双平面骨科机器人系统辅助股骨颈骨折空心螺钉内固定术的实验研究

目的应用双平面骨科机器人系统进行模型骨股骨颈空心螺钉内固定的实验,通过对空心钉导针置入平行度的计算、导针的位置和术中所需X线透视时间来评估该系统的准确性、安全性和有效性。方法双平面骨科机器人系统是由北京积水潭医院和北京航空航天大学联合开发的一种基于术中X线图像的手术导航系统。对5例Synbone模型股骨颈内置入15枚空心钉导针,每例3枚。测量每例任意两枚空心钉导针入点处和出点处距离,用其差值与股骨颈内导针长度的比值(P)来评价导针的平行程度,观察导针在股骨颈内的位置,记录术中X线透视时间,并与12例常规手术中空心钉导针置入X线透视时间及透视次数进行比较。结果P值为0.0037～0.0181,即在100mm的导针长度内,最大平行偏差小于2mm。使用机器人辅助系统的X线透视时间为2.32s,平均照射次数为4.4次。常规手术中的X线透视时间为28.30s,平均照射次数为54.3次。结论双平面骨科机器人系统为股骨颈空心钉导针的置入提供精准的空间定位和稳定的路径导航,同时极大地减少了术中医护人员的X线照射时间,便于临床应用。     

双平面骨科机器人辅助骶髂关节螺钉置入系统精度测试及尸体应用的研究

目的 测试双平面骨科机器人辅助骶髂关节螺钉置入系统的定位精度,探讨应用双平面骨科机器人系统辅助骶髂关节螺钉置入的临床可行性. 方法 本研究包括系统定位精度实验和尸体应用实验两部分内容.①在导航机器人的底板上固定两根尖克氏针,测量其尖端的坐标真值.应用机器人导航系统得到其坐标的计算值,然后计算测量真值与计算值之间的距离作为系统的定位误差.实验共测量10组数据,得出精度结果 .②在原有对4具尸体骨盆标本置入12枚骶髂关节螺钉实验的基础上,对一具新鲜成年男性尸体进行机器人辅助骶髂关节螺钉置入的临床模拟手术,在其一侧S1椎体内置入2枚螺钉.通过透视和CT图像来评价螺钉的置入位置,同时记录手术时间和透视次数,作为临床评价指标. 结果 通过定位精度实验,本系统的定位精度在2 mm以内,可以满足临床应用的需要.术中导针置入位置与规划螺钉位置有极佳的一致性.术后的透视及CT图像显示,2枚骶髂关节螺钉均位于S1"安全区"内.从采集图像完成到螺钉置入的手术操作时间:第一枚螺钉用时10′36″,第二枚螺钉用时6′48″.置入2枚螺钉(包括术中和术后验证)共透视11次. 结论 本系统能够精确而高效地辅助骶髂关节螺钉置入,并且在提供精确导航的同时,大大减少了术中对患者和手术人员的辐射伤害.     

双平面骨科机器人系统辅助股骨颈骨折内固定的实验研究

目的 通过股骨近端模型骨的模拟手术,与传统方法徒手操作的临床病例进行对比,评价改进后的双平面骨科机器人系统辅助股骨颈骨折空心钉导针置入位置的准确性以及螺钉的平行性. 方法使用双平面骨科机器人系统对12根股骨近端模型骨进行辅助股骨颈空心钉置入的模拟手术,每例置入3枚导针,通过股骨颈截面的直接测量来评价机器人系统辅助操作的准确性;通过正、侧位X线片角度的测量和计算来评价机器人系统辅助下空心钉之间的平行性,与传统方法徒手操作的临床病例测算结果比较;同时比较两种操作方法所需的透视次数. 结果所有导针均一次成功置入,标本截面测量导针实际位置与规划位置相比误差范围在1 mm左右;对平行度参数的统计学分析结果显示正、侧位X线片上机器人辅助操作的螺钉平行度均优于徒手操作(P<0.05),稳定性也优于徒手操作(P<0.05);在透视次数上,机器人辅助操作组明显少于徒手操作组. 结论改进后的双平面骨科机器人系统可以有效地辅助完成股骨颈骨折空心钉内固定,导针位置的准确性能满足临床应用的需求.空心钉之间的平行性和操作的稳定性均明显优于传统的徒手操作,同时可以大大减少医患的放射线暴露时间.     

