【摘要】：背景和目的脊髓型頸椎病(cervical spondylotic myelopathy,CSM),是臨床上一種非常常見的退行性疾病。對于神經(jīng)功能實質(zhì)性損傷,或保守治療無效的患者,手術(shù)治療往往能取得不錯的效果。前路頸椎椎間盤切除融合術(shù)(anterior cervical discectomy and fusion,ACDF)已被證實是一種治療脊髓型頸椎病被廣泛接受的手術(shù)方法。在手術(shù)中,為了維持椎間高度,避免移植物沉陷,安全減壓以及置釘牢固,對術(shù)者處理終板下皮質(zhì)骨、后縱韌帶以及置釘操作的要求極高。而手術(shù)機(jī)器人將會作為一個很理想的助手來輔助術(shù)者完成這些高難度操作。近些年,已經(jīng)有一些手術(shù)機(jī)器人被引入到脊柱手術(shù)中。但是他們主要是依賴于機(jī)械剛度、力反饋和視覺反饋。除了上述兩種反饋,聲壓信號也被認(rèn)為是一種有效的反饋。然而,關(guān)于頸椎前路手術(shù)研磨過程中的聲壓信號的分析卻未見文獻(xiàn)報道。本研究目的是收集在體外牛頸椎各種組織上用高速磨鉆進(jìn)行研磨過程中產(chǎn)生的聲壓信號,并對其中纖維環(huán)、終板下皮質(zhì)骨、椎體松質(zhì)骨和后縱韌帶的聲壓信號進(jìn)行分析,區(qū)別其不同。方法實驗總共選用了8只牛(9周)的頸椎,全部標(biāo)本節(jié)段包括C3~C7的全部部分。排除標(biāo)準(zhǔn):(1)存在骨折或病理性創(chuàng)傷;(2)椎體連接處、鉤椎關(guān)節(jié)或關(guān)節(jié)突關(guān)節(jié)處有過渡性骨贅增生;(3)韌帶有肥大增生、鈣化或骨化等情況。在每個標(biāo)本上隨機(jī)使用其中的一個節(jié)段,并在其中選擇完好的纖維環(huán)、終板下皮質(zhì)骨、椎體松質(zhì)骨和后縱韌帶當(dāng)做實驗對象。按照組織的不同進(jìn)行分組。共分為四組,A組:纖維環(huán),B組:終板下皮質(zhì)骨,C組:椎體松質(zhì)骨,D組:后縱韌帶。實驗標(biāo)本冷凍保存,在實驗當(dāng)天解凍處于室溫。對牛頸椎進(jìn)行簡單手術(shù)處理,完整暴露要測試的組織。安裝測試聲壓信號裝置,將高速磨鉆設(shè)置為60000轉(zhuǎn)/分,聲音信號的采樣頻率(frequency of sampling,FS)設(shè)定在50000赫茲。對纖維環(huán)、終板下皮質(zhì)骨、椎體松質(zhì)骨和后縱韌帶分別進(jìn)行研磨。由實驗麥克風(fēng)收集研磨過程中產(chǎn)生的聲壓信號并傳輸給動態(tài)信號采集模塊。采用MATLAB 8.4軟件使用小波包變換(wavelet packet transform,WPT)軟件包對采樣信號進(jìn)行小波包變換,獲得樹形結(jié)構(gòu)的小波包系數(shù),選擇信息代價函數(shù),利用最佳小波包基選取算法選取最佳基。對最佳正交小波包基對應(yīng)的小波包系數(shù)進(jìn)行處理。對處理后的小波包系數(shù)采用小波包重構(gòu)算法得到重構(gòu)信號。進(jìn)而獲得四種組織的聲壓頻譜。采用SPSS 22.0 for windows統(tǒng)計軟件對聲壓信號數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析,對在相同頻率下的樣本均數(shù)進(jìn)行多組獨立樣本秩和檢驗(Kruskal-Wallis Test)。結(jié)果1、聲壓信號頻譜圖顯示,每一種研磨的狀態(tài)在不同頻率上都有強度的不同,彼此之間存在差異。以1000Hz、2000Hz、3000Hz、4000Hz和5000Hz這五個頻率上的強度變化最為明顯。纖維環(huán)、終板下皮質(zhì)骨、椎體松質(zhì)骨和后縱韌帶四組聲壓信號之間總體差異有統(tǒng)計學(xué)意義(p0.05)。2、纖維環(huán)和終板下皮質(zhì)骨的聲壓信號數(shù)據(jù)在1000Hz,2000Hz,3000Hz和5000Hz 4種頻率下差異有統(tǒng)計學(xué)意義(p0.05),在4000Hz頻率下差異無統(tǒng)計學(xué)意義(p0.05)。纖維環(huán)和后縱韌帶的聲壓信號數(shù)據(jù)在2000Hz、3000Hz、4000Hz和5000Hz 4種頻率下,差異有統(tǒng)計學(xué)意義(p0.05),在1000Hz頻率下差異無統(tǒng)計學(xué)意義(p0.05)。終板下皮質(zhì)骨與椎體松質(zhì)骨的聲壓信號數(shù)據(jù)在1000Hz、2000Hz、3000Hz和4000Hz 4種頻率下,差異有統(tǒng)計學(xué)意義(p0.05),在5000Hz頻率下差異無統(tǒng)計學(xué)意義(p0.05)。結(jié)論1、手術(shù)中使用高速磨鉆研磨纖維環(huán)、終板下皮質(zhì)骨、椎體松質(zhì)骨和后縱韌帶所產(chǎn)生的聲壓信號有顯著的區(qū)別。2、高速磨鉆研磨過程中產(chǎn)生的聲壓信號在前路頸椎椎間盤切除融合術(shù)中作為一種信號反饋是很有希望的。
[Abstract]:Background and objective cervical spondylotic myelopathy (CSM) is a very common degenerative disease. Surgical treatment often results in a good effect on patients with a substantial impairment of the neurological function or a conservative treatment. Anterior cervical discectomy and fusion (ACDF) has been proved to be a widely accepted surgical method for the treatment of cervical spondylotic myelopathy. In the operation, in order to maintain the inter-vertebral height, the requirements of graft subsidence, safety pressure reduction and anchor fixation are avoided, and the requirements for the operation of the cortical bone, the posterior longitudinal ligament and the nail-placing operation under the treatment of the endplates are extremely high. The surgical robot will be an ideal assistant to assist the surgeon in completing these high-difficulty operations. In recent years, a number of surgical robots have been introduced into the spinal surgery. however, they rely primarily on mechanical stiffness, force feedback, and visual feedback. In addition to the above two feedback, the sound pressure signal is also considered to be an effective feedback. However, the analysis of the sound pressure signal in the process of anterior cervical surgery is not reported in the literature. The purpose of this study was to collect the sound pressure signal produced during grinding with high-speed grinding drill on various tissues of bovine cervical vertebrae in vitro, and to analyze the sound pressure signals of the fiber ring, the lower cortical bone, the cancellous bone of the vertebral body and the posterior longitudinal ligament. Methods A total of 8 cattle (9 weeks) of cervical spine were selected, all of which included all the parts of C3 to C7. Exclusion criteria: (1) There is a fracture or pathological wound; (2) there is a transitional osteophyte in the joint of the vertebral