與Lehman教授在北京會(huì)面

The most exciting innovations in spine today & tomorrow don't include implants: Key thoughts from Dr. Ronald Lehman

內(nèi)固定技術(shù)并不會(huì)是今后脊柱外科領(lǐng)域最令人興奮的進(jìn)展之一—Ronald Lehman

Ronald Lehman, MD, director of degenerative, minimally invasive and robotic surgery at NewYork-Presbyterian Och Spine Hospital in New York City discusses the big trends and opportunities in the spine arena.

Ronald Lehman作為一位醫(yī)學(xué)博士和紐約長(zhǎng)老會(huì)脊柱醫(yī)院退變·微創(chuàng)·機(jī)器人輔助外科部門(mén)的負(fù)責(zé)人介紹了現(xiàn)今脊柱外科領(lǐng)域的風(fēng)向與機(jī)遇

Question: What emerging technology or technique do you think will have the biggest impact on the spine field five years from now?

問(wèn)：您認(rèn)為在未來(lái)的五年內(nèi)哪些科技或技術(shù)能夠在脊柱領(lǐng)域產(chǎn)生最大的影響力？

Dr. Ronald Lehman: The biggest impact on the field of spine surgery over the next two to five years will be the increased utilization of robotic assistance, navigation guidance and surgical synergy. This is an exciting time for the field of spine surgery, as many of our industry partners are actively pursing the use of 'assist technologies' to help make spine surgery: 1) safer, 2) more efficient, 3) more accurate, and 4) more reproducible for all spine surgeons.

Dr. Ronald Lehman:在未來(lái)2-5年內(nèi)，更多的機(jī)器人輔助技術(shù)、導(dǎo)航技術(shù)和外科優(yōu)勢(shì)協(xié)同會(huì)脊柱領(lǐng)域產(chǎn)生巨大的影響力。這對(duì)于脊柱外科來(lái)說(shuō)是一個(gè)風(fēng)生水起的時(shí)代，很多學(xué)者和機(jī)構(gòu)都致力于開(kāi)發(fā)相關(guān)輔助技術(shù)使得脊柱外科手術(shù)：1）更安全，2）更有效率，3）更加精準(zhǔn)，和4）對(duì)于所有脊柱外科醫(yī)生有更高的可重復(fù)率。

 脊柱外科領(lǐng)域部分最新技術(shù)

Additionally, robotic assistance and navigation are currently being combined into one system, thereby allowing the surgeon and their team to have the best of both worlds. Also, planning software and enabling technologies are actively assisting surgeons to carefully plan their cases preoperatively. Some of these planning tools are incorporated into the robotics platform, thereby allowing true 'surgical synergy' to allow the surgeon and team to begin with planning, culminating with accurate execution in the operating room. 

機(jī)器人輔助脊柱手術(shù)規(guī)劃系統(tǒng)

另外，機(jī)器人輔助技術(shù)和導(dǎo)航技術(shù)目前正在整合成為一個(gè)系統(tǒng)。因此能夠使得脊柱外科醫(yī)師和團(tuán)隊(duì)在兩個(gè)領(lǐng)域都有更好的體驗(yàn)。而且軟件的設(shè)計(jì)和技術(shù)的推動(dòng)可以積極地輔助外科醫(yī)師在術(shù)前更仔細(xì)的規(guī)劃。一些規(guī)劃工具已經(jīng)和機(jī)器人平臺(tái)相結(jié)合，這樣可以讓外科醫(yī)師及團(tuán)隊(duì)進(jìn)行規(guī)劃，在手術(shù)室里更加精準(zhǔn)的操作，做到真正的外科優(yōu)勢(shì)協(xié)同。

朝陽(yáng)骨科開(kāi)展機(jī)器人輔助脊柱畸形手術(shù)

This allows us to perform more minimally invasive spine surgery with more accuracy, and with better techniques, so that we can execute a fusion, decompression of interbody fusion in much the same fashion as standard, traditional open techniques; but with smaller incisions.

這可以使得我們利用更高級(jí)的技術(shù)在微創(chuàng)脊柱手術(shù)中做到更加精確，甚至可以做到用比傳統(tǒng)開(kāi)放手術(shù)更小的切口做和開(kāi)放手術(shù)一樣的融合，椎間融合減壓。

朝陽(yáng)骨科自主創(chuàng)新的PE-TLIF技術(shù)

實(shí)現(xiàn)了“微創(chuàng)置釘減壓融合”的突破 

朝陽(yáng)脊柱團(tuán)隊(duì)參與研發(fā)

世界首臺(tái)光磁一體脊柱手術(shù)導(dǎo)航系統(tǒng)

朝陽(yáng)骨科脊柱團(tuán)隊(duì)開(kāi)展顯微微創(chuàng)脊柱手術(shù)

Another exciting concept is that as these technologies evolve, there will be an increased ability for these systems that utilize segmentation and alignment registration to begin to perform additional aspects of the surgery in addition to pedicle screw placement. This will really allow our field to evolve, similar to other surgical specialties that have been using this technology for over a decade.