天玑骨科手术机器人结合三维成像技术辅助微创治疗骨盆骨折的疗效分析北大核心CSCD

目的探讨天玑骨科手术机器人结合三维成像技术辅助微创手术治疗骨盆骨折的疗效。方法回顾性分析2019年1月至2021年5月广东省阳江市人民医院创伤骨科收治的40例以S1及S2骶髂关节螺钉固定的骨盆骨折患者资料,根据治疗方法不同分为两组:机器人组(采用天玑骨科手术机器人辅助经皮置入骶髂关节螺钉固定)20例,男13例,女7例;年龄为(38.2±8.8)岁。徒手组(采用普通C型臂X线机透视下徒手置入骶髂关节螺钉固定治疗)20例,男11例,女9例;年龄为(37.3±9.2)岁。记录并比较两组患者螺钉置入所用透视时间、导针调整次数、手术时间、术中出血量、术后72 h疼痛视觉模拟评分、术后住院时间、下地活动时间、螺钉置入优良率、并发症发生率、骨折愈合时间、术后6个月Majeed评分、功能评价优良率。结果两组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。机器人组螺钉置入透视时间[(8.2±2.9)s]、导针调整次数[(0.4±0.2)次]、手术时间[(67.4±5.5)min]、术中出血量[(36.5±8.0)mL]显著少于徒手组[(40.4±4.5)s、(8.6±0.7)次、(78.4±7.2)min、(41.6±7.8)mL],疼痛视觉模拟评分[3.0(4.0,5.0)分]显著低于徒手组[4.0(5.0,6.0)分],螺钉置入位置优良率(100%,40/40)显著高于徒手组(85.0%,34/40),并发症发生率(5.0%,1/20)显著低于徒手组(35.0%,7/20),以上比较差异均有统计学意义(P<0.05);两组患者术后住院时间、下地活动时间、骨折愈合时间、Majeed评分、功能评价优良率比较差异均无统计学意义(P>0.05)。结论与徒手置入骶髂关节螺钉固定比较,天玑骨科手术机器人结合三维成像技术辅助微创手术治疗骨盆折效果确切,可以减少辐射暴露、手术时间、出血量、并发症发生率,提高螺钉置入准确率,增加安全性。     

天玑骨科机器人辅助经皮骶髂空心螺钉内固定治疗骨盆后环损伤合并骶骨变异北大核心CSCD

目的 探讨应用天玑骨科机器人辅助经皮骶髂空心螺钉内固定治疗骨盆后环损伤合并骶骨变异的临床疗效,评价其可行性和安全性。方法 回顾分析2020年1月—2021年6月采用天玑骨科机器人辅助经皮骶髂空心螺钉内固定治疗的7例Tile C型骨盆骨折合并骶骨变异患者临床资料。男5例,女2例;年龄17~56岁,平均36岁。致伤原因:交通事故伤4例,高处坠落伤3例。骨盆骨折Tile分型:C1.1型1例,C1.2型1例,C1.3型5例;骶骨骨折根据Denis分区:Ⅰ区3例,Ⅱ区4例;骶骨畸形:腰椎骶化3例,骶椎腰化2例,骶骨副耳状面2例。受伤至手术时间2~7 d,平均4.6 d。记录每枚螺钉植入时间、每枚导针置入透视次数、骨折复位质量(Matta评分)、螺钉位置优良率、骨折愈合时间和并发症发生情况,采用Majeed评分评价临床疗效。结果 术中共植入13枚螺钉,每枚螺钉植入时间为10~23 min,平均18.2 min;导针位置良好,无1例进行导针调整,每枚导针置入透视次数3~7次,中位数4次。术后3 d影像学检查示骶髂螺钉植入位置均为优。无切口感染、血管神经损伤等并发症发生;未发生与机器人设备相关的不良事件。术后3 d采用Matta评分评价骨折复位质量获优6例、良1例,优良率100%。7例患者均获随访,随访时间6~15个月,平均12.4个月。患者骨折均获骨性愈合,愈合时间为18~24周,平均21.2周。末次随访时Majeed评分为81~95分,平均91.5分;其中优5例、良2例,优良率100%。结论 天玑骨科机器人辅助经皮骶髂空心螺钉内固定治疗骨盆后环损伤合并骶骨变异,手术精准、安全、微创、智能,临床效果满意。     

