计算机辅助导航骨科手术及医用机器人技术在创伤骨科的应用

本文介绍了计算机辅助导航骨科手术(CAOS)及医用机器人技术在创伤骨科应用中的主要进展、当前在临床应用中存在的主要问题和相关对策,并对其未来的发展趋势进行了预测,同时简要介绍了北京积水潭医院创伤骨科在计算机辅助导航骨科手术及医用机器人技术方面的研究进展。当前骨科手术导航定位所应用的医学图象导引系统已经由使用单一的C型臂、CT等传统影像设备向应用三维C型臂、多模态图像处理系统等新型影像设备转变,基于多模态图像的导航系统将有可能成为导航手术的主流。医用机器人已经在自动化程度和人机交互模式方面,有了长足进展,摆脱了原有工业机器人的结构模式。医学图像后处理技术及其它相关信息技术极大地丰富了导航和机器人外科,只有在不断完善光学定位技术的同时,加大对其它定位方法的研究,才能够提高定位精度;要对相关设备进行开放式结构设计,使不同导航系统的注册软件能够互相兼容,手术器械能够通用,降低设备成本。骨科医生要正确认识计算机辅助导航骨科手术及医用机器人技术,在充分了解CAOS的技术特点、基本原理、操作程序的基础上,对要实施的手术具有深刻的理解,才能开展CAOS手术。目前,迫切需要建立CAOS技术标准、临床适应证和手术操作规范,进行CAOS产品之间的技术比较和评估,便于医生选择合适的CAOS产品。伴随快速发展的信息技术,数字化手术室、智能化微创导航手术系统、医用机器人辅助的远程医疗将有可能成为未来CAOS技术的主要组成部分。

Medical robots and computer assisted navigation used in surgery of orthopaedic trauma

This paper gives a brief account of current issues, including majo r problems and possible solutions, in application of medical robots and computer assisted orthopaedic surgery (CAOS). Tendency of CAOS development in the future is also discussed. The robot system and present CAOS technology used in our dep artment are introduced. CAOS makes minimally invasive surgery (MIS) further impr oved, by making use of stored patient-specific imaging data to provide guidance during surgical procedures. Images are no longer harvested by conventional tech niques (CT or fluoroscopy) but by Modality-based navigation. Robot-assisted re mote telesurgery can be safely carried out across transoceanic distances. The ab ility to perform complex surgical manipulations from remote locations will elimi nate geographical constraints and make surgical expertise available throughout t he world so as to improve patient treatment and surgical training. Now it is nec essary to establish generally accepted standards for the equipment, operative pr ocedures and result evaluation. With the rapid progress of IT, digital-operatio n room, non-invasive intelligent orthopaedic guidance and robot-assisted remot e telesurgery will became essential components of the future CAOS.