神经外科颅骨磨削温度场预测新模型

基于恒定热流密度的温度场理论计算值与实际温度值的误差较大,是当前磨削温度场理论研究的瓶颈。建立了不同冷却条件下的对流换热系数及材料内部的热传导模型,通过实时采集动态磨削力,利用高次高斯函数拟合建立了动态热流密度模型,并以此为基础建立了神经外科骨磨削温度场预测新模型。在干式磨削、喷雾式及纳米粒子射流喷雾式冷却条件下对骨磨削温度场进行了数值分析,并采用与人体颅骨力学性能最相近的新鲜牛股骨密质骨,采用羟基磷灰石纳米粒子及生理盐水进行了试验验证。结果表明,与试验测得温度值相比,采用基于恒定热流密度的温度场模型计算的温度值误差为18.8%,而采用新模型计算的温度值误差为6.6%,理论分析与试验结果吻合,即骨磨削温度场预测新模型更符合实际工况。     

医疗机器人技术发展综述

医疗机器人在过去几十年获得了飞速发展,根据医疗机器人的功能和用途将医疗机器人分为:神经外科机器人、骨科机器人、腹腔镜机器人、血管介入机器人、假肢外骨骼机器人、辅助康复机器人和胶囊机器人。分别对当前已经商用化的代表性的医疗机器人做了介绍,对其功能、主要技术指标、优缺点做出对比和描述。探讨医疗机器人当前主要的前沿研究问题,对医疗机器人关键技术和难点问题做出分析和讨论,对医疗机器人未来的发展方向和机遇做了展望。     

脑外科机器人控制系统的设计和实现

从无框架立体定向脑外科手术的临床需求出发,设计了微创神经外科机器人黎元BH 600的控制系统．分析确定了系统的控制结构及实施方案,对脑外科机器人的硬件和软件进行了设计,建立了脑外科机器人手术规划和控制平台．通过实验和临床应用结果,验证了该手术控制系统的高精度和稳定可靠性．     

Live delivery of neurosurgical operating theater experience in virtual reality

A system for assisting in microneurosurgical training and for delivering interactive mixed reality surgical experience live was developed and experimented in hospital premises. An interactive experience from the neurosurgical operating theater was presented together with associated medical content on virtual reality eyewear of remote users. Details of the stereoscopic 360‐degree capture, surgery imaging equipment, signal delivery, and display systems are presented, and the presence experience and the visual quality questionnaire results are discussed. The users reported positive scores on the questionnaire on topics related to the user experience achieved in the trial.     

GPU-accelerated elastic 3D image registration for intra-surgical applications

Local motion within intra-patient biomedical images can be compensated by using elastic image registration. The application of B-spline based elastic registration during interventional treatment is seriously hampered by its considerable computation time. The graphics processing unit (GPU) can be used to accelerate the calculation of such elastic registrations by using its parallel processing power, and by employing the hardwired tri-linear interpolation capabilities in order to efficiently perform the cubic B-spline evaluation. In this article it is shown that the similarity measure and its derivatives also can be calculated on the GPU, using a two pass approach. On average a speedup factor 50 compared to a straight-forward CPU implementation was reached.     

枕下正中经小脑延髓裂锁孔人路的显微外科解剖学和量化评价

目的 应用神经导航系统进行尸头颈解剖量化评价枕下正中经小脑延髓裂锁孔人路,探讨其可行性和手术适应证.方法 将6具10%甲醛固定的尸头颈标本,经有色乳胶灌注后用于实验,首先行枕下正中经小脑延髓裂锁孔入路解剖,观察各个步骤显露的解剖结构,第四脑室底的面积和中脑导水管下口与双侧外侧孔连线与正中沟交点处的垂直和水平观察角度,与去除寰椎后弓后的参数比较;并与扩大骨窗成常规人路时寰椎后弓去除前后的相应参数作比较.结果 通过调整尸头颈标本位置和显微镜的投射角度,枕下正中锁孔入路下分离小脑延髓裂后可逐层显露脉络膜、下髓帆、第四脑室底、侧隐窝、外侧孔、小脑下蚓部及中脑导水管开口.虽然锁孔入路下角度显露不如常规入路下宽(P<0.01),但显露第四脑室底的面积与常规入路下差异无统计学意义(P>0.05).去除寰椎后弓也不能增加锁孔人路下第四脑室底的显露面积(P>0.05),但可增加各点垂直观察角度(P<0.05),对水平观察角度没有影响(P>0.05).结论 枕下正中经小脑延髓裂锁孔入路与常规入路具有相似的显露面积,可以安全、微创地进行第四脑室内、脑桥延髓背侧以及小脑下蚓部等部位肿瘤手术.     

