The application research progress of intelligent robot in orthopedics

Rong Fan ,Li-Ang Fan ,Gui-Ying Gao ,Min Zhang ,Gui-Hong Yan

1Jiangsu College of Nursing,Huaian,China.2Criminal Investigation Police University of China,Shenyang,China.3Tianjin University of Traditional Chinese Medicine,Tianjin,China.4Tianjin Hospital of China,Tianjin,China.

Abstract:This paper introduces the application of intelligent robot in orthopedic treatment and nursing research progress,and summarizes the advantages and disadvantages of intelligent robot,the prospect.The aim is to help medical staff understand the basic overview of intelligent robot,and learn cutting-edge knowledge,promote the deep integration of intelligent robot technology and orthopedics field,and provide reference for the future research direction of intelligent robot technology in orthopedics field.

Keywords:intelligent robot;department of orthopedics;nursing

Introduction

Artificial intelligence (AI) is a branch of computer science that involves developing computer programs to accomplish tasks.Artificial intelligence algorithms can solve problems such as learning,perception,language understanding or logical reasoning.Intelligent robots are the bridge between robots and artificial intelligence,which are controlled by artificial intelligence programs.Intelligent robots have the functions of learning,perception,understanding and reasoning [1].At present,intelligent robots are applied to many surgical specialties,including general surgery,gynecology,orthopedics and neurosurgery,especially in the field of orthopedics.In the field of orthopedics,intelligent robots have the advantages of minimally invasive,intelligent,alternative and automation,and have high accuracy,repeatability and durability [2].This paper reviews the research progress,advantages and disadvantages of intelligent robots in orthopedic treatment and nursing.

Application of intelligent robots in orthopedic treatment

Da Vinci intelligent surgical robots are widely used in urology and gynecological surgery.From 2010 to 2017,the use of da Vinci intelligent surgical robots in the United States has almost get better application.Compared with other surgical fields,intelligent robot technology is relatively new for spinal surgery.However,the use of da Vinci intelligent surgical robots has get better application.Spinal surgery usually requires access to important sites through narrow surgical pathways to perform fine surgery and may require long-term repetitive surgery-intelligent robots are ideal for assisting humans to perform surgery [3] 。At present,the most research field of spinal intelligent robot technology is spinal internal fixation,including open surgery and percutaneous thoracolumbar pedicle screw placement.A series study of recent studies showed the rate of screw placement is 96.6%-99%[4-5]，The accuracy of the surgeon's unarmed operation is 93.1 %,and the accuracy of the perspective assisted technology is 91.5 %.In addition to accurate positioning,the new generation of Excelsius GPS spinal robot also has navigation ability.The intelligent robot has the function of real-time image guidance [6].

Intelligent robot systems are currently being used in the field of joint replacement.Early results of single knee arthroplasty and total hip arthroplasty show improved placement accuracy and satisfaction and reduced complications,but further research is needed to confirm the cost-effectiveness of these technologies [7].In spinal tumor diseases,intelligent robot-assisted treatment has attracted more and more attention.Spinal tumor surgery is very suitable for robot-assisted treatment.Da Vinci intelligent robots are mostly used in complex spinal tumors,such as high neck tumors,chest tumors,or presacral tumors.These challenging positions provide opportunities for the use of intelligent robots and greatly reduce the fatigue of operators[8].Robotic system combined with navigation technology has great potential to improve the prognosis of patients and reduce complications [9].

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Intelligent robot was used to assist in the treatment of 17 cases of unstable pelvic fractures.The operation was performed by percutaneous iliac and lumbar double fixation combined with percutaneous pelvic anterior fixation.The Majeed function score was 85-98 at the last follow-up [10].The use of intelligent robot assisted minimally invasive is feasible,and the postoperative effect is good.Arthroscopic examination of the hip joint was performed by the intelligent robot.The intelligent robot successfully examined the neck of the femoral head and the acetabular lip.However,due to the long joint part,the movement of the intelligent robot was limited,and the posterior part of the femoral head and the posterior part of the acetabular lip could not be observed [11].Intelligent robot is also a new method to assist orthopedic rehabilitation treatment.The robot is equipped with a terminal effector,which integrates a virtual game interface and allows patients to exercise their upper limbs.It can help the injured wrist or elbow to perform rehabilitation exercise[12].

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An increasing number of intelligent robots are being developed and will be used in areas such as orthopedic surgery to help doctors provide more accurate judgments,especially in operations requiring fine manipulation that may go beyond manual control.Intelligent robots are replicable in addition to accuracy to help patients achieve better results [16].In a joint replacement operation,8 to 12 therapeutic plates may be required to place surgical instruments.Traditional delivery operations require disinfection of multiple therapeutic plates and a large number of equipment.All equipment takes time to set up,decompose and clean.The loss,replacement,maintenance and maintenance of equipment is an important cost in the medical industry,which is estimated to exceed $ 15 million annually.A 2005 study estimates that the average operating room cost in the United States is $ 66 per minute (and is rising) [17]，Robot technology reduces this medical expenditure.When using robot technology,various surgical operations can be achieved by changing programming.Intelligent robot assisted surgery improves the workflow,reduces the operation time,increases the turnover rate of the operating room and significantly reduces the time spent on the next case.Saving time helps to deal with more things within the working day,which improves the cost utilization of the operating room,staff and equipment.Due to the detailed preoperative planning made before operation,the accuracy was improved in the selection of implant specifications and placement of implants.At the same time,the use of intelligent robot system also reduced intraoperative blood loss and improved the prognosis of patients.Intelligent robots can also be used as a training tool to reduce operating room errors and train trainees,and even enrich the experience of surgeons [18-19].At present,the intelligent robot is also suitable for remote control,and can obtain expert assistance in remote areas.The integration of surgery and telecommunications is one of the main achievements of modern medicine.The development of new technologies in the field of telecommunications provides more possibilities for intelligent robot assisted surgery [20].

