發(fā)布時間：2018-03-28 14:19

  本文選題：股骨干骨折　切入點：閉合復(fù)位髓內(nèi)釘　出處：《中國人民解放軍醫(yī)學(xué)院》2017年碩士論文

【摘要】：第一部分股骨干骨折復(fù)位機器人系統(tǒng)的研發(fā)及測試目的:基于股骨干骨折閉合復(fù)位髓內(nèi)釘手術(shù)的臨床環(huán)境,研制輔助股骨干骨折智能復(fù)位的復(fù)位機器人系統(tǒng),并對其復(fù)位精度進行測試。方法:研發(fā)了基于Stewart平臺的串并聯(lián)復(fù)位機器人系統(tǒng);依據(jù)雙側(cè)股骨鏡像對稱的配準策略,采用基于X光片的2D導(dǎo)航系統(tǒng);基于機器人長骨干性骨折分型,進行了12根模型股骨及2具尸體的復(fù)位試驗,并測量復(fù)位機器人的復(fù)位精度。結(jié)果:復(fù)位機器人系統(tǒng)模型股骨復(fù)位精度:軸向殘余1.67±0.78mm,旋轉(zhuǎn)角度2.08±0.67°,側(cè)方殘余1.33±0.56mm,內(nèi)外翻角度1.50±0.56°;復(fù)位機器人系統(tǒng)尸體復(fù)位精度:軸向殘余3.08±1.51mm,旋轉(zhuǎn)角度2.58±1.24°,側(cè)方殘余1.92±0.61mm,內(nèi)外翻角度1.98±0.62°。結(jié)論:股骨干骨折復(fù)位機器人系統(tǒng)復(fù)位精度高,符合臨床復(fù)位標準,為股骨干骨折的復(fù)位提供了智能、精準、微創(chuàng)的臨床方法。第二部分定位機器人系統(tǒng)的研發(fā)及測試目的:為解決植入股骨髓內(nèi)釘遠端鎖釘過程中醫(yī)生和患者輻射量大和準確植釘難度高等問題,研發(fā)一種輔助股骨髓內(nèi)釘遠端鎖釘植入的定位機器人系統(tǒng),并與傳統(tǒng)植釘法進行比較,分析其優(yōu)勢所在。方法:研發(fā)了基于UR機械臂的定位機器人系統(tǒng);采用基于X光片的2D導(dǎo)航系統(tǒng);分析于2016年1月一2016年12月使用定位機器人系統(tǒng)輔助完成的6例股骨干骨折閉合復(fù)位髓內(nèi)釘遠端鎖釘植入術(shù)的患者資料(試驗組),并與同期采用傳統(tǒng)徒手定位植釘法完成股骨干骨折閉合復(fù)位髓內(nèi)釘遠端鎖釘植入術(shù)的26例患者(對照組)進行比較。兩組患者性別、年齡、骨折側(cè)別、骨折類型等一般資料比較,差異均無統(tǒng)計學(xué)意義(P0.05),具有可比性。通過比較兩組在手術(shù)時間、術(shù)中透視次數(shù)、螺釘一次性成功植入率(未經(jīng)反復(fù)鉆孔)以及術(shù)后在正位X線片上兩枚遠端鎖釘之間的角度等方面的差異,分析定位機器人系統(tǒng)的優(yōu)勢。結(jié)果:試驗組手術(shù)時間為(13.17±4.54) min,較對照組(7.96±1.07) min顯著延長,比較差異有統(tǒng)計學(xué)意義(t=2.795,P=0.037)。試驗組術(shù)中透視次數(shù)、髓內(nèi)釘遠端兩枚鎖釘之間的角度分別為(5.83±2.04)次、(0.35±0.89) °,均較對照組的(28.69±8.41)次、(3.12±2.75)°均顯著降低,比較差異有統(tǒng)計學(xué)意義(t=-6.537,P=0.001;Mann-Whitney U =9.00, P=0.001)。在螺釘一次性成功植入率方面,試驗組(100%)也較對照組(73%)顯著增高,比較差異有統(tǒng)計學(xué)意義(X2=4.135, P=0.042)。結(jié)論:定位機器人系統(tǒng)在輔助股骨髓內(nèi)釘遠端鎖釘植入方面,較傳統(tǒng)徒手植釘法在降低醫(yī)生和患者術(shù)中輻射、提高手術(shù)精度、減少手術(shù)創(chuàng)傷等方面具有顯著優(yōu)勢。
[Abstract]:The first part of the research and development of femoral shaft fracture reduction robot system objective: based on the clinical environment of closed reduction of femoral shaft fracture intramedullary nail surgery, a reduction robot system to assist intelligent reduction of femoral shaft fracture was developed. Methods: a series-parallel reduction robot system based on Stewart platform was developed and 2D navigation system based on X-ray film was adopted according to the registration strategy of bilateral femur mirror symmetry. Based on the classification of long bone fractures by robot, 12 models of femur and 2 cadavers were treated. Results: the reduction accuracy of the reduction robot system model was 1.67 鹵0.78 mm in axial direction, 2.08 鹵0.67 擄in rotation angle, 1.33 鹵0.56 mm in lateral residual and 1.50 鹵0.56 擄in lateral residual. Residual 3.08 鹵1.51 mm, rotation angle 2.58 鹵1.24 擄, lateral residual 1.92 鹵0.61mm, external and internal rotation angle 1.98 鹵0.62 擄. Conclusion: the reduction accuracy of the robot system for femoral shaft fracture reduction is high. According to the clinical reduction standard, it provides intelligence and precision for the reduction of femoral shaft fracture. The second part of the research and development of localization robot system and testing purpose: in order to solve the problem of doctors and patients in the process of implant femoral bone marrow nail distal locking nail high radiation and difficult to accurately implant nail. A localization robot system for distal locking nail placement of femoral bone marrow nail was developed and compared with the traditional nail placement method. Methods: a localization robot system based on UR manipulator was developed. 2D navigation system based on X-ray film is adopted. Data of 6 patients with closed reduction of femoral shaft fracture treated with distal locking nail implantation with location-robot system from January 2016 to December 2016 were analyzed. Twenty-six patients (control group) who underwent closed reduction of femoral shaft fracture with intramedullary nail distal locking nail implantation (control group) were compared between the two groups. There was no significant difference in age, fracture side, fracture type and other general data, which was comparable. The operation time and the times of fluoroscopy were compared between the two groups. The difference of successful screw implantation rate (without repeated drilling) and the angle between two distal locking screws on orthostatic X-ray film, Results: the operation time of the experimental group was 13.17 鹵4.54 mins, which was significantly longer than that of the control group (7.96 鹵1.07) min, and the difference was statistically significant. The angle between the two interlocking nails at the distal end of the intramedullary nail was 5.83 鹵2.04 times (0.35 鹵0.89) 擄, which was significantly lower than that of the control group (28.69 鹵8.41) times (3.12 鹵2.75) 擄. The difference was statistically significant (P < 0.05). Compared with the control group, the experimental group (100) was also significantly higher than the control group (73). The difference was statistically significant (X24.135, P0. 042). Conclusion: the localization robot system can reduce the radiation of doctors and patients during operation. There are significant advantages in improving surgical accuracy and reducing surgical trauma.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3;TP242