《中华创伤骨科杂志》2006年第1期继续教育试题

一、单选题1.国际手外科联合会推荐采用的Ⅱ区亚区是由谁提出的:()A.M oiem en B.E lliot C.汤锦波D.顾玉东E.徐建光2.创立经皮椎体成形术的介入医师H erre D eram ond属哪国人:()A.美国B.德国C.法国D.英国E.荷兰3.双平面骨科机器人系统辅助下置入一枚骶髂关节螺钉的平均透视次数为:()A.1B.1.5C.2D.2.5E.34.双平面骨科机器人系统辅助下置入一枚股骨颈空心螺钉的平均X线暴露时间为:()A.3.28s B.3.30s C.3.32sD.3.34s E.3.36s5.断裂伤韧带经海水浸泡后苦味酸-天狼猩红染色以什么为主:()A.红黄色Ⅰ型胶原B.红黄色Ⅱ型胶原C.红黄色…     

术中实时三维导航下经皮骶髂关节螺钉固定术的初步探讨

目的 探讨基于术前CT扫描的术中实时三维导航技术应用于经皮骶髂关节螺钉置入术的可行性. 方法 术前沿着5具正常骨盆标本髂骨翼各置入1枚钛钉后行CT扫描.将扫描数据导入SuperImage软件完成骨盆的三维重建.将三维模型导入导航软件中,获得钛钉标识点在三维虚拟空间的坐标,并规划骶髂关节螺钉置入的安全路径.术中通过导航探针,获取钛钉的实际空间坐标,并与虚拟标识点进行配准;通过导航系统实时跟踪术中骨盆及手术器械的空间位置.在实时三维导航下按照虚拟规划的安全路径,在5具骨盆标本上各完成1枚经皮骶髂关节螺钉的置入,并记录手术操作时间.术后行骨盆CT扫描及三维重建,观察螺钉的位置,并与术前规划结果进行对比. 结果 在5具正常骨盆标本上按照术前虚拟规划的路径各顺利置入1枚骶髂关节螺钉.术后CT扫描显示5枚螺钉位置均满意,与术前虚拟规划结果基本一致.手术操作时间为19～ 23 min,平均21.6 min. 结论 术中实时三维导航技术充分利用术前虚拟规划信息,术中螺钉置入精度高,且无需X线透视,操作流程简单、快捷,在经皮骶髂关节螺钉固定术中具有良好的可行性.     

机器人导航定位系统辅助经皮骶髂螺钉治疗骨盆后环不稳定型损伤的临床研究

背景:机器人导航定位系统GD-2000是国内自主研发的基于术中X线透视影像的双平面骨科机器人系统,可用于辅助完成经皮股骨颈空心螺钉和骶髂螺钉置入的内固定术。目的:探讨机器人导航定位系统辅助完成经皮骶髂螺钉内固定术的安全性及有效性。方法:回顾性分析2016年6月至2018年8月收治的21例骨盆骨折后环不稳定型损伤患者,均采用机器人导航定位系统辅助经皮骶髂螺钉内固定术,男16例,女5例;年龄27~52岁,平均(38.2±6.9)岁。按Tile分型,B1型7例,B2型6例,B3型5例,C1型3例。记录每枚螺钉的置入时间、X线透视时间、钻孔次数,术后CT检查评价螺钉置入位置,统计术后并发症发生情况,术后6个月随访进行Majeed功能评分。结果:21例患者共置入27枚螺钉,全部患者均一次钻孔完成螺钉置入,每枚螺钉置入时间为18~56 min,平均(38.6±9.5)min;X线透视时间为12~21 s,平均(16.5±3.5)s。所有螺钉位置满意,无螺钉切出骨皮质、误入骶孔或骶管,未出现医源性血管神经损伤及切口感染。术后6个月随访的Majeed评分,优14例,良6例,可1例,优良率为95.2%。结论:应用机器人导航定位系统辅助经皮骶髂螺钉内固定术具有定位准确、稳定性好、手术时间短、创伤小等优点,降低了手术风险,减少医护人员和患者的放射性损害,是一种治疗骨盆后环损伤安全而有效的技术选择。     

