连续体机器人和可弯曲医用螺钉在骨科手术微创干预中的应用

On the Use of a Continuum Manipulator and a Bendable Medical Screw for Minimally Invasive Interventions in Orthopedic Surgery.

作者信息

Alambeigi Farshid, Bakhtiarinejad Mahsan, Sefati Shahriar, Hegeman Rachel, Iordachita Iulian, Khanuja Harpal, Armand Mehran

机构信息

Laboratory for Computational Sensing and Robotics, The Johns Hopkins University, Baltimore, MD 21218 USA.

Laboratory for Computational Sensing and Robotics, The Johns Hopkins University, Baltimore, MD 21218 USA, and also with the Applied Physics Laboratory, The Johns Hopkins University, Laurel, MD 20723 USA.

出版信息

IEEE Trans Med Robot Bionics. 2019 Feb;1(1):14-21. doi: 10.1109/tmrb.2019.2895780. Epub 2019 Jan 28.

DOI:10.1109/tmrb.2019.2895780

PMID:32984776

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7518451/

Abstract

Accurate placement and stable fixation are the main goals of internal fixation of bone fractures using the traditional medical screws. These goals are necessary to expedite and avoid improper fracture healing due to misalignment of the bone fragments. However, the rigidity of the screw, geometry of the fractured anatomy (e.g., femur and pelvis), and osteoporosis may cause an array of complications. To address these challenges, we propose the use of a continuum manipulator and a bendable medical screw (BMS) to drill curved tunnels and fixate the bone fragments. This novel approach provides the clinicians with a degree of freedom in selecting the drilling entry point as well as the navigation of drill in complex anatomical and osteoporotic bones. This technique can also facilitate the treatment of osteonecrosis and augmentation of the hip to prevent osteoporotic fractures. In this paper: 1) we evaluated the performance of the curved drilling technique on human cadaveric specimens by making several curved tunnels with different curvatures and 2) we also demonstrated the feasibility of internal fixation using the BMS versus a rigid straight screw by performing finite element simulation of fracture fixation in an osteoporotic femur.

摘要

精确放置和稳定固定是使用传统医用螺钉进行骨折内固定的主要目标。这些目标对于加快骨折愈合以及避免因骨碎片未对齐导致的不当骨折愈合是必要的。然而，螺钉的刚性、骨折解剖结构的几何形状（如股骨和骨盆）以及骨质疏松症可能会引发一系列并发症。为应对这些挑战，我们提议使用连续体操纵器和可弯曲医用螺钉（BMS）来钻制弯曲隧道并固定骨碎片。这种新颖的方法为临床医生在选择钻孔入口点以及在复杂解剖结构和骨质疏松性骨骼中进行钻孔导航方面提供了一定的自由度。该技术还可以促进骨坏死的治疗以及髋关节增强以预防骨质疏松性骨折。在本文中：1）我们通过制作具有不同曲率的多个弯曲隧道，评估了弯曲钻孔技术在人体尸体标本上的性能；2）我们还通过对骨质疏松性股骨骨折固定进行有限元模拟，展示了使用BMS与刚性直螺钉进行内固定的可行性。