国产“天玑”骨科机器人辅助微创椎弓根钉置入的新技术报道

New technology report of minimally invasive pedicle screw placement based on domestic TiRobot system

目的介绍一种基于“天玑”骨科机器人辅助椎弓根置入新技术,评价其安全性及有效性。方法以1例48岁男性外伤致椎体压缩骨折(L 2)为例,介绍一种基于术中三维扫描定位的“天玑”骨科机器人辅助“精准”椎弓根钉置入手术。主要包括4个步骤:①患者手术台上俯卧位,采用C型臂X线机环形扫描采集数据;②机器人操作平台规划椎弓根螺钉(利用采集椎体三维数据信息,在操作平台上进行模拟椎弓根钉置入位置、角度及方向);③椎弓根导针置入并验证(按照手术中规划进行椎弓根导针置入、术中X线透视,确认导针进针点及方向);④椎弓根螺钉置入(椎弓根导针位置满意后将椎弓根螺钉依次置入,并最后验证),对手术时间、出血量、术中透视次数、手术并发症进行记录,并对术后影像检查X线透视及CT结果进行分析。结果本次手术共耗时160 min,术中进行1次C型臂X线机环扫、9次X线透视;出血量约为20 ml,无任何手术并发症;术后第2天可以下地行走;术后X线检查及CT提示:椎弓根螺钉置入位置满意。结论国产“天玑”骨科机器人辅助脊柱椎弓根钉置入是一种新的精准、微创的手术方案。

Objective To introduce a new technique of pedicle screw placement based on the TiRobot system and to evaluate its safety and effectiveness.Methods A case of a 48-year-old man with trauma-induced vertebral compression fracture(L2)was used to introduce a orthopedic robot-assisted"precision"pedicle screw placement surgery based on intraoperative three-dimensional scanning and positioning.It mainly includes 4 steps:①C-arm ring scan during the operation(data of vertebral segments were acquired through C-arm ring scan with the patient prone position on the operation table);②Robotic operation platform planning for pedicle screws(using the 3D data of the vertebral segments,the surgeon simulate the pedicle screw placement position,angle and direction on the operating platform);③Pedicle guide needle placement and verification(performing the pedicle guide needle placement based on planning,and performing intraoperative fluoroscopy to confirm the point and direction of the guide needle entry);④Pedicle screw placement(if the pedicle guide needle is in a satisfactory position,the pedicle screw is inserted and verified with C-arm).The operation time,blood loss volume,intraoperative fluoroscopy times and surgical complications were recorded,and the results of postoperative imaging examination(X-ray and CT)were analyzed.Results The operation took 160 minutes.One C-arm ring scan and nine fluoroscopies were performed during the operation.The blood loss volume was about 20 ml without any surgical complications;the patient could walk on the second day after the operation;postoperative X-ray and CT showed that the positions of all pedicle screws were satisfactory.Conclusion Spinal pedicle screw placement based on domestic TiRobot system is a new precise and minimally invasive surgical solution.