【參考文獻】

相關(guān)期刊論文 前10條

1 曹延祥;趙燕鵬;徐曉軍;張立海;王國旗;李建濤;周堅鋒;陳宇翔;婁盛涵;唐佩福;;取點數(shù)目對基于CT導(dǎo)航股骨配準精度影響的研究[J];中國數(shù)字醫(yī)學(xué);2016年09期

2 阿布力米提·阿木提;張謝卓;徐超;丁慧勇;;帶鎖髓內(nèi)釘與髓外鋼板修復(fù)股骨干骨折的Meta分析[J];中國組織工程研究;2016年17期

3 趙燕鵬;唐佩福;;骨科機器人及導(dǎo)航技術(shù)研究進展[J];中國矯形外科雜志;2016年03期

4 楊暉;解季凱;;股骨干骨折術(shù)后骨愈合不良原因的相關(guān)性探討[J];臨床醫(yī)藥實踐;2015年04期

5 王劍飛;郭龍;王軍強;武作鵬;蘇永剛;胡磊;王豫;王滿宜;葉軍;;小型醫(yī)用機器人和計算機輔助定位治療脛骨骨折(英文)[J];中國組織工程研究與臨床康復(fù);2008年35期

6 王軍強;趙春鵬;胡磊;王豫;蘇永剛;劉文勇;王劍飛;周力;張英澤;宋朝暉;武作鵬;王滿宜;王田苗;;遠程外科機器人輔助脛骨髓內(nèi)釘內(nèi)固定系統(tǒng)的初步應(yīng)用[J];中華骨科雜志;2006年10期

7 王軍強;王劍飛;胡磊;蘇永剛;王豫;趙春鵬;周力;王田苗;王滿宜;;醫(yī)用機器人輔助股骨帶鎖髓內(nèi)針遠端鎖釘瞄準系統(tǒng)的實驗研究[J];中華醫(yī)學(xué)雜志;2006年09期

8 鄧寧,張戈 ,范紅斌;導(dǎo)航在長骨干骨折髓內(nèi)釘固定中的應(yīng)用[J];中華創(chuàng)傷骨科雜志;2005年07期

9 韓巍;劉文勇;王軍強;王滿宜;;計算機輔助股骨干骨折復(fù)位技術(shù)研究進展[J];北京生物醫(yī)學(xué)工程;2013年01期

10 王劍飛;張建林;胡磊;劉文勇;王豫;王軍強;蘇永剛;趙春鵬;王滿宜;;機器人輔助脛骨髓內(nèi)釘內(nèi)固定手術(shù)系統(tǒng)臨床安全應(yīng)用研究[J];中華創(chuàng)傷骨科雜志;2009年05期

，

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