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강성식(Sung Shik Kang),이동봉(Dong-Bong Lee),김호중(Ho-Joong Kim),염진섭(Jin S. Yeom) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.6
컴퓨터 지원 척추 수술은 척추외과학과 컴퓨터 공학, 기계 공학이 융합되어 탄생된 새로운 학문의 분야이다. 수술 전 지원 방법으로는 수술 모사가 대표적이며, 수술 중 지원 방법으로는 수술장 내 항법장치와 수술용 로봇이 대표적인 예이다. 수술 모사는 임상과 기초 연구 분야의 연구에 활용되고 있다. 현재 척추 분야에서의 항법장치는 척추나사 삽입 지원에 사용되고 있으나, 정확도의 한계와 고가의 장비 구매에 대한 부담감으로 인해 널리 이용되지는 않고 있다. 향후 컴퓨터 지원 척추 수술은 최소침습 척추 수술과 결합된 형태로 발전할 가능성이 높다. 향후 실제 임상 적용의 정확도, 임상 결과, 비용 편익 분석 등의 연구가 필요하다. Computer-assisted spine surgery (CASS) is a new discipline involving application of computer engineering and mechanical engineering to spine surgery. The tools used most commonly include preoperative surgical simulation, intraoperative navigation, and robot-assisted surgery. Surgical simulation has been utilized for both clinical and basic research. Navigation in spine surgery has focused on guidance of screw placement, however, due to limited accuracy and high cost, its use is somewhat sparse. CASS may be combined with minimal invasive spine surgery in the near future. Further validation of clinical accuracy issues and surgical outcomes as well as cost-benefit analysis is required.
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The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications
( Jun-dong Chang ),( In-sung Kim ),( Atul M. Bhardwaj ),( Ramachandra N. Badami ) 대한고관절학회 2017 Hip and Pelvis Vol.29 No.1
In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.
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김강일 ( Kang Il Kim ),유기형 ( Kee Hyung Rhyu ),조계열 ( Kye Youl Cho ),허대석 ( Dae Seok Huh ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4
Despite the overall satisfactory results of total hip arthroplasty, post-operative complications continue to occur. To minimize these problems, computer-assisted total hip arthroplasty using navigation or robot-assisted systems is being developed. A navigation system is defined as a system that locates a position in three-dimensional space and traces the target spot, and a robot-assisted system is defined as a system that performs operations automatically with mechanical robot arms based on prior preoperative planning. Computer-assisted surgeries have shown superior results to conventional methods in implant positioning, fixation, and accurate lower extremity alignment in the limited reports available. However, computer-assisted surgeries take longer compared to conventional methods. Due to the extra time needed, the risk of postoperative infection and blood loss is considered to be higher. Nevertheless, robot-assisted system is being developed for the field of hip arthroplasty, and thus its efficacy and accuracy needs to be further investigated. Since these methods have other advantages compared to conventional methods, they are the focus of much interest.
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Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases
Wei Tian,Mingxing Fan,Cheng Zeng,Yajun Liu,Da He,Qi Zhang 대한척추신경외과학회 2020 Neurospine Vol.17 No.1
Objective: The purpose of this study was to determine the efficacy and feasibility of 5th generation wireless systems (5G) telerobotic spinal surgery in our first 12 cases. Methods: A total of 12 patients (5 males, 7 females; age, 23–71 years) with spinal disorders (4 thoracolumbar fractures, 6 lumbar spondylolisthesis, 2 lumbar stenosis) were treated with 5G telerobotic spinal surgery. Sixty-two pedicle screws were implanted. Results: All patients had substantial relief from their symptoms. Screw placements were classified using Gertzbein-Robbins criteria. There were 59 grade A, 3 grade B. Mean operation time was 142.5±46.7 minutes. Mean guiding wire insertion time was 41.3±9.8 minutes. The deviation between the planned and actual positions was 0.76±0.49 mm. No intraoperative adverse event was found. Conclusion: 5G remote robot-assisted spinal surgery is accurate and reliable. We conclude that 5G telerobotic spinal surgery is both efficacious and feasible for the management of spinal diseases with safety.
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