Platt Institute of Engineering and Nursing School of Duke University jointly developed a remote intelligent remote control robot to help medical staff solve the problem of ‘high risk of infection due to daily interaction with patients and processing contaminated materials’.At present,the intelligent robot can perform about 60%of the nursing tasks,but its speed is 20 times slower than that of nurses[13].'Sofia'is a social companion robot,which encourages patients to eat healthy food,exercise and participate in social activities to improve the quality of life of elderly patients [14].However,during the use of remote intelligent robots,if the network connection is interrupted,the robot may lose control.Li Hui and other researchers used intelligent robots in orthopedics to provide humanized nursing intervention for 500 patients.The results showed that patient satisfaction was significantly improved,medical experience was improved,and nursing service quality was improved [15].In the future,the role of nurses will evolve into ' becoming an intelligent robot coach to help patients achieve better health and outcomes '.

To date,most robotic systems are in the R &D and experimental stage.To be widely recognized in surgery,intelligent robots must first demonstrate their value in clinical applications and ease of use and provide a cost-benefit ratio [21].Although it is feasible to use intelligent robots for hip arthroscopy,there are also some limitations.It is hoped that with the development of the instrument,robots can conduct detailed inspection of each position of the joint.The parameters of intelligent robots have reached a certain degree of precision and automation through the orthopedic surgery planning designed by big data,but still need to be verified and adjusted,and even require surgeons to re-plan manually.In terms of intelligent robots for orthopedic surgery planning,there is a lack of a mature robot hardware and software platform to help doctors make clinical decisions from preoperative diagnosis to postoperative rehabilitation.In addition,the vast majority of surgeons are faced with heavy surgical tasks,and there is little time for fine surgical planning.Therefore,surgeons who have not received robot surgical training cannot learn to use them in a short time,nor can they use these data for new clinical studies.Due to the failure of the optical camera,the relative displacement or respiratory motion of the bone structure,the operation error and other factors,these factors will affect the fluency of the program or lead to the termination of the program.In trauma orthopedics,the position of the implant is often repeatedly confirmed by intraoperative fluoroscopy,and the robot cannot take into account the factors such as motion parameters and soft tissue.Especially in hip and pelvic surgery,the muscle fascia in soft tissue is thick and the pressure is high.Due to insufficient load,the robot may be protectively closed [22].

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In two papers about 1000 cases of surgery with intelligent robots,the failure rate of robots is about 1 %,and 85.7 % of the factors affecting the accuracy of surgery are related to the operation of surgeons [23-24].Therefore,in terms of risk reduction,in addition to the reliability and intelligence of the robot system,the basic surgical training of surgeons is also very important.It is recommended that medical device regulators,intelligent robot manufacturers and medical service providers work together to strengthen supervision,reduce design flaws and reduce risks due to lack of training [25].For emerging intelligent orthopedic robots,effectiveness,adaptability and low cost have stimulated people ’ s interest in robot-assisted surgery.Orthopedic surgery has formed a sound surgical planning before surgery,improved implant-bone contact during surgery,optimized implant placement,and promoted postoperative rehabilitation of patients,improved surgical workflow,improved efficacy,and shortened surgical time [26-27],It is urgent to establish a comprehensive and systematic risk analysis,safety assessment and risk management system,so as to promote extensive clinical application and promote the development of intelligent orthopedics in the new era.

For residents and surgeons,excessive dependence on machines leads to the degradation of doctors ' surgical skills.It is still important to have the basis of non-machine-assisted surgery.Preoperative surgical simulation by intelligent robots increases the opportunity to practice.Does it make doctors obtain the basis of surgery and improve the surgical technology? More research data is needed to confirm.Cost and profitability are different from cost-effectiveness.Whether machine-assisted technology has cost-effectiveness depends on the extension of patient life or the improvement of function,which still requires a lot of research to confirm whether machine-assisted technology has high cost-effectiveness.In short,with the increasing population,the gap between medical staff is huge,and the workload is heavy.The introduction of intelligent orthopedic robots can help solve more orthopedic problems,which will become a new trend in the future development of orthopedics.Intelligent robots have broad application prospects in the future,and make them easier to use,lightweight,in line with the new trend of ergonomic and telecommunications development,so as to be more intelligent,safer and easier to use in clinic.With the development of new technologies such as intelligent robots,nursing work will be affected.Technology will change the way of nursing,but the demand for nurses will still exist.Nurses will become information collectors,robot instructors and transmitters of nursing services.Nursing services will be supported by artificial intelligence technology without being replaced by artificial intelligence technology.At present,there are intelligent chatbots,child care robots,elderly care robots and automatic patient care robots in nursing [28-31].Intelligent pain management can improve work efficiency of nurses and the pain status，shorten length of stays of the post lumbar surgery patients [32].Under the background of the era of intelligence,nursing career can not stand still and needs to be continuously developed.Artificial intelligence will be more conducive to the development of nursing work,save manpower and improve work efficiency.Artificial intelligence is of great significance for the development of clinical nursing work and the improvement of nursing quality.