口腔手术机器人辅助显微根尖手术操作准确性和手术时间的体外模型研究

An in vitro model study of the accuracy and operation time of oral surgery robot-assisted endodontic microsurgery

目的探讨仿真头颅模型上口腔手术机器人辅助显微根尖手术的操作准确性和手术时间,为临床提供参考。方法将3对牙颌模型安装于仿真头颅模型上,每对牙颌模型选择前后牙各10颗,由1位具有3年以上显微根尖手术经验的主治医师分别于自由手、静态导板和口腔手术机器人辅助下完成3组显微根尖手术的定点去骨开窗和根尖切除操作(每种技术使用1对牙颌模型,各20颗牙,共60颗牙),并记录手术时间。术前拍摄锥形束CT,于软件中规划手术路径;术后于模型的手术路径中插入塞规(用以测量孔尺寸的精密量具),并进行口内扫描,评估3组手术操作准确性(起点、终点和角度偏差),并比较手术时间。结果手术机器人组起点偏差、终点偏差和角度偏差[分别为(0.37±0.11)、(0.37±0.10)mm,0.71°±0.17°]均显著小于静态导板组[分别为(0.59±0.14)、(0.65±0.18)mm,2.64°±0.75°](P<0.05),且两组均显著小于自由手组[分别为(1.37±0.31)、(1.10±0.21)mm,9.84°±3.15°](P<0.05)。静态导板组手术时间[(1.20±0.03)min]显著少于手术机器人组[(2.18±0.03)min](P<0.05),且两组均显著少于自由手组[(8.70±3.15)min](P<0.05)。对于自由手组,前牙起点偏差、终点偏差和角度偏差[分别为(1.09±0.10)、(0.90±0.07)mm,7.22°±1.13°]均显著小于后牙[分别为(1.65±0.14)、(1.30±0.06)mm,12.46°±2.10°](P<0.05);前牙手术时间[(5.75±0.57)min]显著少于后牙[(11.65±1.14)min](P<0.05)。对于静态导板组或手术机器人组,前后牙手术操作准确性和手术时间差异均无统计学意义(P>0.05)。结论口腔手术机器人辅助显微根尖手术可提高临床医师操作的准确性,缩短手术时间。

Objective To explore the operational accuracy and operative time of oral surgery robot-assisted endodontic microsurgery on a head-simulator for clinical reference.Methods Three pairs of surgical simulation models were set up on head-simulator.Each model included 10 positions anteriorly and posteriorly,20 teeth for each technique,for a total of 60 teeth.An attending physician with more than 3 years clinical experience in endodontic microsurgery completed fixed-point osteotomy and apicoectomy in three groups of endodontic microsurgery under freehand(FH),static navigation(SN),and surgery robot(SR).The duration of each operation was recorded.Cone-beam CT was taken before the operation and the surgical path was planned in the software;after surgery,a plug gauge(precision gauge for measuring hole dimensions)was inserted into the surgical path for intraoral scanning.Surgical accuracy(starting point,end point,and angular deviation)was assessed in all 3 groups,and surgery time was compared.Results The deviation at the starting point and the end point,and angular deviation was(0.37±0.11),(0.37±0.10)mm,and 0.71°±0.17°in the SR group.The deviations in the SR group were significantly lower than those in the SN group[(0.59±0.14),(0.65±0.18)mm,and 2.64°±0.75°](P<0.05),and both groups were significantly lower than the FH group[(1.37±0.31),(1.10±0.21)mm,and 9.84°±3.15°](P<0.05).The operative time in the SN group[(1.20±0.03)min]was significantly less than that in the SR group[(2.18±0.03)min](P<0.05),and both groups were significantly less than that in the FH group[(8.70±3.15)min](P<0.05).Starting point deviation,end point deviation,and angular deviation[(1.09±0.10),(0.90±0.07)mm,7.22°±1.13°]in anterior teeth using the FH was significantly lower than the starting deviation,endpoint deviation,and angular deviation[(1.65±0.14),(1.30±0.06)mm,12.46°±2.10°]in the posterior teeth using FH(P<0.05),and the operative time in the anterior teeth using the FH[(5.75±0.57)min]was significantly less than that in the posterior teeth using[(11.65±1.14)min](P<0.05).The difference in accuracy and operative time between using SN and SR on anterior and posterior teeth was not statistically significant(P>0.05).Conclusions Oral surgery robot-assisted endodontic microsurgery helps improving the accuracy of clinicians′operations and shorten the operation time.