框架式并联骨科手术机器人辅助椎弓根螺钉置入

Pedicle screw placement assisted by frame-type parallel orthopedic robot

背景:课题组与上海大学机器人研究所以及上海禾璞医疗科技有限公司共同开发了框架式并联骨科手术机器人,希望为国产骨科手术机器人的发展做出贡献。目的:通过动物腰椎实验测试框架式并联骨科手术机器人辅助腰椎手术的可行性,验证其操作性能及辅助置钉的准确度。方法:将12具山羊腰椎随机分成2组,实验组(6具,60个钉道)使用手术机器人根据三维CT数据规划钉道,并应用框架式并联骨科手术机器人辅助置入克氏针;对照组(6具,60个钉道)由医生根据二维X射线数据手动置入克氏针。记录钉道规划时间、克氏针置入时间、X射线暴露时间。实验结束后采集两组CT影像,依据改良Gertzbein-Robbins分类标准评估置入克氏针的准确性与优良率。结果与结论:(1)实验组钉道规划时间长于对照组(P <0.001),两组间克氏针置入时间及X射线暴露时间比较差异无显著性意义(P> 0.05);(2)标本CT扫描显示,实验组置钉成功率、优良率分别为100%,96.7%,对照组置钉成功率、优良率分别为98.3%,85.0%,实验组置钉优良率明显高于对照组(P <0.05);(3)结果表明,与术中C臂机透视引导徒手置钉相比,应用框架式并联骨科手术机器人进行辅助椎弓根螺钉置钉的准确率更高,可以有效提高手术安全性。

BACKGROUND:Our group,together with the Institute of Robotics of Shanghai University and Shanghai Hepu Medical Technology Co.,Ltd.developed this Frame-type Parallel Orthopedic Robot in the hope of contributing to the development of domestic orthopedic surgical ro bots.OBJECTIVE:To test the feasibility of the frame-type parallel orthopedic robot-assisted lumbar spine surgery by animal lumbar spine experiments and to ve rify its operational performance and the accuracy of the assisted nail placement.METHODS:A total of twelve goat lumbar vertebrae were randomized into two groups.In the experimental group(6 vertebra e,60 nail paths),the screw path was planned acco rding to 3 D CT data using the surgical robot and Kirschner wire placement was assisted by frame-type parallel orthopedic robot.The control group(6 vertebra e,60 nail paths) was manually implanted with Kirschner wire under the 2 D X-ray data.The screw path planning tim e,Kirschner wire placement time and X-ray exposure time were reco rded.CT images of both groups were collected after the expe riment.The accuracy and the excellent and good rate of Kirschner wire placement were assessed according to the modified Gertzbein-Robbins criteria.RESULTS AND CONCLUSION:(1) The screw path planning time of the experimental group was longer than that of the control group(P <0.001).There were no statistically significant differences in Kirschner wire placement time and X-ray exposure time between the experimental group and the control group(P> 0.05).(2) According to the CT scan of the specimens after the expe riment,the success rate and the excellent and good rate of the expe rimental group were 100%and 96.7%,and those of the control group were 98.3% and 85.0%.The excellent and good rate of the experimental group was significantly higher than that of the control group(P <0.05).(3) This demonstrates that frame-type parallel orthopedic robot-guided placement of pedicle screws has a higher accuracy rate compared with intraoperative C-arm fluoroscopy-guided freehand screw placement,which can effectively improve surgical safety.