隨著醫療科技的進步，經皮脊椎微創手術可部分取代治療脊椎相關疾病的開放式手術，這類術式的優點在於傷口小、失血量少、復原時間短。本研究以經皮椎弓根導引手術與經皮內視鏡椎間盤切除術的導引裝置雛型系統為發展目標，協助術者更精準快速的找到病灶所在，適應症包含治療腰椎的椎孔狹窄、腰椎滑脫、椎體骨折，與椎間盤突出等腰椎微創手術。
傳統經皮脊椎微創手術過程須不斷拍攝C-arm影像確認導針進針的路徑，醫病雙方恐有過量輻射的風險。本研究開發的腰椎最小侵入式經皮系統可降低C-arm拍攝張數，改良YESS腰椎內視鏡椎間盤切除術流程，為改善前期研究導引機構固定性不佳的問題，原先放置於病患背後皮膚表面之機構設計改以固定於手術床上，增加整體機構剛性，並整合前期經皮椎弓根導引規劃技術到椎間盤內視鏡導引規劃軟體，透過軟體計算獲得硬體機構雙平移雙旋轉參數，以機構實現實體進針路徑。
透過獨立實驗檢測軟體計算上，以及20cm導針於硬體機構上導針與規劃路徑的誤差，分別為0.921±0.243mm與1.428±0.3mm，加總系統最大誤差2.349mm。以假體實驗模擬椎間盤切除術獲得針尖點誤差3.17±0.56mm，假體實驗C-arm平均拍攝張數7.23±0.41次，實驗平均耗時513.5±20.7秒。比較醫師以傳統方式與使用本導引系統進行一次規劃與導引4個腰椎間盤的結果，針尖點平均誤差由4.02±1.70 mm降至3.24±0.41 mm，C-arm拍攝張數由25.75±5.91張降至10±1.41張，平均耗時分別為512.25±77.71秒與556.25±30秒。以本研究定義目標針尖點誤差分級，於可接受誤差範圍2mm的等級I與等級II，比例由25%提升至37.5%。

Due to the advancement of medical technology, percutaneous spinal minimally invasive surgery can replace traditional surgery for the treatment of spine-related pathologies. The advantages of this kind of surgery include small wounds, low blood loss and accelerated recovery time. This study is aimed to assist the surgeon to locate the symptom more accurately and quickly for percutaneous pedicle-guided surgery and percutaneous endoscopic discectomy. The indications include the treatment of the lumbar vertebral foramen Lumbar spine minimally invasive surgery such as stenosis, lumbar spondylolisthesis, vertebral fracture, and intervertebral disc herniation.
In traditional percutaneous spinal minimally invasive surgery, C-arm images must be taken continuously to confirm the path of the guide needle. The surgeon and the patient may be at risk of excessive radiation. The minimally invasive percutaneous system for the lumbar spine developed in this research, which is an improved YESS lumbar endoscopic discectomy procedure, can reduce the number of C-arm shots and eliminate the problem of poor fixation of the guiding mechanism in the previous research; it was originally placed on the skin. The new mechanism can be fastened to the operating table to enhance its rigidity. The percutaneous pedicle guidance planning technology was integrated into the intervertebral disc endoscopic guidance planning software, and obtain the dual translation and dual rotation parameters of the hardware mechanism through software calculations. The mechanism then realizes the physical needle path.
Through independent experiments to test the software calculation, and the 20cm guide needle on the hardware mechanism, the error between the guide needle and the planned path is 0.921±0.243mm and 1.428±0.3mm, respectively, and the total system maximum error is 2.349mm. The prosthesis experiment that simulated the discectomy to obtain a needle point has an error of 3.17±0.56mm. The average number of C-arm images taken during the prosthesis experiment was 7.23±0.41 shots, and the experiment took an average of 513.5±20.7 seconds. Comparing the conventional planning method on all four lumbar intervertebral discs by a physician to our system, the average needle tip error has decreased from 4.02±1.70 mm to 3.24±0.41 mm using our system; the number of C-arm images has decreased from 25.75±5.91 to 10±1.41. The average time is 512.25±77.71 seconds and 556.25±30 seconds, respectively. The target needle point error grading is defined in this research. The ratio of grade I to grade II within the acceptable error range 2mm has increased by 25% to 37.5%.

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