文章简介

出版社:Int J Med Robot

作   者:Kostrzewski S, Duff JM, Baur C, Olszewski M

编   号:doi: 10.1002/rcs.446

年   份:2012     点击量:742

文章摘要 全文翻译

Background

In contemporary surgical clinical practice, spinal instability is often treated with mechanical stabilization techniques in order to protect the spinal cord and nerve roots. These techniques involve placing screws in defined regions of the vertebrae, typically the pedicle, where the strongest bone is found. The challenge for the surgeon is the accurate placement of screws for good mechanical purchase and to avoid damage to surrounding vital anatomical structures. This is especially critical in the cervical region, where the target bone mass is smaller and the spinal cord, nerve roots and vertebral arteries are all at risk. A robotic system enabling the surgeon to precisely place implants into the vertebrae should enhance safety and may potentially improve surgical results.

背景

在当代外科临床实践中,通常采用机械稳定技术治疗脊柱不稳,以保护脊髓和神经根。这些技术包括在脊椎骨放置螺钉,通常是在骨性结构最坚强的椎弓根处植入。外科医生面临的难题是如何精确地置入螺钉,以避免损伤周围重要的解剖结构。这在颈椎尤其重要,其可置钉的骨量较小,脊髓、神经根和椎动脉均处于危险区域。机器人系统使外科医生能够精确地将内植物置入椎骨,提高了安全性且可能改善手术效果。

 

Methods

We describe such a system, which consists of a compact robot positioned using a passive structure, an optical tracking system, a surgical input device and planning and navigational software. The implant trajectory in each vertebra is planned preoperatively, using fine-cut computerized tomography (CT) scans. During surgery, registration matching between the CT scan and the patient’s anatomy is achieved using point to point registration, refined with a surface merge technique. Approximate robot positioning is done passively by the surgeon.Final precise instrument positioning is performed by the robot according to the planned trajectory through the target vertebra. Implants (screws) are then placed through the robot-guided working channel.

方法

该系统包括一个可固定的小巧机器人、光源系统、手术输入设备和导航软件。术前使用薄层计算机断层扫描(CT)规划好每根椎骨的植入路径。术中,通过点对点记录实现CT扫描和患者解剖结构间的匹配,采用表面合并技术进行提炼。固定机器人后,最终精确的内固定选点由机器人根据原先计划好的穿过椎骨的路径完成。随后我们在机器人的引导下置入内植物(螺钉)。

 

Results

Six cadaver experiments, consisting of placing transarticular (i.e. crossing the joints between the vertebrae) screws in the upper two vertebrae of the human cervical spine, were performed. Implant placement accuracy was comparable with that achieved using freehand image-guided techniques by an experienced surgeon.

结果

我们对六具尸体进行试验,通过在人体颈椎最上方两节椎骨里置入跨关节螺钉。植入位置的精确度与一名经验丰富的医生通过透视图像引导技术实现的徒手置钉的精确度相类似。

 

Conclusions

These results confirm the utility and applicability of the system. It is currently in redesign to improve accuracy and to render it compatible with on-line planning.

结论

这些结果证实了该系统的实用性和适用性。目前在重新设计该系统以提高精确度,并使其能在线设计手术。