骨科机器人辅助股骨颈系统治疗股骨颈骨折
Summary
本文介绍了一种使用股骨颈系统治疗股骨颈骨折期间机器人辅助骨科手术的螺钉放置方法，该方法可以更准确地放置螺钉，提高手术效率并减少并发症。
Abstract
套管螺钉固定术是股骨颈骨折的主要治疗方法，尤其是年轻患者。传统的外科手术使用C型臂透视徒手放置螺钉，需要多次调整导丝，这增加了手术时间和辐射暴露。反复钻孔也会对股骨颈的血液供应和骨骼质量造成损害，随后可能出现螺钉松动、不愈合和股骨头坏死等并发症。为了使固定更加精确并减少并发症的发生率，我们的团队应用机器人辅助骨科手术使用股骨颈系统进行螺钉放置，以修改传统手术。该协议介绍了如何将患者的X射线信息导入系统，如何在软件中执行螺钉路径规划，以及机械臂如何协助螺钉放置。使用这种方法，外科医生可以在第一时间成功放置螺钉，提高手术的准确性，并避免辐射暴露。整个方案包括股骨颈骨折的诊断;术中X射线图像的收集;软件中的螺杆路径规划;在外科医生的机械臂协助下精确放置螺钉;以及植入物放置的验证。
Introduction
股骨颈骨折是临床上最常见的骨折之一，约占人体骨折的3.6%和髋部骨折的54.0%1。对于股骨颈骨折的年轻患者，进行手术治疗，通过解剖复位和刚性内固定降低股骨头不愈合和股骨头坏死（FHN）的风险，并尽可能将其功能恢复到术前水平2。最常用的手术治疗是通过三个空心压缩螺钉（CCS）固定。随着患者需求的增加，尤其是年轻患者，股骨颈系统（FNS）逐渐被使用，它结合了角度稳定性、微创性以及比CCS更好的生物力学稳定性等优点，用于不稳定的股骨颈骨折3。
传统上，螺钉由外科医生在透视术中引导下徒手放置。徒手法有许多缺点，例如术中无法规划路径，钻孔时难以控制导丝的方向，反复钻孔导致骨骼和血液供应受损，以及由于定位不当导致螺钉穿透皮层。这些因素可直接或间接引起术后并发症，如骨折不愈合、FHN和内固定失败，从而影响功能预后4。徒手法也与频繁透视对患者和外科医生的辐射损伤增加有关5。因此，在术前计划期间确定最佳螺钉入口点和精确的螺钉放置是手术成功的关键。近年来，机器人辅助微创内固定在骨科手术中的应用越来越频繁6，并因其高精度和减少手术时间和辐射损伤的能力而被整形外科医生广泛接受。我们应用机器人辅助骨科手术系统辅助FNS固定治疗股骨颈骨折，从而实现了更准确高效的螺钉放置过程，更高的螺钉放置成功率和更好的功能恢复。
Protocol
Representative Results
Discussion
FNS是一种固定股骨颈骨折的方法，具有滑动髋螺钉的角度稳定性和多个空心螺钉放置侵入性最小的优点。这种方法不易发生螺丝切割和刺激周围软组织。在Tang等人的研究9中，与CCS组相比，FNS组患者的无股骨颈短或轻度短率较低，愈合时间较短，Harris评分较高。生物力学研究表明，FNS比CCS3具有更好的生物力学性能。FNS在术中与CCS相似，两者都需要通过股骨颈准?…
Divulgaciones
The authors have nothing to disclose.
Acknowledgements
这项工作得到了西安市卫生健康委员会青少年培养项目（项目编号：2023qn17）和陕西省重点研发计划（项目编号：2023-YBSF-099）的支持。
Materials
| C-arm X-ray | Siemens | CFDA Certified No:20163542280 | Type: ARCADIS Orbic 3D |
| Femoral neck system | DePuy, Synthes, Zuchwil, Switzerland | CFDA Certified No: 20193130357 | Blot:length (75mm-130mm,5mm interval), diameter (10mm); Anti-rotation screw:length (75mm-130mm,5mm interval,match the lenth of the blot), diameter (6.5mm); Locking screw:length(25mm-60mm,5mm interval),diameter(5mm) |
| Robot-assisted orthopedic surgery system | Tianzhihang, Beijing,China | CFDA Certified No:20163542280 | 3rd generation |
| Traction Bed | Nanjing Mindray biomedical electronics Co.ltd. | Jiangsu Food and Drug Administration Certified No:20162150342 | Type:HyBase 6100s |
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