CT与C型臂辅助遥控型脊柱微创手术机器人系统打孔可靠性研究

目的利用术前电子计算机X射线断层扫描技术(CT)和术中C型臂X线机辅助遥控型脊柱微创手术机器人系统进行牛脊骨标本打孔,评价该系统的精确性。探讨实验前CT、术中C型臂系统辅助遥控型脊柱手术机器人系统打孔的可行性。方法遥控型脊柱微创手术机器人系统由中科院沈阳自动化研究所与第三军医大学新桥医院骨科合作研发,可进行遥控打孔。由于该系统目前尚不能与虚拟手术系统或导航系统结合,因此本实验中预先在牛脊骨标本棘突置入克氏针作为标志物,然后进行CT摄影并以此为依据进行术前计划。根据C型臂X线机影像调整手术机器人系统前端夹持气钻位置,当C型臂X线机影像显示该气钻位置与椎弓根理想置钉位置重合时,遥控机器人系统进行打孔操作。之后再次拍摄CT并评估该系统精确性。结果遥控脊柱微创手术机器人系统进行打孔操作,可避免打孔过程中X射线对医师的损伤,该系统平均打孔时间为330(280～378)s/孔,平均X线透视次数为6(5～8)次。打孔数据与计划角度差值无统计学差异(P=0.209)。该系统存在一定的学习曲线,熟悉该系统后,应用此方法角度偏差能控制在4°之内。结论脊柱微创手术机器人系统打孔精确,利用实验前CT扫描结果进行实验前计划,根据该计划辅以C型臂系统遥控脊柱微创手术机器人系统进行打孔具有可行性。

Feasibility of pre-clinical drilling in minimally invasive spine surgery robotic system(remote type)

Objective To evaluate the drilling accuracy of minimally invasive spine surgery robotic system(remote type) assisted by computed tomography(CT) and C-arm system,and preliminary investigate the possibility of the combination of the imaging equipment and this robotic system.Methods Minimally invasive spine surgery robotic system(remote type),which is researched and developed jointly by Shenyang Institute of Automation,Chinese Academy of Sciences and our department,is used to drill(remote) in spine surgery.Since the robotic system still lack of the assistant of the navigation system or virtual surgery system,this study in advance was designed to drill holes into the spinous process of bovine spine specimens and put K-wires into the holes as markers,with CT scanning as a basis for surgical planning.In the experiment,under the guide of the C-arm X-ray machine operation robot system,the gas drilling clamp’s position was adjusted.Remote drilling was performed till the coincidence of the image of the gas drilling position and ideal hole position in the spinous process.Then CT scanning was carried out again after the experiment for assessing.Results Minimally invasive spine surgery robotic system(remote type) could drill precisely and avoid radiation injury to the doctor.And the system average drilling time was 330 s/hole(ranging from 280 to 378 s),while the average number of X-ray was 6 times(5 to 8 times).The results of the statistical analysis showed that P value was 0.209(>0.05) between the data of the drilling by CT photography and the surgical plan(one-sample t-test).The system had a certain learning curve,and the angle of deviation could be controlled within 4 after profound learning.Conclusion Minimally invasive spine surgery robotic system(remote type) is precise in drilling,with no statistical difference between the preoperative plan and the drilling hole,though a learning process is needed.It is feasible to make drilling with the robotic system assisted by CT scanning.