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用于髂嵴皮瓣切取的协作机器人辅助切割方法的开发与验证:随机交叉试验

Development and validation of collaborative robot-assisted cutting method for iliac crest flap raising: Randomized crossover trial.

作者信息

Becker Paulina, Li Yao, Drobinsky Sergey, Egger Jan, Xie Kunpeng, Rashad Ashkan, Radermacher Klaus, Röhrig Rainer, de la Fuente Matías, Hölzle Frank, Puladi Behrus

机构信息

Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.

Institute of Medical Informatics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.

出版信息

Sci Rep. 2025 May 15;15(1):16909. doi: 10.1038/s41598-025-01293-8.


DOI:10.1038/s41598-025-01293-8
PMID:40374784
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12081624/
Abstract

The current gold standard of computer-assisted jaw reconstruction includes raising microvascular bone flaps with patient-specific 3D-printed cutting guides. The downsides of cutting guides are invasive fixation, periosteal denudation, preoperative lead time and missing intraoperative flexibility. This study aimed to investigate the feasibility and accuracy of a robot-assisted cutting method for raising iliac crest flaps compared to a conventional 3D-printed cutting guide. In a randomized crossover design, 40 participants raised flaps on pelvic models using conventional cutting guides and a robot-assisted cutting method. The accuracy was measured and compared regarding osteotomy angle deviation, Hausdorff Distance (HD) and Average Hausdorff Distance (AVD). Duration, workload and usability were further evaluated. The mean angular deviation for the robot-assisted cutting method was 1.9 ± 1.1° (mean ± sd) and for the 3D-printed cutting guide it was 4.7 ± 2.9° (p < 0.001). The HD resulted in a mean value of 1.5 ± 0.6 mm (robot) and 2.0 ± 0.9 mm (conventional) (p < 0.001). For the AVD, this was 0.8 ± 0.5 mm (robot) and 0.8 ± 0.4 mm (conventional) (p = 0.320). Collaborative robot-assisted cutting is an alternative to 3D-printed cutting guides in experimental static settings, achieving slot design benefits with less invasiveness and higher intraoperative flexibility. In the next step, the results should be tested in a dynamic environment with a moving phantom and on the cadaver.

摘要

目前计算机辅助颌骨重建的金标准包括使用患者特异性3D打印切割导板掀起微血管骨瓣。切割导板的缺点是侵入性固定、骨膜剥脱、术前准备时间长以及术中缺乏灵活性。本研究旨在探讨与传统3D打印切割导板相比,机器人辅助切割方法掀起髂嵴皮瓣的可行性和准确性。在随机交叉设计中,40名参与者使用传统切割导板和机器人辅助切割方法在骨盆模型上掀起皮瓣。测量并比较了截骨角度偏差、豪斯多夫距离(HD)和平均豪斯多夫距离(AVD)的准确性。进一步评估了持续时间、工作量和可用性。机器人辅助切割方法的平均角度偏差为1.9±1.1°(平均值±标准差),3D打印切割导板为4.7±2.9°(p<0.001)。HD的平均值为1.5±0.6mm(机器人)和2.0±0.9mm(传统方法)(p<0.001)。对于AVD,分别为0.8±0.5mm(机器人)和0.8±0.4mm(传统方法)(p=0.320)。在实验静态环境中,协作式机器人辅助切割是3D打印切割导板的一种替代方法,具有切口设计优势,侵入性更小,术中灵活性更高。下一步,应在带有移动模型的动态环境和尸体上测试结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/c8a4dccea26d/41598_2025_1293_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/dfbad9559962/41598_2025_1293_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/6664b2e02016/41598_2025_1293_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/4b532e1204c3/41598_2025_1293_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/1a48fde8d28a/41598_2025_1293_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/7a1117eef3f5/41598_2025_1293_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/7f846d7549c7/41598_2025_1293_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/43ee3f9011a3/41598_2025_1293_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/c8a4dccea26d/41598_2025_1293_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/dfbad9559962/41598_2025_1293_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/6664b2e02016/41598_2025_1293_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/4b532e1204c3/41598_2025_1293_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/1a48fde8d28a/41598_2025_1293_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/7a1117eef3f5/41598_2025_1293_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/7f846d7549c7/41598_2025_1293_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/43ee3f9011a3/41598_2025_1293_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8d2f/12081624/c8a4dccea26d/41598_2025_1293_Fig8_HTML.jpg

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本文引用的文献

[1]
The localization of septo-cutaneous perforators of free fibular flaps determines the postoperative accuracy of maxillofacial reconstructions and should therefore be included in virtual surgical planning procedures.

Oral Maxillofac Surg. 2025-3-25

[2]
Orthopedic surgical robotic systems in knee arthroplasty: a comprehensive review.

Front Bioeng Biotechnol. 2025-2-20

[3]
Comparison of Patient-Specific Plates and Pre-Bent Plates for Preserving Condylar Position in Mandible Reconstruction.

J Craniofac Surg. 2025-6-1

[4]
Fronto-orbital advancement with patient-specific 3D-printed implants and robot-guided laser osteotomy: an in vitro accuracy assessment.

Int J Comput Assist Radiol Surg. 2025-3

[5]
Accuracy and efficiency of drilling trajectories with augmented reality versus conventional navigation randomized crossover trial.

NPJ Digit Med. 2024-11-10

[6]
Analysis of condylar positioning in the temporomandibular joint following mandibular reconstruction: Introduction of a new classification system and assessment of influencing factors on displacement.

Head Neck. 2025-2

[7]
Levels of autonomy in FDA-cleared surgical robots: a systematic review.

NPJ Digit Med. 2024-4-26

[8]
Dosiomics and radiomics improve the prediction of post-radiotherapy neutrophil-lymphocyte ratio in locally advanced non-small cell lung cancer.

Med Phys. 2024-1

[9]
Changes in condylar position and morphology after mandibular reconstruction by vascularized fibular free flap with condyle preservation.

Clin Oral Investig. 2023-10

[10]
Robot-guided osteotomy in fibula free flap mandibular reconstruction: a preclinical study.

Int J Oral Maxillofac Surg. 2024-4

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