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Computer-assisted spine surgery
計(jì)算機(jī)輔助脊柱手術(shù)
Introduction（介紹）
Computer-assisted spine surgery enables surgeons to view the position of their instruments against three-dimensional images of a patient’s spine, increasing the accuracy and safety of the procedure. The instrument tracking technology is similar to the way a GPS satellite tracks automobiles on the roads. The ability to see and track instruments in three-dimensional views allows for accurate targeting, improved measurements, and precision in surgical spine procedures that were not possible using the naked eye alone.
計(jì)算機(jī)輔助脊柱外科手術(shù)使外科醫(yī)生能看到手術(shù)器械相對(duì)于患者脊柱的位置的三維圖像，增加手術(shù)的精確性和安全性。器械跟蹤技術(shù)與GPS衛(wèi)星跟蹤路上汽車的方法相似。從三維視角觀察并跟蹤器械的能力有助于精準(zhǔn)靶向定位、精準(zhǔn)測(cè)量，并在脊柱外科手術(shù)中精確操作，具有裸眼所不具備的優(yōu)點(diǎn)。
Components (Part 1) 組件（第一部分）
A computer-assisted spine surgery system consists of four primary components: a digital camera array and computer, smart instrumentation, software, and monitors. The digital camera array uses infrared signals to work with the computer to track instruments against the position of the spine. The smart instrumentation consists of wireless devices such as a pedicle feeler used for probing, an awl used for creating or enlarging holes in bone, and a patient spine tracker that attaches to a vertebra to ensure the 3D imagery remains accurate, even if the patient is repositioned. Maintaining an update of the spinal detail with the spine tracker can eliminate or reduce the amount of imaging required during the operation.
計(jì)算機(jī)輔助脊柱外科手術(shù)系統(tǒng)包括四個(gè)主要部件：數(shù)字照相機(jī)陣列和計(jì)算機(jī)、智能化手術(shù)器械、軟件以及顯示器。數(shù)字照相機(jī)陣列使用紅外信號(hào)，通過(guò)計(jì)算機(jī)追蹤手術(shù)器械相對(duì)于脊柱的位置。智能手術(shù)器械包括無(wú)線設(shè)備，比如用于探測(cè)的椎弓根感知器，用于在骨頭里鉆孔或擴(kuò)孔的錐子，以及連到椎體上的患者脊柱跟蹤定標(biāo)儀，確保既使患者位置變動(dòng)后3D圖像仍保持精確。用脊柱跟蹤定標(biāo)儀保持脊柱細(xì)節(jié)的更新可減少或降低術(shù)中需要獲取的圖像的數(shù)量。
Components (2) 組件（第二部分）
The computer-assisted spine surgery system uses sophisticated, intuitive software to create three-dimensional images of the patient’s spine by correlating imagery taken before or during the procedure with instrument calibrations done at the start of surgery. The software also tracks and displays the positions and trajectories of the smart instrumentation. The monitors provide surgeons an alternate, real time, three-dimensional view of the spine that can be zoomed and rotated, greatly extending the viewing capabilities beyond what is seen in the exposed surgical field.
計(jì)算機(jī)輔助脊柱外科手術(shù)系統(tǒng)使用復(fù)雜的、直觀的軟件通過(guò)術(shù)前或術(shù)中獲得的相關(guān)影像來(lái)創(chuàng)建患者脊柱的三維圖像，并在手術(shù)開(kāi)始時(shí)用儀器進(jìn)行校準(zhǔn)。軟件還能跟蹤并顯示智能手術(shù)器械的位置和軌跡線。顯示器為外科醫(yī)生提供交替、實(shí)時(shí)的脊柱三維圖像，可以變焦放大、旋轉(zhuǎn)，很好地?cái)U(kuò)展了顯示手術(shù)視野周圍的能力。
Preparation （準(zhǔn)備）
Prior to spine surgery, imagery from a CT (computed tomography) scan or MRI (magnetic resonance imaging) scan may be loaded into the computer. The software interprets the imaging data and prepares three-dimensional, virtual images of the patient’s spine. The surgeon can then study the images to preplan details such as the proper size of instruments and hardware, or the best trajectories for inserting hardware into bone. The operating room is set up and the camera is positioned to track the instruments and spine position. To ensure a direct match between the virtual images and the actual patient anatomy, a series of points are selected using the software. These points are identified on the patient’s spine at the beginning of the procedure.
