定有3个红外线珠子的动态追踪标志DRB,Y型DRB牢固安装在近侧股骨,T型DRB牢固安装在远侧股骨,SMSDRB固定在机械臂上。卸下DRB,在Zwick/Roell机器上通过三点折弯造成股骨骨折,骨折区域3D透视成像,利用导航系统虚拟真实骨折断端的图像,通过机械手带动骨折远端进行主-仆型的机械手骨折复位。观察骨折断端的侧方移位误差,外翻/内翻成角误差,旋转误差。结果与结论:与传统的骨折复位比较,这种机器人辅助骨折复位系统运行良好,对简单骨折复位效果满意,平均复位时间4min34s,侧方移位平均误差1.61mm,外翻/内翻成角平均误差1.09°,前/后成角平均误差1.42°,内/外旋转平均误差1.37°;由于复杂骨折主折块间不能直接对合,复位结果稍差,但是即便是非常复杂的骨折,旋转误差还是在4°以下。提示此种机器人辅助骨折复位系统运行良好,复位结果满意,有望形成一个标准的完整的机器人骨折复位解决平台。

BACKGROUND：Robot-assisted surgery is the future of femoral fracture treatment.It coud create a real minimally invasive fracture manipulation,which is the one-time,single-way,fine-tune gentle reduction.It can greatly decrease the systemic and local damage of fracture manipulation. OBJECTIVE：To report a new system of robot-assisted surgery for femoral fracture and the preliminary experimental results. METHODS：The study was accomplished in Hannvoer Medical University in Germany.Human femoral cadavers and navigation system and St？ubli RX 90CR robot system were employed,dynamic reference bases（DRB）was mounted on the distal and proximal femur and the robotic arm as well to record the initial spatial relative relationship.The femur was fractured by Zwick/Roell machine,the 3D fluoroscopy imaging of the fracture area was created by three-dimensional fluoroscopy,and the fracture fragments were visualized on the screen,with the navigation system,the fracture was reduced by the robot arm based on the visual reality.The accuracy of the reduction result in terms of lateral displacement and angulation and malrotation were measured. RESULTS AND CONCLUSION：This robot-assisted fracture reduction system worked well.In simple fracture,the reduction time was 4 minutes and 34 seconds on the average,the mean lateral displacement was 1.61 mm,the mean angle error was 1.42°,and the rotation error was 1.37°.The rotation error was still below 4° for complex fractures.This solution of robotic fracture reduction is promising.It seems to be a universal platform in the research of robotic fracture treatment.