基于动物标本的机器人自主椎体穿刺压力与路径准确性的相关性研究

Correlation analysis of robotic autonomous vertebral puncture pressure and path accuracy based on animal specimens

目的探讨骨科机器人在自主穿刺推进中不同骨质的压力峰值对穿刺路径偏移及骨水泥渗漏的影响。方法自行设计一种用于自主椎体穿刺和骨水泥推注的脊柱手术机器人系统,并对6具离体猪脊柱标本进行单节段或双节段模拟经皮椎体成形术。测量穿刺路径准确性(Gertzbein-Robbins分级)、骨水泥渗漏分型及骨钻峰值压力,评估不同密度的椎体皮质骨与松质骨对骨科机器人执行自主椎体穿刺准确性及骨水泥渗漏情况。结果模拟穿刺64个离体猪椎体,其中Gertzbein-Robbins分级A级53椎,B级8椎,C级3椎。A级椎体的皮质骨压力(6.663±0.319)N,低于B级和C级的(8.348±0.418)和(11.500±0.600)N,差异有统计学意义(F=341.000,P<0.001);A、B、C级椎体的松质骨压力分别为(3.660±0.317)、(3.594±0.608)、(4.117±0.257)N,差异无统计学意义(F=2.496,P=0.091)。骨水泥无渗漏40椎、Ⅰ型(注入椎体内渗漏至椎体周围)20椎、Ⅱ型(注入椎体内渗漏至椎管内)3椎,总体渗漏发生率为36%(23/64)。无渗漏、Ⅰ型与Ⅱ型渗漏的皮质骨峰值压力分别为(6.638±0.301)、(6.792±0.404)、(6.753±0.473)N,松质骨压力峰值分别为(3.634±0.279)、(3.783±0.423)、(3.920±0.255)N,差异均无统计学意义(F=1.521,P=0.227;F=2.106,P=0.131)。结论新型骨科机器人在自主穿刺推进过程中穿过皮质骨穿刺压力较高时自主穿刺路径准确性降低,且侵犯椎弓根的概率增加;皮质骨与松质骨的穿刺压力对骨水泥渗漏的发生率无明显影响。

ObjectiveTo investigate the impact of peak pressure upon different bone densities during autonomous puncture by orthopedic robot on puncture path deviation and bone cement leakage.MethodsA spinal surgery robot system was designed for autonomous vertebral puncture and bone cement injection,and six porcine spine specimens were used for single-segment or double-segment simulated percutaneous vertebral augmentation surgery.The accuracy of puncture path(Gertzbein-Robbins grading),bone cement leakage classification,and peak bone drill pressure were measured to assess the accuracy of autonomous vertebral puncture and bone cement leakage in vertebral cortical and cancellous bone of different densities.ResultsA total of 64 porcine vertebrae were simulated for puncture,among which 53 vertebrae were classified as Grade A,8 as Grade B,and 3 as Grade C according to the Gertzbein-Robbins grading.The cortical bone pressure of Grade A vertebrae was 6.663±0.319 N which was lower than that of Grade B(8.348±0.418 N)and Grade C(11.500±0.600 N),with significant differences(F=341.000,P<0.001).The cancellous bone pressure of Grade A,B,and C vertebrae were 3.660±0.317,3.594±0.608,and 4.117±0.257 N,respectively,with no significant difference(F=2.496,P=0.091).There were 40 cases of no leakage,20 cases of Type I leakage(leakage into the surrounding vertebrae),and 3 cases of Type II leakage(leakage into the vertebral canal),with an overall leakage rate of 36%(23/64).The peak cortical bone pressure for no leakage,Type I,and Type II leakage was 6.638±0.301,6.792±0.404,and 6.753±0.473 N,respectively,and the peak cancellous bone pressure was 3.634±0.279,3.783±0.423,and 3.920±0.255 N,respectively,with no significant difference(F=1.521,P=0.227;F=2.106,P=0.131).ConclusionDuring the autonomous puncture process of the novel orthopedic robot,the accuracy of autonomous puncture path decreased when the puncture pressure through the cortical bone was high,and the probability of invading the pedicle increased.The puncture pressure of cortical and cancellous bone had no significant effect on the occurrence rate of bone cement leakage.