在脊柱手術(shù)前，從CT（計(jì)算機(jī)斷層掃描）或MRI（磁共振成像）掃描所得的影像被導(dǎo)入到計(jì)算機(jī)。軟件讀取圖像數(shù)據(jù)并準(zhǔn)備患者脊柱的三維的虛擬圖像。從而外科醫(yī)生可以研究圖像并預(yù)先制訂詳細(xì)計(jì)劃，比如內(nèi)植物的正確尺寸，將螺釘打入骨頭的最佳軌跡。將手術(shù)室設(shè)置好，并安裝照相機(jī)以追蹤器械和脊柱的位置。為保持虛擬圖像與實(shí)際病人解剖的直接匹配，用軟件選擇一系列的點(diǎn)，手術(shù)開(kāi)始時(shí)在患者脊柱上對(duì)這些點(diǎn)進(jìn)行識(shí)別。
Registration（注冊(cè)）
Matching the actual spine anatomy to the virtual images is called registration. The procedure starts with an incision, and a patient spine tracker is clamped to a vertebra. This step ensures that the camera will detect any spine movement. Next, the smart instruments are identified for tracking with a one step validation process. Once instruments are identified, the points previously selected in the software are touched in sequence. The camera tracks when an instrument contacts the registration points and the software performs calculations to ensure the virtual image is accurate.
將實(shí)際的脊柱解剖結(jié)構(gòu)與虛擬圖像相匹配稱為注冊(cè)。手術(shù)開(kāi)始先作切口，將患者脊柱跟蹤器夾在椎骨上。此步驟可確保相機(jī)檢測(cè)到任何脊椎運(yùn)動(dòng)。接下來(lái)，通過(guò)一步驗(yàn)證過(guò)程識(shí)別智能儀器進(jìn)行跟蹤。一旦識(shí)別出儀器，按順序接觸軟件中先前選擇的點(diǎn)。當(dāng)儀器與注冊(cè)點(diǎn)接觸時(shí)，相機(jī)會(huì)跟蹤，軟件會(huì)進(jìn)行計(jì)算，以確保虛擬圖像的準(zhǔn)確性。
Procedure (1) 手術(shù)步驟（1）
The surgery can proceed once the short registration process is complete. The surgeon can see both the exposed spinal anatomy as well as three-dimensional images on the monitor. A variety of different angles and views are available, including a tools-eye view from the tip of an instrument. In addition to being able to track and pinpoint the smart instruments, a trajectory line is also displayed on the monitor, which helps accurately position instruments. In this example, screws will be inserted into the pedicle regions of vertebrae. This is done to add instrumentation that will stabilize the spine following a partial disc removal.
一旦簡(jiǎn)短的注冊(cè)過(guò)程完成之后就可以進(jìn)行手術(shù)。外科醫(yī)生同時(shí)能夠看到顯露好的實(shí)際的脊柱解剖和顯示器上的三維圖像。能得到各種各樣不同的角度和視圖，包括來(lái)自于器械尖端的工具眼。除了可以追蹤和確定智能手術(shù)器械位置，在顯示器上還能顯示軌跡線，這有助于工具的準(zhǔn)確定位。在這例中，將在椎體的椎弓根區(qū)域擰入螺釘。這樣做是為了在椎間盤部分切除后用內(nèi)植物穩(wěn)定脊柱。
Procedure (2) 手術(shù)步驟（2）
After using the software for measurements to determine the proper insertion point for pedicle screws, a tracked awl is used to create pilot holes. A universal tracker can be used with a drill to monitor the position and depth of the drill bit as pilot holes are drilled deep enough to accept the pedicle screws. This process is repeated for each screw before it is fastened into bone. Next, the smart instrumentation is removed before affixing the metal rods that will stabilize the spine. Finally, the incision is closed to complete the procedure.
用軟件測(cè)量并確定椎弓根螺釘合適的進(jìn)釘點(diǎn)后，用示蹤錐開(kāi)口，鉆頭聯(lián)合通用示蹤器可顯示鉆頭的位置和深度，使鉆孔足夠深來(lái)接納椎弓根螺釘。在每枚螺釘擰入骨頭之前，重復(fù)這個(gè)過(guò)程。然后，在安裝用于穩(wěn)定脊柱的金屬棒之前，將智能手術(shù)器械撤除。最后，關(guān)閉切口，完成手術(shù)。
Summary （總結(jié)）
Computer-assisted spine surgery allows surgeons to actively track instruments against a virtual 3D image of a patient’s spine during a procedure. This technology provides the ability to preplan procedures, perform precise measurements and targeting, and visualize instrument trajectories. Computer-assisted spine surgery results in improved efficiency and reduced operating room time with increased safety in technical spine surgery procedures.
計(jì)算機(jī)輔助脊柱外科手術(shù)使外科醫(yī)生在術(shù)中能夠相對(duì)于患者脊柱的3D圖像積極跟蹤器械。這一技術(shù)能夠提供術(shù)前規(guī)劃，實(shí)施精準(zhǔn)的測(cè)量和定位，以及可視化的內(nèi)植物軌跡。計(jì)算機(jī)輔助脊柱外科手術(shù)提高了效率，降低了手術(shù)室占用時(shí)間，同時(shí)增加了技術(shù)性很強(qiáng)的脊柱外科手術(shù)的安全性。
（高晨珉 轉(zhuǎn)）
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