基于虚拟现实的计算机辅助立体定向神经外科手术系统

介绍了一个计算机辅助立体定向神经外科手术系统,该系统基于实时可视化绘制、机器人和虚拟现实技术,辅助医生完成立体定向神经外科手术,系统首先利用患者脑部的扫描数据重构并绘制出患者脑部的三维组织结构,为医生调整和确定手术规划提供参照。系统采用了标记点的校准方法,在手术前和手术中分别进行脑部模型和患者的坐标校准。通过机械臂的导航,使机械壁达到了手术规划规定的位置和姿态,医生利用安装在机械臂上的手术器械完成     

Surgical tool motion during conventional freehand and robot-assisted microsurgery conducted using neuroArm

Surgical tool motion during microsurgery could arguably reflect surgical performance. This paper reports on how the motion of a surgical tool correlates or differs between conventional freehand surgery and robot-assisted surgery. In this pilot study, components of the position and orientation as well as the linear and angular velocities of a surgical tool, over the same period of operation, are compared during the two scenarios. For freehand surgery, a bipolar forceps is retrofitted with a tracking system to measure translational and rotational components of the tool motion. In robot-assisted surgery, the position and orientation components are obtained using kinematics of the neuroArm image-guided robotic system. A cross correlation analysis was used to investigate correlation between each pair of displacement or velocity components from freehand and robot-assisted scenarios to indicate how strongly or weakly two sets of data are linked together. The absolute maximum value of the cross correlation coefficient is calculated for each pair of components to quantitatively investigate the correlation between two sets of data. Results showed that the positional and rotational components, reflecting the surgical workspace, in both scenarios are correlated. However, for the cases studied, surgical tool rate of motion differs between the two scenarios. Results are important as they can be utilized to design robot-assisted neurosurgical systems that reflect characteristics of freehand surgery gained by surgeons through years of training, knowledge, and experience.     

微量泵在神经外科患者针对性干预中的应用效果观察

目的:观察基于循证导向的针对性干预在神经外科患者微量泵使用中的效果。方法:纳入安徽医科大学附属六安医院神经外科2019年1月~2020年12月期间80例使用微量泵注射的患者作为研究对象,采用随机数字表法分为观察组、对照组各40例,对照组实施常规干预,观察组实施基于循证导向的针对性干预。比较两组患者对微量泵的心理接受程度,不良感受,风险事件发生率及护理满意度。结果:干预后,观察组患者对微量泵主动接受率高于对照组(P<0.05);观察组患者排斥、烦躁、不安全、恐惧等不良感受发生率均低于对照组(P<0.05);观察组药液外渗、针头脱落、静脉炎总发生率低于对照组(P<0.05);观察组患者护理总满意度高于对照组(P<0.05)。结论:神经外科患者微量泵使用中实施基于循证导向的针对性干预可提高患者心理依从性,改善其不良感受,减少护理风险时间,提高护理满意度。     

神经外科病人术后ICP增高与高碳酸血症的临床相关性研究

目的：探讨NICU术后持续ICP监测病人发生ICP升高的临床意义及其与术后高碳酸血症的相关性。方法：对428例行神经外科开颅手术并安装颅内皮层下颅内压探头的NICU患者,术后给予持续颅内压监测,进行血气分析,判断有无CO2潴留、高碳酸血症。结果：153例患者术后有ICP升高,其中32例患者血气分析结果提示CO2蓄积,占20．91％;改善患者通气情况,及时纠正高碳酸血症可有效降低ICP。结论：术后ICP水平与机体CO2潴留、高碳酸血症的严重程度呈正相关。