Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.
Image-Guided Surgical Robotic System for Percutaneous Reduction of Joint Fractures.
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DOI：
10.1007/s10439-017-1901-x
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发表时间：
2017-11
影响因子：
3.8
通讯作者：
Dogramadzi S
中科院分区：
文献类型：
--
作者：
Dagnino G;Georgilas I;Morad S;Gibbons P;Tarassoli P;Atkins R;Dogramadzi S
复杂的关节骨折通常需要开放性手术，这与广泛的软组织损伤和较长的住院和康复时间有关。经皮技术可以潜在地减轻这些风险，但其在关节骨折中的应用受到目前不理想的二维术中成像（透视）和碎片操作所涉及的高强度（由于软组织，例如肌肉的存在）的限制，这可能导致骨折复位不良。机器人辅助和3D图像引导的集成可以潜在地克服这些问题。作者提出了一种图像引导的手术机器人系统，用于膝关节骨折的经皮治疗，即机器人辅助骨折手术（RAFS）系统。它允许同时操作两个骨碎片，更安全的机器人骨固定系统，以及一个牵引执行机器人机械手。该系统产生了一种新的临床工作流程，并已在实验室和临床相关的尸体试验中进行了测试。RAFS系统在9具尸体标本上进行了测试，能够以可接受的精度（≈1 mm,≈5°）复位9例股骨远端骨折中的7例（T型和y型33-C1），证明其在膝关节骨折固定中的适用性。这项研究为开发经皮治疗复杂骨折（包括髋关节、踝关节和肩部）的新技术铺平了道路，从而向微创骨折手术迈出了一步。本文的在线版本（doi:10.1007/s10439-017-1901-x）包含补充材料，可供授权用户使用。
Complex joint fractures often require an open surgical procedure, which is associated with extensive soft tissue damages and longer hospitalization and rehabilitation time. Percutaneous techniques can potentially mitigate these risks but their application to joint fractures is limited by the current sub-optimal 2D intra-operative imaging (fluoroscopy) and by the high forces involved in the fragment manipulation (due to the presence of soft tissue, e.g., muscles) which might result in fracture malreduction. Integration of robotic assistance and 3D image guidance can potentially overcome these issues. The authors propose an image-guided surgical robotic system for the percutaneous treatment of knee joint fractures, i.e., the robot-assisted fracture surgery (RAFS) system. It allows simultaneous manipulation of two bone fragments, safer robot-bone fixation system, and a traction performing robotic manipulator. This system has led to a novel clinical workflow and has been tested both in laboratory and in clinically relevant cadaveric trials. The RAFS system was tested on 9 cadaver specimens and was able to reduce 7 out of 9 distal femur fractures (T- and Y-shape 33-C1) with acceptable accuracy (≈1 mm, ≈5°), demonstrating its applicability to fix knee joint fractures. This study paved the way to develop novel technologies for percutaneous treatment of complex fractures including hip, ankle, and shoulder, thus representing a step toward minimally-invasive fracture surgeries. The online version of this article (doi:10.1007/s10439-017-1901-x) contains supplementary material, which is available to authorized users.
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