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Computer-assisted spine surgery
计算机辅助脊柱手术
Introduction(介绍)
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.
计算机辅助脊柱外科手术使外科医生能看到手术器械相对于患者脊柱的位置的三维图像，增加手术的精确性和安全性。器械跟踪技术与GPS卫星跟踪路上汽车的方法相似。从三维视角观察并跟踪器械的能力有助于精准靶向定位、精准测量，并在脊柱外科手术中精确操作，具有裸眼所不具备的优点。
Components (Part 1)组件(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.
计算机辅助脊柱外科手术系统包括四个主要部件：数字照相机阵列和计算机、智能化手术器械、软件以及显示器。数字照相机阵列使用红外信号，通过计算机追踪手术器械相对于脊柱的位置。智能手术器械包括无线设备，比如用于探测的椎弓根感知器，用于在骨头里钻孔或扩孔的锥子，以及连到椎体上的患者脊柱跟踪定标仪，确保既使患者位置变动后3D图像仍保持精确。用脊柱跟踪定标仪保持脊柱细节的更新可减少或降低术中需要获取的图像的数量。
Components (2)组件(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.
计算机辅助脊柱外科手术系统使用复杂的、直观的软件通过术前或术中获得的相关影像来创建患者脊柱的三维图像，并在手术开始时用仪器进行校准。软件还能跟踪并显示智能手术器械的位置和轨迹线。显示器为外科医生提供交替、实时的脊柱三维图像，可以变焦放大、旋转，很好地扩展了显示手术视野周围的能力。
Preparation(准备)
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.
在脊柱手术前，从CT(计算机断层扫描)或MRI(磁共振成像)扫描所得的影像被导入到计算机。软件读取图像数据并准备患者脊柱的三维的虚拟图像。从而外科医生可以研究图像并预先制订详细计划，比如内植物的正确尺寸，将螺钉打入骨头的最佳轨迹。将手术室设置好，并安装照相机以追踪器械和脊柱的位置。为保持虚拟图像与实际病人解剖的直接匹配，用软件选择一系列的点，手术开始时在患者脊柱上对这些点进行识别。
Registration(注册)
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.
将实际的脊柱解剖结构与虚拟图像相匹配称为注册。手术开始先作切口，将患者脊柱跟踪器夹在椎骨上。此步骤可确保相机检测到任何脊椎运动。接下来，通过一步验证过程识别智能仪器进行跟踪。一旦识别出仪器，按顺序接触软件中先前选择的点。当仪器与注册点接触时，相机会跟踪，软件会进行计算，以确保虚拟图像的准确性。
Procedure (1)手术步骤(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.
一旦简短的注册过程完成之后就可以进行手术。外科医生同时能够看到显露好的实际的脊柱解剖和显示器上的三维图像。能得到各种各样不同的角度和视图，包括来自于器械尖端的工具眼。除了可以追踪和确定智能手术器械位置，在显示器上还能显示轨迹线，这有助于工具的准确定位。在这例中，将在椎体的椎弓根区域拧入螺钉。这样做是为了在椎间盘部分切除后用内植物稳定脊柱。
Procedure (2)手术步骤(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.
用软件测量并确定椎弓根螺钉合适的进钉点后，用示踪锥开口，钻头联合通用示踪器可显示钻头的位置和深度，使钻孔足够深来接纳椎弓根螺钉。在每枚螺钉拧入骨头之前，重复这个过程。然后，在安装用于稳定脊柱的金属棒之前，将智能手术器械撤除。最后，关闭切口，完成手术。
Summary(总结)
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.
计算机辅助脊柱外科手术使外科医生在术中能够相对于患者脊柱的3D图像积极跟踪器械。这一技术能够提供术前规划，实施精准的测量和定位，以及可视化的内植物轨迹。计算机辅助脊柱外科手术提高了效率，降低了手术室占用时间，同时增加了技术性很强的脊柱外科手术的安全性。
(高晨珉 转)
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