另外一個(gè)令人欣喜的是隨著這些技術(shù)不斷發(fā)展，這些系統(tǒng)會(huì)有更大的潛力去分割和標(biāo)準(zhǔn)化除了椎弓根釘置入以外的手術(shù)其他方面。這會(huì)真正使得我們的領(lǐng)域就像其他已經(jīng)利用這樣技術(shù)的外科領(lǐng)域一樣得到進(jìn)化。

Furthermore, there is a growing understanding of using predictive modeling, risk stratification and artificial intelligence to predict which patients will have good outcomes after surgical intervention. By understanding and mitigating risk factors, we can better optimize and predict patient-reported outcome measures, therefore allowing us to have better dialogue and understanding to tell patients what the 'real' risks are for various surgeries.

還有越來(lái)越多的人選擇用預(yù)測(cè)模型，危險(xiǎn)分級(jí)和人工智能去預(yù)測(cè)哪些患者在手術(shù)干預(yù)之后會(huì)有更好的預(yù)后。充分了解并降低風(fēng)險(xiǎn)因素，使我們能更好地利用患者自我報(bào)告結(jié)局估量結(jié)果。在與患者溝通的時(shí)候才能告訴他們不同的手術(shù)方案真正的風(fēng)險(xiǎn)都是什么。

Q:What do you think will fade or disappear from the spine field over the next few years?

問(wèn)：您認(rèn)為在未來(lái)幾年哪些技術(shù)會(huì)逐漸退出舞臺(tái)呢？

RL: It is always difficult to predict if anything will fade or disappear, but there continues to be better adoption of more minimally invasive techniques, less muscle and tissue dissection and faster return to work and activities. Now that we are truly beginning to understand that we have to restore lordosis in the lumbar spine, even with one-and two-level surgeries, we hope that we can prevent the need for performing three column osteotomies (pedicle subtraction osteotomies).

Dr. Ronald Lehman：真的很難說(shuō)哪些技術(shù)會(huì)逐漸退出舞臺(tái)，但是會(huì)有越來(lái)越多的人選擇使用更加微創(chuàng)的方案，更少的肌肉與軟組織的分離，使得患者更快返回工作崗位和日?；顒?dòng)?，F(xiàn)在我們意識(shí)到即使在單節(jié)段或是雙節(jié)段腰椎手術(shù)中都要恢復(fù)腰椎前凸的重要性。我們希望減少需要進(jìn)行三柱截骨（PSO）的手術(shù)。

Q: Where do you see the biggest room for innovation in spine? What do you need to provide better care that doesn't currently exist?

問(wèn)：您認(rèn)為脊柱創(chuàng)新發(fā)展的最大空間是什么？您對(duì)哪些尚不存在的技術(shù)更加關(guān)心？

RL:The biggest room for innovation will be in coordinating preoperative planning, reproducibly executing the plan intraoperatively and understanding in 'real-time' if we achieved our surgical goals. This will allow us to make everything more objective, so that we are relatively certain before leaving the operating theatre that we achieved all of our goals for each individual patient. As previously stated, the next several years will be an exciting time for innovation in our field as our understanding of patient-specific risk factors, assessing and executing surgical goals and being able to standardize this approach across the world continues to improve the care for our patients.

Dr. Ronald Lehman：在脊柱領(lǐng)域有創(chuàng)新發(fā)展的最大發(fā)展空間的是在我們完成手術(shù)目標(biāo)時(shí)協(xié)調(diào)術(shù)前規(guī)劃，術(shù)中有效的操作和實(shí)時(shí)情況之前的關(guān)系。這樣會(huì)使得我們做任何事情都更加客觀。這樣當(dāng)我們完成針對(duì)個(gè)體病人的手術(shù)目標(biāo)之后，離開(kāi)手術(shù)室的時(shí)候能夠更加篤定。就像之前提到的一樣，未來(lái)的幾年對(duì)我們的領(lǐng)域來(lái)說(shuō)會(huì)是一個(gè)生機(jī)勃勃的時(shí)代。我們會(huì)通過(guò)了解患者特定風(fēng)險(xiǎn)因素，分析和完成手術(shù)目標(biāo)，并能夠完成全球標(biāo)準(zhǔn)化，來(lái)達(dá)到我們不斷提高患者醫(yī)療質(zhì)量的目標(biāo)。

可謂是英雄所見(jiàn)略同呀。

脊柱外科手術(shù)的未來(lái)發(fā)展趨勢(shì)，就是各種先進(jìn)數(shù)字技術(shù)、大數(shù)據(jù)技術(shù)、精準(zhǔn)微創(chuàng)技術(shù)的開(kāi)發(fā)、應(yīng)用和推廣。相信我們可以通過(guò)努力，在不遠(yuǎn)的將來(lái)為廣大患者提供更安全、更精準(zhǔn)和更有效的治療手段。

原文鏈接：

https://www./spine/item/44745-the-most-exciting-innovations-in-spine-today-tomorrow-don-t-include-implants-key-thoughts-from-dr-ronald-lehman.html?origin=spinee&utm_source=spinee

感謝張瀚文同學(xué)翻譯本文部分內(nèi)容。