仰卧位与俯卧位骶髂置钉术的对比研究

目的探讨仰卧位经皮骶髂置钉术的可行性,并与俯卧位状态进行比较。方法选择成人短期防腐湿尸10具,男5具,女5具。C型臂X线机透视下经皮骶髂置入1枚直径7.2mm空心钛钉,左侧取仰卧位,右侧俯卧位。手术前后摄骨盆前后位、腰椎侧位X线片,及骶髂关节CT扫描,比较2种手术操作的手术时间、透视时间、透视次数及螺钉在S1椎体中的位置。结果平均手术时间:仰卧位组为(17.333±1.862)min,俯卧位组为(16.333±2.805)min;透视时间:仰卧位组为(28.500±3.332)s,俯卧位组为(28.500±4.278)s;透视次数:仰卧位组为(12.000±2.000)次,俯卧位组为(11.667±2.422)次;2种方法均有1枚螺钉突破椎体后缘皮质,侵及椎管。统计学显示2种手术方法无显著性差异(P0.05)。结论仰卧位经皮骶髂置钉固定术是安全、可行的,与俯卧位相比,无显著性差异;该术式为微创治疗骨盆后环损伤找到了一条新的途径。     

TiRobot机器人辅助治疗骶髂关节骨折脱位

[目的]介绍TiRobot机器人辅助经皮空心螺钉内固定治疗骨盆骨折骶髂关节骨折脱位的手术技术与初步临床结果。[方法] 2019年1月～2020年1月,采用TiRobot机器人辅助经皮空心螺钉内固定治疗的骨盆骨折骶髂关节骨折脱位13例。术前影像明确骨折类型,进行手术设计。将机器人机械臂移动并固定至手术床旁。将示踪器固定于健侧髂前上棘骨质中,透视获取机器人定位标记点,在主控系统规划软件上进行手术螺钉路径规划。于入钉点行2 cm小切口,将机械臂所持套筒尖端抵至入钉点骨皮质,在主控工作站确认入钉点和虚拟探针方向是否符合规划,并进行微调,确认路径精准后,内钻入导针,沿导针拧入空心螺钉。[结果]手术共置入20枚螺钉,未出现医源性血管、神经及脏器损伤。置入的螺钉位置优良率100%。[结论] TiRobot机器人适用于辅助骨盆骨折骶髋关节骨折脱位,具有精确性高、安全性好的优点。     

First generation computerized fluoroscopic navigation in percutaneous pelvic surgery

Percutaneous internal fixation of pelvic fractures has gained popularity allowing rapid mobilization with reduced surgical related morbidity; however, this method depends on conventional fluoroscopy, which exposes the patient and the surgeon to a significant amount of radiation. The use of computerized fluoroscopic navigation systems enables the simultaneous use of several radiographic projections. These preliminary fluoroscopic views are taken when the operating team stands at a distance from the radiation source. No further fluoroscopic radiation is used later during the surgical procedure. Computerized fluoroscopic navigation was used in the percutaneous insertion of 45 cannulated screws in 29 patients, including sacroiliac screws, pubic ramus screws, posterior column screws, and a supraacetabular transverse screw. Fluoroscopic verification of screw placement demonstrated a deviation 相似文献   

Minimally invasive fluoro-navigation screw fixation for the treatment of pelvic ring injuries

Intensive use of intraoperative fluoroscopy is mandatory to achieve good accuracy and avoid neural or vascular injury and may prolong surgical time and increase exposure-related hazards. New methods of percutaneous treatment in conjunction with innovative fluoroscopy-based computerized navigation have evolved in an attempt to overcome the existing difficulties. This report described our experience in applying fluoroscopic surgical navigation technique and evaluated its clinical application to pelvic ring injuries, including its feasibility, merits and limitations. Twenty-two patients with pelvic ring injuries were treated with percutaneous pubic ramus screw and sacroiliac screw techniques under the guidance of a fluoroscopy-based navigation system. A total of forty-four screws were inserted, including twenty-seven pubic ramus screws and seventeen sacroiliac screws. The average operation time and the average fluoroscopy time per screw were 23.6 minutes and 22.2 seconds respectively. Compared to the final position of the screw, the average deviated distance of wire tip was 2.8 mm and the average trajectory difference was 2.6°. A ventral cortex perforation of the sacrum was found in one sacroiliac screw without any clinical symptoms. No superficial or deep infection occurred. No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw fixation of pubic ramus fractures, sacroiliac disruptions, or sacral fractures. Our results showed that fluoroscopy-based navigation technique for the pelvic ring injuries could become a safe and effective alterative method for the treatment of pelvic ring injuries in some selected patients.     

