摘要
目的研究基于MicronTrack可见光导航系统的三维导航机械臂手术系统应用于经皮螺钉固定骨盆环的可行性和精确性。方法实验组为3具成人干燥骨盆标本，5具模型骨盆。应用MarchingCube算法，将在VC图形软件平台上自主研发基于CT—Dicom2．0数据的三维导航手术软件系统结合MicronTrack可见光导航系统及改装的5个自由度机械臂硬件平台，搭建三维导航机械臂手术系统。对每具实验骨盆实施三维导航结合机械臂辅助经皮螺钉固定双侧骶髂关节（每侧S．椎体置入2枚螺钉，共32枚）和双侧耻骨支（每侧逆行置入l枚螺钉，共16枚）。对照组为4具成人干燥骨盆标本，4具模型骨盆。在红外光学导航手术系统及术中C型臂X线机辅助下，徒手持电钻经皮螺钉固定双侧骶髂关节（每侧S，椎体置人2枚，共32枚）和双侧耻骨支（每侧逆行置入1枚螺钉，共16枚）。所用螺钉为7．3mmAO—Synthes中空螺钉。记录2组中每枚螺钉置入所需操作时间，对每组指标的平均值进行组间t检验。C型臂X线机术中多角度透视及肉眼直视下评估螺钉置放位置。结果实验组48枚螺钉在三维导航机械臂辅助下平均每枚螺钉机械臂操作时间为（3．6±1．2）min，明显少于对照组在红外光学导航手术系统辅助下的平均操作时间（9．1±0．8）min，差异具有统计学意义（t=2．50，P〈0．01）。两组螺钉均准确置入，无明显差异。结论三维导航结合机械臂辅助经皮螺钉固定骨盆环稳定、简便、精确、安全，是比较理想的微创手术。
Objectives To investigate a new targeting mechanical arm for CT-based navigated percutaneous fixation of pelvic fractures, and to evaluate the safety and efficiency of the procedures. Methods Using CT-based 3D navigation software combined with targeting mechanical arm, percutaneous insertion of pelvic models （3 dry human cadaver pelvic skeletons and 5 plastic Sybone pelvic models） were performed, 8 pelvic models allowed percutaneous cannulated screw insertion of both S-I joint（ 2 S-I screws placement for each side ,total 32 screws in this experiment） and both superior ramus （ 1 ramus medullary screw placement for each side, total 16 screws in this experiment）. Percutaneous insertion of pelvic models （4 dry human cadaver pelvic skeletons and 4 plastic Sybone pelvic models, 1 S-I screws and 1 ramus medullary sere placement for each side, 32 screws in this experiment ） were performed using fluoro-navigation system （Stryker,USA）. Time necessary for every screw insertion were recorded. Accuracy of screw placement was assessed using C-arm imaging and direct eyes inspecting. The time and accuracy of the two methods were compared. Results The time required for the CT-based 3 D navigation procedure （ 3.6 ± 1.2 ） min was significantly less than using the targeting mechanical arm compared to drilling freehand with navigation （9. 1 ± 0. 8 ） min （ t = 2. 50, P 〈 0. 01 ）. There was no significant difference in accuracy between the two methods. Conclusion CT-based 3D navigation software combined with targeting mechanical arm should be potential to apply percutaneous sacroiliac screwing for pelvic fractures with more accurate and more reliable.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第6期555-559,共5页
Chinese Journal of Surgery
基金
北京市科委科技计划重大资助项目（H060720050230）
北京市科技新星资助项目（2005818）
关键词
外科手术
计算机辅助
骨盆
骨折固定术
内
骨钉
Surgery,computer-assisted
Pelvis
Fracture fixation, internal
Bone nails
