摘要
目的 探讨骨科机器人在自主穿刺推进中不同骨质的压力峰值对穿刺路径偏移及骨水泥渗漏的影响.方法 自行设计一种用于自主椎体穿刺和骨水泥推注的脊柱手术机器人系统,并对6具离体猪脊柱标本进行单节段或双节段模拟经皮椎体成形术.测量穿刺路径准确性(Gertzbein-Robbins分级)、骨水泥渗漏分型及骨钻峰值压力,评估不同密度的椎体皮质骨与松质骨对骨科机器人执行自主椎体穿刺准确性及骨水泥渗漏情况.结果 模拟穿刺64个离体猪椎体,其中Gertzbein-Robbins分级A级53椎,B级8椎,C级3椎.A级椎体的皮质骨压力(6.663±0.319)N,低于B级和C级的(8.348±0.418)和(11.500±0.600)N,差异有统计学意义(F=341.000,P＜0.001);A、B、C级椎体的松质骨压力分别为(3.660±0.317)、(3.594±0.608)、(4.117±0.257)N,差异无统计学意义(F=2.496,P=0.091).骨水泥无渗漏40椎、Ⅰ型(注入椎体内渗漏至椎体周围)20椎、Ⅱ型(注入椎体内渗漏至椎管内)3椎,总体渗漏发生率为36％(23/64).无渗漏、Ⅰ型与Ⅱ型渗漏的皮质骨峰值压力分别为(6.638±0.301)、(6.792±0.404)、(6.753±0.473)N,松质骨压力峰值分别为(3.634±0.279)、(3.783±0.423)、(3.920±0.255)N,差异均无统计学意义(F=1.521,P=0.227;F=2.106,P=0.131).结论 新型骨科机器人在自主穿刺推进过程中穿过皮质骨穿刺压力较高时自主穿刺路径准确性降低,且侵犯椎弓根的概率增加;皮质骨与松质骨的穿刺压力对骨水泥渗漏的发生率无明显影响.
Abstract
Objective To investigate the impact of peak pressure upon different bone densities during autonomous punc-ture by orthopedic robot on puncture path deviation and bone cement leakage.Methods A spinal surgery robot system was de-signed for autonomous vertebral puncture and bone cement injection,and six porcine spine specimens were used for single-seg-ment or double-segment simulated percutaneous vertebral augmentation surgery.The accuracy of puncture path(Gertzbein-Rob-bins grading),bone cement leakage classification,and peak bone drill pressure were measured to assess the accuracy of autono-mous vertebral puncture and bone cement leakage in vertebral cortical and cancellous bone of different densities.Results A to-tal of 64 porcine vertebrae were simulated for puncture,among which 53 vertebrae were classified as Grade A,8 as Grade B,and 3 as Grade C according to the Gertzbein-Robbins grading.The cortical bone pressure of Grade A vertebrae was 6.663±0.319 N which was lower than that of Grade B(8.348±0.418 N)and Grade C(11.500±0.600 N),with significant differences(F=341.000,P＜0.001).The cancellous bone pressure of Grade A,B,and C vertebrae were 3.660±0.317,3.594±0.608,and 4.117±0.257 N,respec-tively,with no significant difference(F=2.496,P=0.091).There were 40 cases of no leakage,20 cases of Type Ⅰ leakage(leakage into the surrounding vertebrae),and 3 cases of Type Ⅱ leakage(leakage into the vertebral canal),with an overall leakage rate of 36％(23/64).The peak cortical bone pressure for no leakage,Type Ⅰ,and Type Ⅱ leakage was 6.638±0.301,6.792±0.404,and 6.753±0.473 N,respectively,and the peak cancellous bone pressure was 3.634±0.279,3.783±0.423,and 3.920±0.255 N,respec-tively,with no significant difference(F=1.521,P=0.227;F=2.106,P=0.131).Conclusion During the autonomous puncture pro-cess of the novel orthopedic robot,the accuracy of autonomous puncture path decreased when the puncture pressure through the cortical bone was high,and the probability of invading the pedicle increased.The puncture pressure of cortical and cancellous bone had no significant effect on the occurrence rate of bone cement leakage.
基金项目
广州市科技计划项目-重点研发计划(202206010186)
广州市市校(院)联合资助项目基础与应用基础研究项目(202201020480)
维普
万方数据