基于数据包络分析的股骨颈手术机器人导航系统临床有效性分析

Efficiency evaluation of a robotic navigation system for femoral neck surgery in clinical trials by data envelopment analysis

目的利用数据包络分析法(data envelopment analysis,DEA)对已开发的机器人导航系统在股骨颈空心钉内固定手术中的临床有效性进行评估,为定量评估机器人导航系统的临床效率提供支持。方法该机器人导航系统利用双平面定位算法,根据两张术中透视图像计算手术路径的空间位置和方向,并应用一种新型的串并混联结构的机器人引导医生沿着计算好的手术路径完成手术操作。有机器人系统辅助和没有机器人系统辅助的临床手术被建模成决策单元(decision making units,DMU),其中应用机器人导航系统辅助的手术病例25例作为实验组,传统方式完成的25例病例作为对照组。选取C^2R模型进行DEA有效性的计算,采用对偶规划模型中的效率指数V作为判断DMU是否DEA有效的标准,V=1则DEA有效,V<1则非DEA有效。结果机器人辅助手术的效率指数V计算结果是1,传统手术的结果是0.986 338 8。依据DEA模型定义证明有机器人辅助的手术相对高效。结论基于DEA的评估证明此机器人导航系统确实可以提高临床手术效率。

Objective A robotic navigation system for cannulated screw fixation of femoral neck fracture has been developed and applied in clinical trials.A data envelopment analysis （DEA） based method has been proposed and implemented to evaluate the efficiency of this system.It can provide a support for the clinical efficiency in the quantitative evaluation of the robotic navigation system.Methods The robotic navigation system used bi-planar algorithm to calculate the spatial position and orientation of the operation path from two intraoperative fluoroscopy images.The system also used a novel serial-parallel structured robot to navigate the surgeons to operate following the calculated operation path.Femoral neck surgeries with and without the robotic system were modeled as DMUs.Totally 25 clinical trials which had been done with the assistance of the robotic navigation system were chosen as experiment group,and another 25 cases which had been done in traditional ways were chosen as control group.C2R model was chosen to calculate the DEA efficiency.Efficiency index V in dual program model was used as the criteria to judge whether the DMU was DEA efficient.If V =1,the DMU was DEA efficient,if V ＜ 1,the DMU was non-DEA efficient.Results The efficiency index of robot assisted surgery was 1,and the efficiency index of traditional surgery was 0.9863388.According to the definition of DEA model,this result proved the high efficienoy of the robotic system.Conclusions The DEA-based evaluation proved that this robotic navigation system could indeed improve clinical efficiency.