ABSTRACT
This paper introduces the applications of Computer Assisted Orthopaedic Surgery (CAOS), including pre-operative planner, surgical simulator, intra-operative navigation systems and medical robotics. Basic principals of surgical navigation are also discussed. In view of the high precision requirement for navigation assisted procedures, there exists a definite need for development of medical robotics to carry out these procedures. We have a brief review on the different robot systems and present the surgical navigation arm developed in the Chinese University of Hong Kong. The laboratory test results of navigation guided distal targeting of intramedullary nail with or without surgical navigation arm showed the better repeatability and precision when the robot arm was used. So far the surgical navigation arm has been successfully applied in clinical practice, including distal targeting of intramedullary nailing; percutaneous sacro-iliac screw and percutaneous trans-iliac screw in pelvic fractures and hip screw fixation for fracture of femoral neck. To conclude, medical robotics is an essential component of the future CAOS.
ABSTRACT
Rapid progress has been made in computer assisted orthopedic surgery (CAOS) in the last decade. It has been clinically used in nearly every domain of orthopedic surgery. Its clinical benefits are no longer questioned. Because of limitations of devices and technology, CAOS is now facing the following problems today: First, there have been no generally accepted standards for the equipment, operative procedures or evaluation of the results. Secondly, there have been many potential pitfalls due to incorrect use of the devices and incorrect navigational feedbacks. Thirdly, the devices are expensive and the techniques of CAOS are still faulty. To be aware of the problems helps us to understand the technology thoroughly and reduce financial losses and clinical risks in application. Orthopedists should not rush to apply this technology in their operation rooms with no regard of their particular conditions.
ABSTRACT
The International Society for Computer Assisted Orthopaedic Surgery (CAOS-International) is an organization, which aims at bringing together those individuals throughout the world, who, by their contributions and activities in the areas of biomechanical engineering, research, clinical study, and use, have indicated or are indicating interest in computer assisted orthopaedic surgery. CAOS-International has held annual meetings and related workshops and disseminated information to its members either at these meetings or independently, since its foundation in 2001. Its further purpose is to serve as a forum for the exchange of information of both an investigative and clinical nature, which relates to preoperative planning, intraoperative execution, and postoperative follow-up by means of computer assistance. The Society aims at promoting a new partnership between orthopaedic surgeons and technologists as a necessary basis for the successful integration of computer assisted surgical tools and techniques into the daily clinical routine. In China, this integration is at an early stage. Participation in CAOS-International' s activities to obtain the information helps China track the international current development and promote related research.
ABSTRACT
Objective To assess effects and security of the insertion of sacroiliac screws by the bi-planar navigation robot system. Methods In a simulated surgical setup, 12 AO cannulated screws were placed into the S1 vertebral bodies of 4 human pelvic bone under the guidance of the bi-planar navigation robot system which was developed jointly by Beijing Aeronautics and Space University and our hospital. To compare this new technique with the conventional technique, another 12 cannulated screws were placed into 4 Synbone pelvic models under fluoroscopic control. The fluoroscopic times, the radiation exposure time and operation time between image acquisition and guide-wire insertion were recorded. Results With the guidance of the bi-planar navigation robot system, the average fluoroscopic times were 2.5, the average radiation exposure time was 1.5 seconds, and the average operation time was 253 seconds. All the screws were in the safe area. Under the fluoroscopic control, the average fluoroscopic times were 20.3, the average radiation exposure time was 13.7 seconds, and the average operation time was 246 seconds. Two screws (16.7%) were misplaced. The fluoroscopic times and the radiation exposure time were reduced significantly when the bi-planar navigation robot system was used (P0.05). Conclusions The bi-planar navigation robot system can provide precise navigation for insertion of sacroiliac screws within several minutes, and reduce the radiation exposure to the patient and the staff significantly. The results of this prospectively controlled experimental study are encouraging for further clinical trials.
ABSTRACT
Objective To investigate clinical feasibility, security, and effects of cannulated screw fixation of femoral neck fractures aided by the bi-planar navigation robot system. Methods Under the guidance of the robot system which was developed jointly by Beijing Aeronautics and Space University and our hospital, 15 pins were inserted into the femoral necks of 5 Synbone models. The difference between the distance of any 2 points at the entry point and that at the outlet point was measured in the 5 cases. The ratio (P) of the difference to the length of the pin within the femoral neck of the Synbone models was calculated to evaluate how parallel the 2 pins were. The fluoroscopic times and the radiation exposure time in the robot-aided treatment were recorded and compared with those in the 12 cases of conventional operations which were conducted in our department from June to September, 2005. Results P was about 0.003 7 to 0.018 1, and the X-ray exposure time in robot aided system was 2.32 s vs 28.30 s in the conventional operations. The average fluoroscopic times in robot aided system were 4.4 vs 54.3 in the conventional operations. Conclusion As the bi-planar navigation robot system can provide accurate space orientation and stable navigation route, and can decrease the X-ray radiation to the patient and staff, it has a significant value in clinical application.