“天玑”骨肿瘤机器人在股骨远端个性化截骨的锯骨实验研究

A Sawbone Experimental Study of the TIANJI Bone Tumor Robot for Individualized Osteotomy of the Distal Femur

  • 摘要: 背景 骨肿瘤保肢手术中,截骨切缘安全直接关系局部复发与长期预后。股骨远端骨肿瘤部分病例需实施多平面个性化截骨,在复杂解剖条件下稳定维持安全切缘仍是临床难点。目的 评估“天玑”骨肿瘤机器人系统在股骨远端个性化截骨中的执行稳定性与截骨精度,并与徒手截骨进行比较。方法 选取24 个左侧股骨人工骨模型构建股骨远端病灶模型。机器人组16 个,其中两平面截骨组8 个、三平面截骨组8 个;徒手组8 个,均采用两平面截骨方案。机器人组术前基于CT影像完成截骨规划,并通过锥形束计算机断层扫描(CBCT)完成术中配准。术后测量实际截骨面与计划截骨面之间的距离误差和角度偏差。结果 机器人组两平面与三平面截骨方案的平均绝对距离误差分别为0.64±0.30 mm和0.67±0.31 mm,平均角度偏差分别为0.76°±0.30°和0.71°±0.36°,差异均无统计学意义(P=0.783、0.645)。两组均未见明显向肿瘤侧偏移趋势,其中三平面截骨方案最小有符号距离误差为-1.16 mm。两平面场景下,机器人组平均绝对距离误差和角度偏差均低于徒手组(0.64±0.30 mm vs 3.95±0.99 mm,0.76°±0.30° vs 6.62°±1.89°;P均<0.001)。结论 “天玑”机器人系统在模型骨多平面个性化截骨中具有较好的执行稳定性与截骨精度,在两平面场景下其截骨精度优于徒手截骨。

     

    Abstract: Background In limb-salvage surgery for bone tumors, the safety of osteotomy margins is directly associated with local recurrence and long-term prognosis. In some cases of distal femoral bone tumors, multiplanar individualized osteotomy is required, and maintaining safe margins under complex anatomical conditions remains clinically challenging.Objective To evaluate the execution stability and osteotomy accuracy of the TIANJI robotic system in individualized osteotomy of the distal femur and to compare its performance with freehand osteotomy. Methods Twenty-four left femoral synthetic bone models were used to construct distal femoral lesion models. Sixteen models were assigned to the robotic group, including a two-plane osteotomy group (n=8) and a three-plane osteotomy group (n=8). Eight models were assigned to the freehand group, all undergoing the two-plane osteotomy protocol. In the robotic group, preoperative osteotomy planning was performed based on CT images, and intraoperative registration was completed using cone beam computed tomography (CBCT). Postoperatively, the distance error and angular deviation between the actual and planned osteotomy planes were measured. Results In the robotic group, the mean absolute distance error was 0.64±0.30 mm in the two-plane osteotomy group and 0.67±0.31 mm in the three-plane osteotomy group, while the mean angular deviation was 0.76±0.30°and 0.71±0.36°, respectively, with no statistically significant differences between groups (P =0.783 and 0.645). No obvious tendency toward deviation to the tumor side was observed in either group. The minimum signed distance error in the three-plane osteotomy group was -1.16 mm. Under the two-plane condition, the robotic group showed lower mean absolute distance error and angular deviation than the freehand group (0.64±0.30 mm vs 3.95±0.99 mm, and 0.76±0.30° vs 6.62±1.89°, respectively; both P<0.001).Conclusion The TIANJI robotic system demonstrated good execution stability and osteotomy accuracy in multiplanar individualized osteotomy using synthetic bone models, and its osteotomy accuracy was superior to freehand osteotomy under the two-plane condition.

     

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