Yang Yongkang, Jia Yishi, Liu Chang, Li Liang, Wang Boyao
Nanjing Medical University, Nanjing, 211166, China.
The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China.
J Orthop Surg Res. 2025 May 2;20(1):440. doi: 10.1186/s13018-025-05790-4.
Surgical errors of orthopedics robotic are influenced by a multitude of factors. This study aims to investigate the impact of non-navigational errors on the accuracy of pedicle screw placement in orthopedic surgery.
Initially, a robot-assisted Kirschner wire (K-wire) placement simulation system was constructed, comprising a universal arm, wide-angle cameras, microscope cameras, and a vertebral base. Utilizing this system, we conducted a systematic analysis of the effects of four factors on non-navigational errors: operator habits, guide-to-bone surface distance, robotic arm stiffness, and vertebral fixation stiffness.We investigated two distinct operator habits: Habit 1 involves first positioning the K-wire against the bone surface through the guide and then inserting it using a bone drill; Habit 2 involves clamping the K-wire onto the bone drill and then inserting it together. Based on the control variable method, we designed precision measurement experiments for K-wire placement under different factors, forming 26 variable combinations to investigate the K-wire placement errors under each factor and their proportions in the overall error.
A total of 933 K-wire placements were performed in this study. The average deviation under Habit 2 conditions was 0.51 mm, compared to 0.13 mm under Habit 1 conditions; the average deviation was 0.36 mm when the guide-to-bone surface distance was 5 cm, and 0.28 mm when the distance was 1 cm; the average deviation was 0.36 mm under the 600 mm robotic arm condition, and 0.24 mm under the 500 mm robotic arm condition; the average deviation was 0.37 mm in the Plaster-Fixed Vertebra Group, and 0.85 mm in the Silicone-Fixed Vertebra Group.
Operator habits and vertebral fixation stiffness are the primary factors influencing non-navigational errors, while guide-to-bone surface distance and robotic arm stiffness are secondary factors. This study recommends adopting Habit 1 in clinical surgeries, minimizing the guide-to-bone surface distance, and enhancing the stiffness of the robotic arm and vertebral fixation to reduce non-navigational errors and improve the accuracy of robot-assisted pedicle screw placement.
骨科机器人手术失误受多种因素影响。本研究旨在探讨非导航失误对骨科手术中椎弓根螺钉置入准确性的影响。
首先构建了一个机器人辅助克氏针置入模拟系统，该系统包括一个通用手臂、广角摄像头、显微镜摄像头和一个椎体基座。利用该系统，我们对四个因素对非导航失误的影响进行了系统分析：操作者习惯、导向器与骨表面距离、机器人手臂刚度和椎体固定刚度。我们研究了两种不同的操作者习惯：习惯1是先通过导向器将克氏针靠在骨表面定位，然后用骨钻插入；习惯2是将克氏针夹在骨钻上然后一起插入。基于控制变量法，我们设计了不同因素下克氏针置入的精度测量实验，形成26种变量组合，以研究各因素下克氏针置入误差及其在总误差中的占比。
本研究共进行了933次克氏针置入操作。习惯2条件下的平均偏差为0.51毫米，而习惯1条件下为0.13毫米；导向器与骨表面距离为5厘米时平均偏差为0.36毫米，距离为1厘米时为0.28毫米；600毫米机器人手臂条件下平均偏差为0.36毫米，500毫米机器人手臂条件下为0.24毫米；石膏固定椎体组平均偏差为0.37毫米，硅胶固定椎体组为0.85毫米。
操作者习惯和椎体固定刚度是影响非导航失误的主要因素，而导向器与骨表面距离和机器人手臂刚度是次要因素。本研究建议在临床手术中采用习惯1，尽量减小导向器与骨表面距离，并提高机器人手臂和椎体固定的刚度，以减少非导航失误，提高机器人辅助椎弓根螺钉置入的准确性。
