股骨干骨折智能微创手术机器人系统研发及测试

发布时间：2018-03-28 14:19

本文选题：股骨干骨折　切入点：闭合复位髓内钉　出处：《中国人民解放军医学院》2017年硕士论文

【摘要】：第一部分股骨干骨折复位机器人系统的研发及测试目的:基于股骨干骨折闭合复位髓内钉手术的临床环境,研制辅助股骨干骨折智能复位的复位机器人系统,并对其复位精度进行测试。方法:研发了基于Stewart平台的串并联复位机器人系统;依据双侧股骨镜像对称的配准策略,采用基于X光片的2D导航系统;基于机器人长骨干性骨折分型,进行了12根模型股骨及2具尸体的复位试验,并测量复位机器人的复位精度。结果:复位机器人系统模型股骨复位精度:轴向残余1.67±0.78mm,旋转角度2.08±0.67°,侧方残余1.33±0.56mm,内外翻角度1.50±0.56°;复位机器人系统尸体复位精度:轴向残余3.08±1.51mm,旋转角度2.58±1.24°,侧方残余1.92±0.61mm,内外翻角度1.98±0.62°。结论:股骨干骨折复位机器人系统复位精度高,符合临床复位标准,为股骨干骨折的复位提供了智能、精准、微创的临床方法。第二部分定位机器人系统的研发及测试目的:为解决植入股骨髓内钉远端锁钉过程中医生和患者辐射量大和准确植钉难度高等问题,研发一种辅助股骨髓内钉远端锁钉植入的定位机器人系统,并与传统植钉法进行比较,分析其优势所在。方法:研发了基于UR机械臂的定位机器人系统;采用基于X光片的2D导航系统;分析于2016年1月一2016年12月使用定位机器人系统辅助完成的6例股骨干骨折闭合复位髓内钉远端锁钉植入术的患者资料(试验组),并与同期采用传统徒手定位植钉法完成股骨干骨折闭合复位髓内钉远端锁钉植入术的26例患者(对照组)进行比较。两组患者性别、年龄、骨折侧别、骨折类型等一般资料比较,差异均无统计学意义(P0.05),具有可比性。通过比较两组在手术时间、术中透视次数、螺钉一次性成功植入率(未经反复钻孔)以及术后在正位X线片上两枚远端锁钉之间的角度等方面的差异,分析定位机器人系统的优势。结果:试验组手术时间为(13.17±4.54) min,较对照组(7.96±1.07) min显著延长,比较差异有统计学意义(t=2.795,P=0.037)。试验组术中透视次数、髓内钉远端两枚锁钉之间的角度分别为(5.83±2.04)次、(0.35±0.89) °,均较对照组的(28.69±8.41)次、(3.12±2.75)°均显著降低,比较差异有统计学意义(t=-6.537,P=0.001;Mann-Whitney U =9.00, P=0.001)。在螺钉一次性成功植入率方面,试验组(100%)也较对照组(73%)显著增高,比较差异有统计学意义(X2=4.135, P=0.042)。结论:定位机器人系统在辅助股骨髓内钉远端锁钉植入方面,较传统徒手植钉法在降低医生和患者术中辐射、提高手术精度、减少手术创伤等方面具有显著优势。
[Abstract]:The first part of the research and development of femoral shaft fracture reduction robot system objective: based on the clinical environment of closed reduction of femoral shaft fracture intramedullary nail surgery, a reduction robot system to assist intelligent reduction of femoral shaft fracture was developed. Methods: a series-parallel reduction robot system based on Stewart platform was developed and 2D navigation system based on X-ray film was adopted according to the registration strategy of bilateral femur mirror symmetry. Based on the classification of long bone fractures by robot, 12 models of femur and 2 cadavers were treated. Results: the reduction accuracy of the reduction robot system model was 1.67 卤0.78 mm in axial direction, 2.08 卤0.67 掳in rotation angle, 1.33 卤0.56 mm in lateral residual and 1.50 卤0.56 掳in lateral residual. Residual 3.08 卤1.51 mm, rotation angle 2.58 卤1.24 掳, lateral residual 1.92 卤0.61mm, external and internal rotation angle 1.98 卤0.62 掳. Conclusion: the reduction accuracy of the robot system for femoral shaft fracture reduction is high. According to the clinical reduction standard, it provides intelligence and precision for the reduction of femoral shaft fracture. The second part of the research and development of localization robot system and testing purpose: in order to solve the problem of doctors and patients in the process of implant femoral bone marrow nail distal locking nail high radiation and difficult to accurately implant nail. A localization robot system for distal locking nail placement of femoral bone marrow nail was developed and compared with the traditional nail placement method. Methods: a localization robot system based on UR manipulator was developed. 2D navigation system based on X-ray film is adopted. Data of 6 patients with closed reduction of femoral shaft fracture treated with distal locking nail implantation with location-robot system from January 2016 to December 2016 were analyzed. Twenty-six patients (control group) who underwent closed reduction of femoral shaft fracture with intramedullary nail distal locking nail implantation (control group) were compared between the two groups. There was no significant difference in age, fracture side, fracture type and other general data, which was comparable. The operation time and the times of fluoroscopy were compared between the two groups. The difference of successful screw implantation rate (without repeated drilling) and the angle between two distal locking screws on orthostatic X-ray film, Results: the operation time of the experimental group was 13.17 卤4.54 mins, which was significantly longer than that of the control group (7.96 卤1.07) min, and the difference was statistically significant. The angle between the two interlocking nails at the distal end of the intramedullary nail was 5.83 卤2.04 times (0.35 卤0.89) 掳, which was significantly lower than that of the control group (28.69 卤8.41) times (3.12 卤2.75) 掳. The difference was statistically significant (P < 0.05). Compared with the control group, the experimental group (100) was also significantly higher than the control group (73). The difference was statistically significant (X24.135, P0. 042). Conclusion: the localization robot system can reduce the radiation of doctors and patients during operation. There are significant advantages in improving surgical accuracy and reducing surgical trauma.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;TP242

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