Extracorporeal single dose and radiographic dosage in image-controlled and fluoroscopic navigated pedicle screw implantation

AIM: Goal of the current study was to compare radiation dose and fluoroscopy time of fluoroscopic computer assisted pedicle screw implantation versus the conventional technique. METHOD: For each of 10 specimens two pedicle screws were placed using conventional technique (group 1) and two screws were inserted with fluoroscopic navigation system (group 2) contralateraly. RESULTS: For implantation of two pedicle screws the mean radiation dose was 0.041 mSv in group 1 and 0.029 mSv in group 2. Fluoroscopy time was 34 seconds in group 1 and 25 seconds in group 2. The differences of radiation dose and fluoroscopy time for group 1 and 2 were statistically significant (radiation dose p = 0.00044, fluoroscopy time p = 0.00039). CONCLUSION: We achieved significantly lower radiation dose and fluoroscopy time with fluoroscopic computer assisted pedicle screw implantation compared with the conventional technique. Concerning exposure to radiation for patients and personnel fluoroscopic navigated screw insertion is to favour.     

A comparison of optical and electromagnetic computer-assisted navigation systems for fluoroscopic targeting

OBJECTIVES: Freehand targeting using fluoroscopic guidance is routine for placement of interlocking screws associated with intramedullary nailing and for insertion of screws for reconstruction of pelvic and acetabular injuries. New technologies that use fluoroscopy with the assistance of computer guidance have the potential to improve accuracy and reduce radiation exposure to patient and surgeon. We sought to compare 2 fluoroscopic navigation tracking technologies, optical and electromagnetic versus standard freehand fluoroscopic targeting in a standardized model. INTERVENTION: Three experienced orthopaedic trauma surgeons placed 3.2-mm guide pins through test foam blocks that simulate cancellous bone. The entry site for each pin was within a circular (18-mm) entry zone. On the opposite surface of the test block (130-mm across), the target was a 1-mm-diameter radioopaque spherical ball marker. Each surgeon placed 10 pins using freehand targeting (control group) navigation using Medtronic iON StealthStation (Optical A), navigation using BrainLAB VectorVision (Optical B), or navigation using GE Medical Systems InstaTrak 3500 system (EM). OUTCOME MEASUREMENTS: Data were collected for accuracy (the distance from the exit site of the guidewire to the target spherical ball marker), fluoroscopy time (seconds), and total number of individual fluoroscopy images taken. RESULTS: The 2 optical systems and the electromagnetic system provided significantly improved accuracy compared to freehand technique. The average distance from the target was significantly (3.5 times) greater for controls (7.1 mm) than for each of the navigated systems (Optical A = 2.1 mm, Optical B = 1.9 mm EM = 2.4 mm; P < .05). Accuracy was similar for the 3 navigated systems, (P > 0.05). The ability to place guidewires in a 5-mm safe zone surrounding the target sphere was also significantly improved with the optical systems and the EM system (99% of wires in the safe zone) compared to controls (47% in the safe zone) (P < 0.002). Safe zone placement was similar among the 3 navigated systems (P > 0.05). Fluoroscopy time (seconds) and number of fluoroscopy images were similar among the three navigated groups (P > 0.05). Each of these parameters was significantly less when using the computer-guided systems than for freehand-unguided insertion (P < 0.01). CONCLUSIONS: Both optical and electromagnetic computer-assisted guidance systems have the potential to improve accuracy and reduce radiation use for freehand fluoroscopic targeting in orthopaedic surgery.     

Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws

A prospective controlled experimental study was done to assess the value of fluoroscopy-based, computer-assisted orthopaedic surgery for the insertion of sacroiliac screws and to compare this new technology with the conventional technique, using image intensification. In a simulated surgical setup, 140 cannulated screws were placed into the S1 and S2 vertebral bodies of 35 pelvic models. The screws were inserted under fluoroscopy-based image guidance or with the conventional technique. Different drills were tested with both techniques, including a 2.8-mm guide wire and a 5-mm solid drill. The 2.8-mm guide wire proved inaccurate with the computer-assisted image guidance system because of guide wire flexibility. Using the more rigid 5-mm drill, the results of computer-assisted image guidance were comparable with the image intensifier technique. The radiation exposure during screw insertion was reduced considerably when using the image guidance system. System-specific requirements warranted adjustment of surgical technique and instruments. The major advantages of this new technology are immediate intraoperative image acquisition and provision of surgical guidance in as much as four planes simultaneously. The results of this experimental study are encouraging and have led to initiation of a clinical trial.