摘要
目的经皮骶髂关节螺钉内固定是治疗骨盆骨折的重要手段,由于骶髂关节周围解剖结构复杂,骶髂关节螺钉的误置容易损伤重要血管和神经。手术机器人以其高精度、稳定性好、安全度高的特点,越来越多的运用在经皮骶髂关节螺钉手术中。但目前的手术机器人只能解决精确定位问题,手术规划仍然依赖医生手动完成。本研究旨在基于数字建模与几何规划,研究个性化的骶髂关节螺钉最优通道自动规划方法,实现自动化、定量化、最优化的螺钉通道规划。方法将14套骶髂关节螺钉术后骨盆CT导入Mimics 17. 0中,分割出骨盆模型用于自动规划;计算术后螺钉位置,作为手动规划结果进入对照组。将骨盆模型导入自动规划模块,手工指定螺钉通道起点和终点的种子点,自动生成起点和终点点阵,联接任意起点和终点构成一条螺钉通道。遍历所有螺钉通道,以体素模型布尔运算的方法筛选出完全位于骨性结构中的通道作为安全通道,再定义通道周围表面点到通道中心线的最短距离为通道安全度,选出安全通道中安全度最高的一条作为最优手术规划。结果对比实验中,10例S1骶髂关节螺钉自动规划安全度为6. 339 mm±1. 499 mm,优于手动规划安全度2. 482 mm±1. 571 mm,差异有统计学意义(P <0. 001); 10例S2骶髂关节螺钉自动规划安全度为5. 777 mm±1. 250 mm,优于手动规划安全度1. 784 mm±1. 531 mm,差异有统计学意义(P <0. 001)。S1骶髂关节螺钉自动规划优良率为100%,手动规划优良率80%; S2骶髂关节螺钉自动规划优良率为100%,手动规划优良率60%。结论实验结果表明本研究提出的自动规划方法能够实现个性化的骶髂关节螺钉最优通道自动规划,规划结果明显优于手动规划,为骨科手术的自动规划方法研究提供了新的思路。
Objective Percutaneous sacroiliac joint screw is an important method for the treatment ofpelvic fracture. Due to the complex anatomical structure around the sacroiliac joint, the misplacement of thesacroiliac screw is highly possible to damage the blood vessels and nerves. Surgical robot is more and more usedin the operation of percutaneous sacroiliac joint screw because of its high accuracy, good stability and high safety. At present, however, in robot assisted sacroiliac joint screw surgery, robots can only solve the problemof precise positioning while the surgical planning still relies on the doctor to do it manually. The purpose of thisstudy is to implement an automatic, quantitative and optimized sacroiliac screw channel planning method basedon the digital modeling and geometric calculation. Methods The pelvic CT scan data of 14 patients aftersacroiliac screw surgery were processed into Mimics 17. 0 for the 3D reconstruction of the pelvis. The pelvicmodels were used for automatic planning. The postoperative screws’ locations were calculated as manualplanning results into the control group. A pelvic model was imported into the automatic planning module onwhich the starting point and end point of the screw channel were manually specified as two seed points. Twopoint arrays were automatically generated from two seed points. One starting point and one end point forms ascrew channel. The channels completely located in the bone structure were selected as safe channels through themethod of Boolean operation of volume models. The shortest distance between the surface points around thescrew channel and the center line of the screw channel was defined as the security safety of the channel. Thechannel with the highest security degree was identified as the optimal channel. Results In 10 cases of S1 sacroiliac screw operation, automatic planning result was 6. 339 mm±1. 499 mm, better than manual planningresult which was 2. 482 mm± 1. 571 mm, and the difference was statistically significant. In 10 cases of S2sacroiliac screw operation, automatic planning result was 5. 777 mm±1. 250 mm, better than manual planningresult which was 1. 784 mm±1. 531 mm, and the difference was statistically significant. The qualification rate ofS1 sacroiliac screw automatic planning result was 100 percent, better than the qualification rate of S1 sacroiliacscrew manual planning result which was 80 percent. The qualification rate of S2 sacroiliac screw automaticplanning result was 100 percent, better than the qualification rate of S2 sacroiliac screw manual planning resultwhich was 60 percent. Conclusions The experimental results prove that the automatic planning method ofsacroiliac screw in this study can realize the optimal channel planning of the individual sacroiliac screw, andthe automatic planning result is better than the manual planning result. Our research provides a new idea for thestudy of automatic planning method of orthopaedic surgery.
作者
师述昌
朱罡
王豫
樊瑜波
王军强
吴新宝
SHI Shuchang;ZHU Gang;WANG Yu;FAN Yubo;WANG Junqiang;WU Xinbao(School of Biomedical Engineering,Beihang University,Beijing 100191;Beijing Advanced Innovation Center for Biomedical Engineering,Beihang University,Beijing 100083;Beijing Jishuitan Hospital,Beijing 100035)
出处
《北京生物医学工程》
2018年第6期551-558,565,共9页
Beijing Biomedical Engineering
基金
国家重点研发计划(2017YFC0110602)
国家自然科学基金(61201313
61372178)
北京市科委2018年度医药协同科技创新研究项目(Z181100001918024)
北京市科技计划(Z161100000116023)资助
关键词
骶髂关节螺钉
自动手术规划
计算机辅助骨科手术
安全螺钉通道
最优螺钉通道
sacroiliac joint screw
automatic surgical planning
computer assisted orthopedic surgery
safety screw channel
optimal screw channel
