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目的 验证自主研发的颅底病变穿刺机器人辅助侧颅底肿物穿刺活检的可行性及精确性,为口腔临床机器人研发提供参考.方法 2016年5月至7月在2个人头颅标本(北京大学医学部解剖教研室提供,男性1个,女性1个)颅底颞下区注射碘帕醇模拟肿物,行术前锥形束CT扫描,将影像数据导入手术设计系统,分割肿物影像,选取皮肤进针点及穿刺靶点后生成穿刺路径.完成系统配准后,发送穿刺路径数据至机器人控制系统,在导航仪引导下机器人自动完成穿刺操作(每个标本各10次,左右侧各5次).穿刺完成后导航仪获取穿刺针针尖点即刻位置的坐标,与穿刺靶点坐标相比,计算导航精度.将穿刺针从执行器末端松解,对头颅行术后锥形束CT扫描,将手术前后锥形束CT图像融合,选取术后图像针尖点坐标,与穿刺靶点坐标相比,计算穿刺精度.用配对t检验比较导航精度与穿刺精度的差异,用独立样本t检验比较2个标本的穿刺精度差异.采用皮尔逊相关系数(r)分析穿刺精度与穿刺深度的关系.结果 20次穿刺活检术均1次成功完成.导航精度为(0.67±0.28) mm,穿刺精度为(3.19±0.39) mm,差异有统计学意义(t=-23.238,P＜0.001);两个标本的穿刺精度差异无统计学意义(t=-1.116,P=0.279);穿刺深度为(5.14±0.21) cm.穿刺精度与穿刺深度有较强的相关性(r=0.714,P＜0.001).结论 机器人辅助侧颅底肿物穿刺活检具有高效、可靠的特点.导航精度、穿刺针偏移是影响机器人辅助穿刺活检术的重要因素.

Objective To evaluate the accuracy and feasibility of a custom robot system guided by navigation for lateral skull base tumor biopsy.Methods Two cadaver heads were used,with iopamidol injected into different areas in the skull base and infratemporal region to imitate the tumor.Cone beam CT (CBCT) scanning was performed before operation.With image data transferred to the graphical user interface of the computer workstation,the "tumor"was segmented as the target.The needle trajectory was determined by selecting the skin entry point and the target point on the surgical planning software.Following point-based registration,the data was sent to the robot control unit.The needle was automatically inserted into the intended target by the robot guided by optical navigation.After the procedure was performed,the instantaneous data of needle tip position acquired by navigation system was sent back to the computer workstation for accuracy verification.Subsequently,after the needle was released,CBCT scanning was performed again,and the pre-and post-operative skull were superimposed.The position data of needle tip was acquired on the postoperative image and the accuracy was re-verified.The paired t-test was used to compare the differences in the accuracy calculated by intraoperative navigation and postoperative image fusion.The independent samples t-test was used to compare the accuracy between the cadavers.The Pearson correlation coefficients (r) was used to analyze correlation between the needle intervention accuracy and insertion depth.Results All 20 interventions were successfully performed.The mean deviation of the needle tip was (0.67± 0.28) mm (measured by the navigation system) and (3.19±0.39) mm (measured by image fusion) respectively (t=-23.238,P＜0.001).The comparison of accuracy test showed no significant difference between the cadavers (t=-1.116,P=0.279).Pearson correlation coefficients (r=0.714,P＜0.001) showed the close correlation between the needle intervention accuracy and insertion depth.The mean insertion depth was (5.14±0.21) cm.Conclusions The experimental results show that the robot system is efficient and reliable.The navigation accuracy and the needle deflection are the most significant factors affecting robotic puncture procedures.