机器人辅助导航与电子探测器导航在脊柱畸形矫正术中的临床应用
发布时间：2018-08-25 11:46
【摘要】：脊柱侧凸矫形一直以来都是脊柱外科领域含金量最高的“高阶”手术。脊柱畸形病因复杂,形态多样,年龄分布广,使得脊柱侧弯的治疗既有法可循又情况多变,个体化强,成为很多脊柱外科医生的手术禁区。近10年来,椎弓根螺钉系统的得以广泛应用,配合多级截骨技术的推广,脊柱侧凸后路三维截骨矫形手术取得了前所未有的进步。椎弓根螺钉准确置入,是钉棒系统完成良好矫形的前提,而脊柱畸形的患者由于椎体合并了旋转和畸形,使得置钉准确性大大折扣,由此给患者带来了很多不可逆损伤甚至瘫痪。为了提高脊柱畸形患者椎弓根螺钉的置钉准确性,减少神经血管及脏器损伤,提高手术成功率,各式各样的脊柱导航系统得以研发应用,包括神经电生理检测、计算机辅助术中CT三维重建导航、Mazor机器人导航以及基于椎体电阻抗的电子导航等等。脊柱导航系统的出现,有望提高置钉的准确性,缩短手术时间,减少术后并发症,成为脊柱“高阶”手术的保护伞。研究目的:本研究前期通过对脊柱机器人导航系统和基于生物电阻抗导航系统的学习,熟练掌握两种导航系统的操作方法。在脊柱侧弯后路矫形术中分别应用两种不同的导航系统进行椎弓根螺钉的置入,分别就螺钉的平均置入时间,螺钉的准确性,电辐射量等参数进行统计分析,进一步验证脊柱导航新技术的实用性与安全性,为复杂脊柱畸形的矫形提供安全保障。研究方法:1、应用脊柱机器人导航技术辅助脊柱侧弯螺钉置入。首先完成脊柱机器人操作的理论学习,熟悉脊柱机器人Renaissance系统(术前计划、平台固定、3D匹配、手术操作)及手术适应症;通过尸体的临床培训,熟练掌握机器人的实际操作。收集病例,针对需要手术矫形的脊柱侧弯患者,术前完善影像学检查并制定手术计划。采用脊柱机器人导航技术进行脊柱后路椎弓根螺钉的置入,统计收集脊柱机器人导航辅助下置入的椎弓根螺钉的数量,术中电透视次数,置钉时间,术后通过脊柱CT平扫,判定椎弓根螺钉的准确性。分析数据,完成脊柱机器人导航技术辅助置钉的准确率及安全性统计。2、应用基于椎体电阻抗的电子导航开路器辅助脊柱侧弯螺钉置入。熟练掌握基于椎体电阻抗导航的设计原理及使用方法,随机将脊柱侧弯患者平均分配到实验组(电子导航组)与对照组(徒手置钉组)。分别用两种不同的开路设备进行椎弓根螺钉的置入,对比电子导航开路器与传统徒手开路器两者之间置钉的准确性(术后CT平扫),置钉时间及电辐射量的差别。整理数据,分析电子导航开路器的临床优劣性。研究结果:1、本组共收集26例青少年特发性脊柱侧弯患者,男性4例,女性22例,平均年龄(14.6±2.8)岁,主弯Cobb角平均值(68.8±7.2)°,机器人导航辅助下共置入221枚椎弓根螺钉,其余螺钉经传统徒手操作,平均匹配次数为(1.5±0.7)次,平均电透视次数为(9.6±2.5)次,每枚螺钉的平均置入时间为(3.3±0.9)min,平均匹配时间(平台固定+3D匹配)为(20.3±5.6)min,术后CT平扫验证,机器人导航辅助下椎弓根螺钉的准确率高达96.8%(214/221)。2、本部分共收集48例青少年特发性脊柱侧弯患者,男性7例,女性41例,平均年龄(15.2±2.6)岁;主弯Cobb角平均值(58.3±9.0)°,电子导航组置入161枚椎弓根螺钉,徒手置钉158枚,电子导航组螺钉准确率97.5%(157/161),徒手置钉准确性93.0%(147/158),电子导航组平均电透视次数(3.3±0.7)次,徒手操作组(5.5±0.8)次,电子导航组平均置钉时间(2.7±0.4)min,徒手组(3.2±0.6)min。研究结论:脊柱畸形复杂多样,无论是冠状位、矢状位还是轴壮位都存在着一定的旋转畸形,致使椎弓根螺钉的置入完全依靠术者的经验和三维构想。现在的机器人导航技术通过术前术中的脊柱三维重建,指导置钉,大大减小了螺钉的穿孔率;基于阻抗的电子导航开路器,将不同组织的阻抗信息转化为声音和频率,术者可以借此参考来寻找最佳的进钉通路,降低了螺钉的勿置率,同时减少了医生和患者的电辐射量。
[Abstract]:Scoliosis correction has always been the most gold-rich "high-level" surgery in the field of spinal surgery. The causes of spinal deformities are complex, diverse in shape, and widely distributed in age, making the treatment of scoliosis both feasible and changeable, with strong individualization, and becoming a forbidden area for many spine surgeons. In the past 10 years, the pedicle screw system has been widely used. Accurate placement of pedicle screws is a prerequisite for good orthodontics of the screw-rod system, and the accuracy of screw placement is greatly reduced in patients with spinal deformities due to the combination of rotation and deformity of the vertebral body. In order to improve the accuracy of pedicle screw placement in patients with spinal deformities, reduce the injury of nerves, blood vessels and organs, and improve the success rate of surgery, various spinal navigation systems have been developed and applied, including neuroelectrophysiological detection, computer-assisted intraoperative CT three-dimensional reconstruction navigation, Mazor. The emergence of spine navigation system is expected to improve the accuracy of screw placement, shorten the operation time, reduce postoperative complications, and become the umbrella for spinal "high-level" surgery. Objective: In the early part of this study, through the spine robot navigation system and based on bioelectrical impedance guidance. In the posterior spinal curvature surgery, two different navigation systems were used for the placement of pedicle screws. The average placement time, the accuracy of screws, electrical radiation and other parameters were statistically analyzed to further verify the new spinal navigation technology. Methods: 1. Robot-assisted scoliosis screw placement. First, complete the theoretical study of spinal robot manipulation, familiar with the Renaissance system (preoperative planning, platform fixation, 3D matching, operation) and hand manipulation. Surgical