机器人辅助耳硬化症手术中镫骨的松动与脱位：力与距离分析。

文献信息

中文摘要

目的： 评估在颞骨标本中进行机器人辅助镫骨松动和镫骨前庭脱位时所施加的力和距离。
方法： 将12具尸体人颞骨的内耳通过上半规管和內耳道在10 cm H₂O的受控静水压下填充亚甲蓝染料。用羟基磷灰石骨水泥固定镫骨足板。进行机器人辅助镫骨松动，直至镫骨可在环状韧带无液体渗漏的情况下自由活动，随后进行镫骨前庭脱位直至发生液体渗漏。六轴力传感器（Nano17，ATI）记录每次操作期间的峰值力（N）。还测量了器械抵靠砧骨长突的距离（mm）。
结果： 镫骨松动和镫骨前庭脱位分别需要最大力1.4 ± 0.18 N和2.6 ± 0.31 N（p = 0.0054，Mann-Whitney检验）。镫骨松动和镫骨前庭脱位的距离分别为1.5 ± 0.24 mm和1.9 ± 0.13 mm（NS，Mann-Whitney检验）。砧骨脱位发生在四次操作中，力为2.0 ± 0.61 N，距离为2.5 ± 0.59 mm。
结论： 在本研究的实验条件下，成功的镫骨松动似乎与在镫骨平面内的操作以及通常分别低于约1.5 N和1.5 mm的力和距离相关，需要进一步的临床验证。

英文摘要

PURPOSE: To evaluate the forces and distances applied during robot-assisted stapes mobilization and stapedovestibular luxation in temporal bone specimens.
METHODS: The inner ear of 12 cadaveric human temporal bones was filled with methylene blue dye via the superior semicircular canal and internal auditory canal under a controlled static pressure of 10 cm H₂O. The stapes footplate was fixed with hydroxyapatite cement. Stapes robot-assisted mobilization was performed until the stapes could be freely mobilized without fluid leakage at the annular ligament, followed by stapedovestibular luxation until fluid leakage occurred. A six-axis force sensor (Nano17, ATI) recorded peak forces (N) during each manipulation. Distance (mm) of the tool against the long process of the incus was also measured.
RESULTS: Stapes mobilization and stapedovestibular luxation required maximal forces of 1.4 ± 0.18 N and 2.6 ± 0.31 N (p = 0.0054, Mann-Whitney test), respectively. Distance was 1.5 ± 0.24 mm and 1.9 ± 0.13 mm for stapes mobilization and stapedovestibular luxation, respectively (NS, Mann-Whitney test). Incus luxation happened in four manipulations at a force of 2.0 ± 0.61 N and distance of 2.5 ± 0.59 mm.
CONCLUSION: Under the experimental conditions of this study, successful stapes mobilization appeared associated with manipulation within the stapes plane and forces and distances generally below approximately 1.5 N and 1.5 mm, respectively, requiring further clinical validation.