body, the joint of the hook and the joint or the joint of the joint, and (3) the ligament has hypertrophy, calcification or ossification. One of the sections was randomly used on each specimen and the intact fiber ring, the lower cortical bone of the endplates, the cancellous bone of the vertebral body, and the posterior longitudinal ligament were used as experimental subjects. Groups are grouped according to the organization's differences. It was divided into four groups: group A: fiber ring, group B: lower cortical bone of endplates, group C: cancellous bone of vertebral body, D group: posterior longitudinal ligament. The experimental specimens were frozen and stored and thawed at room temperature on the same day of the experiment. Simple surgical treatment of the bovine cervical spine and complete exposure to the tissue to be tested. Install the test sound pressure signal device, set the high-speed drill to 60000 rpm, and the sampling frequency of the sound signal (frequency of sampling, FS) is set at 50,000 Hz. The fiber ring, the lower cortical bone of the endplates, the cancellous bone and the posterior longitudinal ligament of the vertebral body are respectively ground. and the sound pressure signal generated during the grinding process is collected by the experimental microphone and transmitted to the dynamic signal acquisition module. The wavelet packet transform is used to transform the sampled signal by using the wavelet packet transform (WPT) software package, and the wavelet packet coefficient of the tree structure is obtained, the information cost function is selected, and the optimal base is selected by using the optimal wavelet packet base selection algorithm. and the wavelet packet coefficients corresponding to the optimal orthogonal wavelet packet base are processed. and a wavelet packet reconstruction algorithm is adopted for the processed wavelet packet coefficients to obtain a reconstructed signal. and then the sound pressure spectrum of the four tissues is obtained. The statistical analysis of the sound pressure signal data was carried out by using the SPSS 10.0 for windows statistical software, and multiple independent sample rank and test (Kruskal-Wallis Test) were performed on the average number of samples at the same frequency. As a result, the sound pressure signal spectrum diagram shows that the state of each grinding is different in different frequencies, and there is a difference between each other. The intensity changes at the five frequencies of 1000Hz, 2000Hz, 3000Hz, 4000Hz and 5000Hz are the most obvious. There is a significant difference in the overall difference between the four groups of sound pressure signals of the fiber ring, the lower cortical bone of the endplates, the cancellous bone of the vertebral body and the four groups of the posterior longitudinal ligament (p0.05). The data of the sound pressure signal of the cortical bone under the fiber ring and the end plate is statistically significant at the frequencies of 1000Hz, 2000Hz, 3000Hz and 5000Hz (p0.05). There was no significant difference in the frequency of 40000Hz (p0.05). The sound pressure signal data of the fiber ring and the posterior longitudinal ligament had statistical significance (p0.05) at the frequency of 2000Hz, 3000Hz, 40000Hz and 5000Hz (p0.05), and there was no statistical difference at the frequency of 1000Hz (p0.05). The acoustic pressure signal data of the lower cortical bone and the cancellous bone of the vertebral body were statistically significant at the frequency of 1000Hz, 2000Hz, 3000Hz and 4000Hz (p0.05), and there was no statistical significance at the 5000Hz frequency (p0.05). Conclusion 1. There is a significant difference between the sound pressure signal produced by the high-speed grinding and grinding of the fiber ring, the lower cortical bone, the cancellous bone of the vertebral body and the posterior longitudinal ligament in the operation. The sound pressure signal produced during the high-speed grinding and grinding process is very promising as a signal feedback in the anterior cervical discectomy and fusion.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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