Smart Impedance Controlled Osteotomy Instrumentation

智能阻抗控制截骨术仪器

• 批准号: 241205630
• 负责人: Professor Dr.-Ing. Steffen Leonhardt
• 金额: --
• 依托单位: Lehrstuhl für Medizinische Informationstechnik (MedIT)
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2013
• 资助国家: 德国
• 起止时间: 2012-12-31 至 2016-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/241205630?language=en
• 关键词: Smart; Impedance; Controlled; Osteotomy; Instrumentation

Osteotomy, the cutting of bones, is a standard procedure in different surgical disciplines. Efficient cutting of the bone and a good protection of close sensitive soft tissue structures is crucial. Two procedures of high relevance in this area are craniotomy (opening of the skull, around 66000 cases, Germany/2008) and resternotomy (reopening of the chest, approximately 13500 cases, Germany/2008). In both cases a bicortical bone is cut, while underlying sensitive and live critical soft tissue structures (e.g. central nervous system, heart, blood vessels) have to be protected. During craniotomy in 30 % of all cases a tear of the dura mater occurs, which leads to a significant increase in operation time and a worse result for the patient. Moreover, injuries of the retrosternal structures during repeated sternotomy (resternotomy) are responsible for a high mortality which even increases with every reoperation performed.To support the surgeon during osteotomies many active hand held instruments and robotic systems were developed. These semiautomatic instruments or automatic robots process the bone on the basis of pre- or intraoperative acquired imaging data (e.g. CT, ultrasound). The disadvantages of these approaches are the many additional procedures necessary and the complex integration into the medical standard workflow. In case of a hand guided instrument, which controls one or two degrees of freedom automatically only on the basis in process acquired data, this is not the case. One of the applicants was able to show the general feasibility for a light based in process measurement and control approach. Due to the light based measurements and the current control strategy the system is very sensitive to failures and disturbances. However, in collaborative work, the two applicants were able to show the potential of bio impedance spectroscopy (BIS) for the automatic in process control of a surgical robot system for the bone cement removal in revision total hip replacement.In the proposed research project the potential of a hand guided, sensor integrated and controlled, intelligent instrument for resternotomy and craniotomy is investigated. For this reason, the optimal integration of BIS into a sensor controlled instrument has to be analyzed and after that its use is verified in-vitro. Central challenges are the online BIS measurement during the cutting process and the active fault tolerant control of the instrument under involvement of the surgeon. Object of research is also the combination of the high technical precision (knowledge based, sensor controlled process control) of the intelligent instrument with the high cognitive abilities of the surgeon for the control of the overall process. This signifies that in complement to the complex measurement process, the approaches for active fault tolerant control particularly with regard to a synergistic man-machine interaction have to be implemented into a demonstrator system and finally evaluated.

截骨术，即骨头的切割，是不同外科学科的标准程序。有效切割骨骼和良好保护紧密敏感的软组织结构至关重要。该领域高度相关的两个手术是开颅手术（打开颅骨，约 66000 例，德国/2008 年）和再切开术（重新打开胸部，约 13500 例，德国/2008 年）。在这两种情况下，双皮质骨都会被切割，同时必须保护下面的敏感和活的关键软组织结构（例如中枢神经系统、心脏、血管）。在开颅手术期间，有 30% 的病例会发生硬脑膜撕裂，这会导致手术时间显着增加，并且对患者造成更糟糕的结果。此外，重复胸骨切开术（胸骨切开术）期间胸骨后结构的损伤导致高死亡率，甚至随着每次再次手术的进行而增加。为了在截骨期间支持外科医生，开发了许多主动手持式器械和机器人系统。这些半自动仪器或自动机器人根据术前或术中获取的成像数据（例如 CT、超声）处理骨骼。这些方法的缺点是需要许多额外的程序以及与医疗标准工作流程的复杂集成。对于仅根据过程获取的数据自动控制一个或两个自由度的手动引导仪器，情况并非如此。其中一位申请人能够展示基于光的过程测量和控制方法的总体可行性。由于基于光的测量和电流控制策略，系统对故障和干扰非常敏感。然而，在合作工作中，两位申请人能够展示生物阻抗谱（BIS）在手术机器人系统自动过程控制中的潜力，该手术机器人系统用于翻修全髋关节置换术中的骨水泥去除。在拟议的研究项目中，研究了用于胸骨切开术和开颅术的手动引导、传感器集成和控制的智能仪器的潜力。因此，必须分析 BIS 与传感器控制仪器的最佳集成，然后在体外验证其使用。主要挑战是切割过程中的在线 BIS 测量以及外科医生参与下的仪器主动容错控制。研究目标还将智能仪器的高技术精度（基于知识、传感器控制的过程控制）与外科医生控制整个过程的高认知能力相结合。这意味着，为了补充复杂的测量过程，主动容错控制方法，特别是协同人机交互的方法，必须实施到演示系统中并最终进行评估。