Before surgery, it passes the imaging examination such as CT in the evening in advance, and quickly models after reading the examination results. The patient's surgical area, surgical entrance and even the entry angle of the instruments and artificial joints are clearly planned. During the operation, the chief surgeon is assisted to carry out joint replacement throughout the process to ensure that the fit of the joint and joint mortar reaches a tight suture. After the operation, it can even assist the doctor to close the wound and measure the length of the leg on the surgical side to avoid the embarrassment of one foot long and one foot short caused by unilateral replacement of the joint...
On September 24, an intelligent robot named "Mako" officially "started" in the operating room of the First Affiliated Hospital of Jinan University, under the guidance of Professor Zha Zhengang, the leader of the discipline, and with the support of Vice President Zheng Xiaofei, the leader of the hospital, Liu Ning, director of the "Mako" intelligent robot assisted orthomotor surgery, successfully replaced the artificial hip joint for an 84-year-old man with femoral neck fracture, which took only 38 minutes. The elderly can move in bed on the day of surgery and get out of bed the next day to walk.
It is reported that this operation is the first time that this intelligent robot named "Mako" has been applied in South China. The original extensive, jingling orthopedic and osteoarticular surgery has been transformed into a high-tech clinical application with precise navigation. Complex and painstaking orthopedic surgery is moving towards digitalization, precision and personalization.
The elderly encountered a "fatal" fracture
Sparse bone mass makes surgical correction difficult
The 84-year-old elderly suffer from one of the fractures that the elderly group fear most, the fracture of the femur neck. Because the bone is loose and brittle, the femur, which supports walking, is fractured, and the fracture position is also located at the awkward femoral neck.
Before minimally invasive osteoarthral surgery, similar fractures were fatal. On the one hand, the elderly are difficult to get surgical treatment with the open surgery that has been open and closed in the past; on the other hand, this fracture will make the elderly incapacitated, pressure ulcers, cardiopulmonary function decline as a shadow, and accelerate the death of patients. With the progress of artificial joint replacement, similar elderly people can get a good recovery as long as they replace the hip joint on the fractured side in time.
"But the bone of the elderly is brittle, and inexperienced doctors are particularly prone to messing up the operation, causing some unnecessary iatrogenic damage." Liu Ning said that for example, the positioning depth of the joint mortar, and then the angle of joint implantation, extension. This requires a wealth of experience and proficiency in human anatomy, "it takes at least 10 years of experience for a general orthopedic surgeon to grow into a doctor of joint orthopedics." ”
Also because after the joint replacement, it may lead to the shortening or prolongation of the leg on the diseased side, which will bring the patient a feeling of long and short feet if it exceeds 5 mm compared with the normal leg.
"Hip replacement is becoming more and more common in the elderly, but the experts and doctors who can carry out this replacement surgery are growing slowly, and the training cycle is too long."
After the systematic evaluation of Liu Ning's team, it was clear that the artificial total hip replacement with extreme precision and stability was needed to solve her pain, and before the operation, Mako intelligent robot quickly estimated the size and joint model required by the elderly in advance, and assisted the whole process of this total hip replacement surgery.
After the robot assists in planning the surgical plan
The operation will be completed with minimal error assistance on the operating table
The problem of the long learning cycle of specialists is also found in some developed countries of medical technology. So the orthopedic intelligent surgical robot "Mako" was developed and applied to the clinic. And two years ago it was allowed to enter the application of our country.
With the assistance of this robot, international and domestic orthopedic teams have found an unexpected benefit. That is to greatly shorten the training time of specialists. "After six months of training, orthopedic surgeons can get hands-on. High-precision hip replacement surgery, with the assistance of robots, can also be performed by some young doctors. Liu Ning said that before operating the first robot-assisted surgery, he also received strict training and passed the assessment to take up his post.
As long as the robot is allowed to read the patient's imaging results, it can assist the doctor in planning the operation. The angle, depth, and even where the opening of the artificial joint is implanted are planned. Doctors can simulate surgery in advance by planning the route, and during the operation, the determined depth, angle and even force are monitored by robots throughout the process. "When the angle error exceeds 5 degrees, the robot arm will stop working, ensuring that the operation is back on the right path. The robot can also instantly alert the molar prosthesis to the depth of the molar until the implant is tightly placed in the intended position. ”
Taking the elderly who underwent the operation as an example, the accurate data measurement of the patient's double lower limbs was strictly carried out before the operation, and the measurement data was imported into the robot system and simulated, and the robot carried out 3D intelligent modeling based on CT to generate a personalized surgical plan for the patient. Accurately measure the size and position of implanted prostheses, and further realize the digitization, precision and personalization of hip replacement surgery.
The patient was pushed into the operating room as scheduled, and based on its precise preoperative design, the Mako intelligent robot accurately positioned and guided by the robotic arm, the hip prosthesis was accurately placed in the patient's body, and the double lower limbs were restored to the same length, and the surgical process was smooth. Through the whole process of digital navigation, intelligent human-computer interaction, perfect control of surgical accuracy, can effectively reduce the operation errors of traditional surgery, improve the standardization, precision, minimally invasive, efficient, intelligent and personalized level of surgery. In just 38 minutes, Liu Ning and his assistants successfully completed a total hip replacement for the elderly. The elderly can move the surgical side thighs in the hospital bed on the same day, and the next day they can walk under the support of assistive devices.
It is reported that Mako intelligent robots have been installed and put into clinical application in 26 countries and regions such as the United States, the United Kingdom, the European Union, Australia, Japan, South Korea, Singapore, Thailand, Chinese mainland, Hong Kong, and Taiwan. The system has played steadily under a large number of surgeries and has been recognized and respected by the use of hospitals and orthopedic experts.
"Previously, hip replacement surgery required at least one main knife and three assistants. With robots, you can reduce one assistant. Its advantage in knee replacement is even greater, and with the assistance of robots, a single operation can even be completed with only one surgeon. ”
Liu Ning said that he believes that in the future, with the assistance of intelligent robots, the digitization, precision and personalization of joint replacement surgery will be realized, and better serve the friends of patients, hoping that more patients will enjoy the precision treatment brought by artificial intelligence.
Written by: Nandu reporter Wang Daobin intern Ye Ying
Correspondent Zhang Cancheng