indications; clinical training of cadavers to master the actual operation of robots. Case collection, preoperative imaging examination and surgical planning for patients with scoliosis requiring surgical correction. Posterior pedicle screw placement using spinal robot navigation technology, statistical collection of spinal robot navigation assistance. The number of pedicle screws, the number of electro-fluoroscopy during operation, the time of screw placement, and the accuracy of pedicle screws were determined by CT plain scan after operation. The accuracy and safety of robot-assisted screw placement were statistically analyzed by analyzing the data. 2. The patients with scoliosis were randomly assigned to the experimental group (electronic navigation group) and the control group (unarmed screw group). Two different open-circuit devices were used to insert pedicle screws. The electronic navigation opener and the traditional one were compared. Results: 1. A total of 26 adolescent patients with idiopathic scoliosis were collected, including 4 males and 22 females, with an average age of (14.6 (+ 2.8) years, and the mean Cobb angle of the main curve (68.8 (+ 7.2)). A total of 221 pedicle screws were implanted with the aid of robot navigation. The other screws were operated by traditional bare hands. The average matching times were (1.5 The accuracy of pedicle screws assisted by human navigation was 96.8% (214/221). In this section, 48 adolescent idiopathic scoliosis patients, 7 males and 41 females, with an average age of (15.2 (+ 2.6) years, the average Cobb angle of the main curve (58.3 (+ 9.0)degrees), 161 pedicle screws, 158 bare-handed screws and 158 screws in the electronic navigation group were collected. The accuracy rate was 97.5% (157/161), 93.0% (147/158) for unarmed nailing, 3.3 (+ 0.7) for electrofluoroscopy, 5.5 (+ 0.8) for unarmed navigation, 2.7 (+ 0.4) min for electronic navigation, and 3.2 (+ 0.6) min for unarmed navigation. Because of the deformity of rotation, the placement of pedicle screws depends entirely on the experience and three-dimensional conception of the surgeon. Robotic navigation technology guides the placement of screws through preoperative and intraoperative three-dimensional reconstruction of the spine, which greatly reduces the penetration rate of the screws. Impedance-based electronic navigation opener converts the impedance information of different tissues into sound. And frequency, the surgeon can use this reference to find the best way to enter the screw, reduce the screw not to place rate, while reducing the doctor and patients with electrical radiation.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2202787
[Abstract]:Scoliosis correction has always been the most gold-rich "high-level" surgery in the field of spinal surgery. The causes of spinal deformities are complex, diverse in shape, and widely distributed in age, making the treatment of scoliosis both feasible and changeable, with strong individualization, and becoming a forbidden area for many spine surgeons. In the past 10 years, the pedicle screw system has been widely used. Accurate placement of pedicle screws is a prerequisite for good orthodontics of the screw-rod system, and the accuracy of screw placement is greatly reduced in patients with spinal deformities due to the combination of rotation and deformity of the vertebral body. In order to improve the accuracy of pedicle screw placement in patients with spinal deformities, reduce the injury of nerves, blood vessels and organs, and improve the success rate of surgery, various spinal navigation systems have been developed and applied, including neuroelectrophysiological detection, computer-assisted