可穿戴混合现实全息影像技术指导经颅穿刺置管的初步研究

Intracranial catheter insertion guided by wearable mixed reality holograms: A preliminary study

目的初步探讨可穿戴混合现实全息影像指导经颅穿刺置管的可行性和可靠性。方法前瞻性连续纳入2017年7月至2018年1月在首都医科大学宣武医院神经外科需要急诊行经颅穿刺置管的25例患者为试验组(A组;脑室穿刺18例、血肿穿刺6例、脑脓肿穿刺1例)。回顾性连续纳入同一术者于2017年2月至7月已急诊行穿刺引流的25例患者为对照组(B组;脑室穿刺20例、血肿穿刺4例、脓肿穿刺1例)。A组根据术前计划所得穿刺深度和方向,在头戴式混合现实全息影像技术指导下完成穿刺引流操作,B组采取传统定位方法完成穿刺引流。比较两组的穿刺总花费时间、穿刺次数及靶点偏移距离的差异。结果A组患者全部实现了全息影像指导穿刺置管,穿刺平均总花费时间为(63.2±10.6)min,比B组的(24.7±18.4)min增加(38.1±12.5)min。A组平均穿刺次数为(1.2±0.2)次,B组为(2.8±0.8)次;A组的平均目标靶点偏差为(4.5±1.7)mm,B组为(13.5±5.9)mm,上述指标差异均有统计学意义(均P<0.01)。A组患者无一例发生与全息影像指导经颅穿刺置管相关的不良事件,B组患者穿刺后CT发现2例(8.0%)穿刺道血肿。结论可穿戴混合现实全息影像技术指导经颅穿刺置管安全、可靠,有待于进一步降低操作时间。

Objective To preliminarily evaluate the feasibility and reliability of wearable mixed reality holograms in guiding the intracranial catheter insertion. Methods A total of 25 consecutive patients undergoing emergent intracranial catheter insertion at Department of Neurosurgery, Xuanwu Hospital, Capital Medical University between July 2017 and January 2018 were prospectively enrolled into Group A (18 external ventricular drain, 6 intracranial hematoma aspiration and 1 brain abscess puncture). Other 25 consecutive patients who underwent the same operation between February 2017 and July 2017 were retrospectively enrolled into Group B (20 external ventricular drain, 4 intracranial hematoma aspiration and 1 brain abscess puncture). According to the planned depth and trajectory orientation, catheter insertion under the three-dimensional holographic guidance of a head-mounted device was applied in Group A. Group B underwent the operation based on the classical localizing method. Total operation time, number of insertions and target deviation distance were compared between the 2 groups. Results All patients in Group A achieved holographic guided catheter insertion with an average operation time of 63.2±10.6 min, which was 38.1 ± 12.5 min longer than that in Group B. The mean number of insertions was 1.2 ± 0.2 in Group A and 2.8 ± 0.8 in Group B. The average target deviation in Group A was 4.5 ± 1.7 mm and 13.5 ± 5.9 mm in Group B. Those differences were all statistically significant (P<0.01). None of the patients in Group A had adverse events associated with transcranial puncture catheterization with wearable mixed reality holographic guidance, and 2 (8%) cases of puncture tract hematoma were found after puncture in Group B patients. Conclusion This study has preliminarily verified the feasibility and reliability of wearable mixed reality holographic guidance technique for the procedure of intracranial catheter insertion. Further reduction of its operation time is expected.