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.

骨切开骨切割是骨骼的切割，是不同手术学科中的标准手术。有效切割骨头，对密切敏感的软组织结构进行良好的保护至关重要。在该地区，有两个高相关性的程序是颅骨切开术（颅骨开放，大约66000例，德国/2008年）和雷德诺切开术（重新开放胸部，大约13500例，德国/2008年）。在这两种情况下，都必须保护双皮质骨，同时必须保护敏感和生命的临界软组织结构（例如中枢神经系统，心脏，血管）。在颅骨切开术中，在30％的所有情况下，都会发生硬脑膜撕裂，从而导致手术时间大幅增加，并且患者的结果较差。此外，重复的胸骨切开术（雷底切开术）期间的胸骨后结构的伤害是高死亡率的原因，甚至随着每次重新手术的进行而增加。为了在截骨期间支持外科医生，开发了许多主动的手持仪器和机器人系统。这些半自动仪器或自动机器人根据术中或术中获得的成像数据（例如CT，超声）处理骨骼。这些方法的缺点是需要进行许多其他程序，并且复杂整合到医疗标准工作流程中。如果使用手动指导仪器，该仪器仅根据过程获得的数据自动控制一个或两个自由度，则不是这种情况。其中一位申请人能够显示出基于流程测量和控制方法的光的一般可行性。由于基于光的测量和当前的控制策略，系统对故障和干扰非常敏感。然而，在合作工作中，两名申请人能够显示出生物阻抗光谱（BIS）的潜力，用于自动进行手术机器人系统的过程控制，用于修订整体髋关节置换术中的骨水泥系统。因此，必须分析将双BI的最佳整合到传感器控制的仪器中，之后其使用验证了维特罗。核心挑战是在切割过程中的在线BIS测量以及在外科医生参与下对仪​​器的主动容错控制。研究的对象也是智能工具的高技术精度（基于知识，传感器控制过程控制）的组合，以及外科医生的高认知能力，以控制整个过程。这表明，在复杂的测量过程中，必须将主动容错控制的方法尤其是在协同的人机相互作用方面进行，必须将其实施到示威者系统中，并最终对其进行评估。