intraoperative CT three-dimensional reconstruction navigation, Mazor. The emergence of spine navigation system is expected to improve the accuracy of screw placement, shorten the operation time, reduce postoperative complications, and become the umbrella for spinal "high-level" surgery. Objective: In the early part of this study, through the spine robot navigation system and based on bioelectrical impedance guidance. In the posterior spinal curvature surgery, two different navigation systems were used for the placement of pedicle screws. The average placement time, the accuracy of screws, electrical radiation and other parameters were statistically analyzed to further verify the new spinal navigation technology. Methods: 1. Robot-assisted scoliosis screw placement. First, complete the theoretical study of spinal robot manipulation, familiar with the Renaissance system (preoperative planning, platform fixation, 3D matching, operation) and hand manipulation. Surgical indications; clinical training of cadavers to master the actual operation of robots. Case collection, preoperative imaging examination and surgical planning for patients with scoliosis requiring surgical correction. Posterior pedicle screw placement using spinal robot navigation technology, statistical collection of spinal robot navigation assistance. The number of pedicle screws, the number of electro-fluoroscopy during operation, the time of screw placement, and the accuracy of pedicle screws were determined by CT plain scan after operation. The accuracy and safety of robot-assisted screw placement were statistically analyzed by analyzing the data. 2. The patients with scoliosis were randomly assigned to the experimental group (electronic navigation group) and the control group (unarmed screw group). Two different open-circuit devices were used to insert pedicle screws. The electronic navigation opener and the traditional one were compared. Results: 1. A total of 26 adolescent patients with idiopathic scoliosis were collected, including 4 males and 22 females, with an average age of (14.6 (+ 2.8) years, and the mean Cobb angle of the main curve (68.8 (+ 7.2)). A total of 221 pedicle screws were implanted with the aid of robot navigation. The other screws were operated by traditional bare hands. The average matching times were (1.5 The accuracy of pedicle screws assisted by human navigation was 96.8% (214/221). In this section, 48 adolescent idiopathic scoliosis patients, 7 males and 41 females, with an average age of (15.2 (+ 2.6) years, the average Cobb angle of the main curve (58.3 (+ 9.0)degrees), 161 pedicle screws, 158 bare-handed screws and 158 screws in the electronic navigation group were collected. The accuracy rate was 97.5% (157/161), 93.0% (147/158) for unarmed nailing, 3.3 (+ 0.7) for electrofluoroscopy, 5.5 (+ 0.8) for unarmed navigation, 2.7 (+ 0.4) min for electronic navigation, and 3.2 (+ 0.6) min for unarmed navigation. Because of the deformity of rotation, the placement of pedicle screws depends entirely on the experience and three-dimensional conception of the surgeon. Robotic navigation technology guides the placement of screws through preoperative and intraoperative three-dimensional reconstruction of the spine, which greatly reduces the penetration rate of the screws. Impedance-based electronic navigation opener converts the impedance information of different tissues into sound. And frequency, the surgeon can use this reference to find the best way to enter the screw, reduce the screw not to place rate, while reducing the doctor and patients with electrical radiation.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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