Togawa Daisuke, Kayanja Mark M, Reinhardt Mary K, Shoham Moshe, Balter Alin, Friedlander Alon, Knoller Nachshon, Benzel Edward C, Lieberman Isador H
Cleveland Clinic Spine Institute, Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Neurosurgery. 2007 Feb;60(2 Suppl 1):ONS129-39; discussion ONS139. doi: 10.1227/01.NEU.0000249257.16912.AA.
To evaluate the accuracy of a novel bone-mounted miniature robotic system for percutaneous placement of pedicle and translaminar facet screws.
Thirty-five spinal levels in 10 cadavers were instrumented. Each cadaver's entire torso was scanned before the procedure. Surgeons planned optimal entry points and trajectories for screws on reconstructed three-dimensional virtual x-rays of each vertebra. Either a clamp or a minimally invasive external frame was attached to the bony anatomy. Anteroposterior and lateral fluoroscopic images using targeting devices were obtained and automatically registered with the virtual x-rays of each vertebra generated from the computed tomographic scan obtained before the procedure. A miniature robot was mounted onto the clamp and external frame and the system controlled the robot's motions to align the cannulated drill guide along the planned trajectory. A drill bit was introduced through the cannulated guide and a hole was drilled through the cortex. Then, K-wires were introduced and advanced through the same cannulated guide and left inside the cadaver. The cadavers were scanned with computed tomography after the procedure and the system's accuracy was evaluated in three planes, comparing K-wire positions with the preoperative plan. A total of fifty-five procedures were evaluated.
Twenty-nine of 32 K-wires and all four screws were placed with less than 1.5 mm of deviation; average deviation was 0.87 +/- 0.63 mm (range, 0-1.7 mm) from the preoperative plan in this group. Sixteen of 19 K-wires were placed with less than 1.5 mm of deviation. There was one broken and one bent K-wire. Another K-wire was misplaced because of collision with the previously placed wire on the contralateral side of the same vertebra because of a mistake in planning, resulting in a 6.5-mm deviation. When this case was excluded, average deviation was 0.82 +/- 0.65 mm (range, 0-1.5 mm).
These results verify the system's accuracy and support its use for minimally invasive spine surgery in selected patients.
评估一种新型骨固定微型机器人系统用于经皮椎弓根螺钉和经椎板小关节螺钉置入的准确性。
对10具尸体的35个脊柱节段进行器械置入。在手术前对每具尸体的整个躯干进行扫描。外科医生在每个椎体重建的三维虚拟X射线上规划螺钉的最佳进针点和轨迹。将夹具或微创外固定架附着于骨骼解剖结构上。使用靶向装置获得前后位和侧位透视图像，并自动与术前计算机断层扫描生成的每个椎体的虚拟X射线进行配准。将微型机器人安装在夹具和外固定架上，系统控制机器人的运动，使空心钻导向器沿规划轨迹对齐。通过空心导向器插入钻头并在皮质上钻孔。然后，通过同一空心导向器插入克氏针并推进，留在尸体内部。手术后对尸体进行计算机断层扫描，并在三个平面上评估系统的准确性，将克氏针位置与术前计划进行比较。共评估了55例手术。
32根克氏针中有29根以及所有4枚螺钉的置入偏差小于1.5 mm；该组与术前计划的平均偏差为0.87±0.63 mm（范围为0 - 1.7 mm）。19根克氏针中有16根的置入偏差小于1.5 mm。有1根克氏针折断，1根弯曲。另一根克氏针因规划失误与同一椎体对侧先前置入的克氏针碰撞而位置错误，导致偏差6.5 mm。排除该病例后，平均偏差为0.82±0.65 mm（范围为0 - 1.5 mm）。
这些结果证实了该系统的准确性，并支持其在特定患者的微创脊柱手术中的应用。
