考虑耳蜗几何因素的机器人辅助与手动人工耳蜗植入电极阵列插入的比较。

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中文摘要

目的： 本研究旨在比较机器人辅助与手动人工耳蜗植入电极阵列插入在人类颞骨中偶然造成的耳蜗内创伤，并评估耳蜗几何形态对插入结果的影响。
材料与方法： 二十个人类颞骨按耳蜗大小配对，使用HiFocus SlimJ阵列经圆窗插入，分别采用手动或iotaSOFT®插入系统。术后锥形束计算机断层扫描（CBCT）和微型CT用于测量角度插入深度（AID）和耳蜗尺寸，并评估电极阶位置以定义创伤水平。此外，使用耳蜗植入成像工具测量外侧鼓阶高度并估计角度插入深度。
结果： 机器人组未发生阶移位，而手动组发现三例移位。机器人插入的平均创伤评分（0.30±0.48）低于手动插入（0.89±0.93）。手动插入产生的AID（428±82°）显著深于机器人插入（304±47°，p=0.004）。机器人组表现出显著更多的耳蜗外接触（2.3±1.8）比手动组（0.3±0.7，p=0.011）。更大的AID与更严重的创伤相关（r=0.682，p=0.001）。较小的耳蜗尺寸与更深的估计AID和增加的创伤相关。移位病例的外侧鼓阶高度低于非移位病例，表明其对创伤风险的影响。
结论： 机器人辅助人工耳蜗植入相比手动插入导致更少的创伤发生。然而，创伤风险强烈受耳蜗几何形态和插入深度的影响。这些发现表明耳蜗几何形态与插入创伤相关，并可能支持未来患者特异性规划和机器人辅助插入策略以减少创伤。

英文摘要

PURPOSE: Purpose of the present study was to compare the intracochlear trauma coincidentally caused by robotic-assisted and manual cochlear implant electrode array insertions in human temporal bones, and to evaluate the influence of cochlear geometry on insertion outcomes.
MATERIALS AND METHODS: Twenty human temporal bones, paired according to cochlear size, underwent round window insertion with a HiFocus SlimJ array, either manually or using the iotaSOFT® insertion system. Postoperative cone beam computed tomography (CBCTs) and micro-CTs were used to measure angular insertion depth (AID) and cochlear dimensions, and to assess electrode scalar location to define the level of trauma. Additionally, a cochlea implant imaging tool was used to measure lateral scala tympani height and estimate angular insertion depth.
RESULTS: No scalar translocation occurred in the robotic group, whereas three translocations were found in the manual group. Mean trauma scores were lower for robotic insertions (0.30 ± 0.48) compared with manual insertions (0.89 ± 0.93). Manual insertion produced significantly deeper AID (428 ± 82°) than robotic insertions (304 ± 47°, p = 0.004). The robotic group exhibited significantly more extra-cochlear contacts (2.3 ± 1.8) than the manual group (0.3 ± 0.7, p = 0.011). Greater AID correlated with more severe trauma (r = 0.682, p = 0.001). Smaller cochlear dimensions were associated with deeper estimated AID and increased trauma. Lower lateral scala tympani height was found for the translocations compared to non-translocations, indicating an influence on trauma risk.
CONCLUSION: Robotic-assisted cochlear implantation resulted in less trauma occurrence compared to manual insertion. However, trauma risk was strongly influenced by cochlear geometry and insertion depth. These findings indicate that cochlear geometry is associated with insertion trauma and may support future patient-specific planning and robotic-assisted insertion strategies to reduce trauma.