无框架患者追踪与粘性光学皮肤标记用于脊柱手术中的增强现实手术导航。
Frameless Patient Tracking With Adhesive Optical Skin Markers for Augmented Reality Surgical Navigation in Spine Surgery.
机构信息
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
出版信息
Spine (Phila Pa 1976). 2020 Nov 15;45(22):1598-1604. doi: 10.1097/BRS.0000000000003628.
STUDY DESIGN
Observational study.
OBJECTIVE
The aim of this study was to evaluate the accuracy of a new frameless reference marker system for patient tracking by analyzing the effect of vertebral position within the surgical field.
SUMMARY OF BACKGROUND DATA
Most modern navigation systems for spine surgery rely on a dynamic reference frame attached to a vertebra for tracking the patient. This solution has the drawback of being bulky and obstructing the surgical field, while requiring that the dynamic reference frame is moved between vertebras to maintain accuracy.
METHODS
An augmented reality surgical navigation (ARSN) system with intraoperative cone beam computed tomography (CBCT) capability was installed in a hybrid operating room. The ARSN system used input from four video cameras for tracking adhesive skin markers placed around the surgical field. The frameless reference marker system was evaluated first in four human cadavers, and then in 20 patients undergoing navigated spine surgery. In each CBCT, the impact of vertebral position in the surgical field on technical accuracy was analyzed. The technical accuracy of the inserted pedicle devices was determined by measuring the distance between the planned position and the placed pedicle device, at the bone entry point.
RESULTS
The overall mean technical accuracy was 1.65 ± 1.24 mm at the bone entry point (n = 366). There was no statistically significant difference in technical accuracy between levels within CBCTs (P ≥ 0.12 for all comparisons). Linear regressions showed that null- to negligible parts of the effect on technical accuracy could be explained by the number of absolute levels away from the index vertebrae (r ≤ 0.007 for all, β ≤ 0.071 for all).
CONCLUSION
The frameless reference marker system based on adhesive skin markers is unobtrusive and affords the ARSN system a high accuracy throughout the navigated surgical field, independent of vertebral position.
LEVEL OF EVIDENCE
研究设计
观察性研究。
目的
本研究旨在通过分析手术视野内椎体位置的影响，评估一种新的无框架参考标记系统用于患者跟踪的准确性。
背景资料概要
大多数现代脊柱手术导航系统依赖于附着在椎骨上的动态参考框架来跟踪患者。这种解决方案的缺点是体积庞大且妨碍手术视野，同时需要在椎骨之间移动动态参考框架以保持准确性。
方法
在混合手术室中安装了具有术中锥形束计算机断层扫描（CBCT）功能的增强现实手术导航（ARSN）系统。ARSN 系统使用四个摄像机输入来跟踪放置在手术区域周围的粘性皮肤标记。首先在四个人体尸体中评估无框架参考标记系统，然后在 20 名接受导航脊柱手术的患者中进行评估。在每个 CBCT 中，分析手术视野中椎体位置对技术准确性的影响。通过测量计划位置与放置的椎弓根器械之间的距离来确定插入的椎弓根器械的技术准确性，在骨入口点处。
结果
总体平均技术精度为 1.65±1.24mm（n=366）。在 CBCT 内的各个水平之间，技术精度没有统计学上的显著差异（所有比较的 P≥0.12）。线性回归表明，技术精度的影响几乎可以忽略不计，可以用距参考椎骨的绝对水平数来解释（所有 r≤0.007，所有β≤0.071）。
结论
基于粘性皮肤标记的无框架参考标记系统不显眼，并为 ARSN 系统提供了整个导航手术区域的高精度，与椎体位置无关。
证据水平
3。
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