Image-Guided Workstation and Tools for Bone Defects

摘要 我们的长期目标是开发一种图像引导工作站，它使用一种新型的Continuum Dexterous 机械手(CDM)和工具，以实现下一代最小和较小侵入性的程序，从而 在骨科手术中，可以接触到目前用传统手术工具无法接触到的区域。系统 设备将能够治疗骨缺损，如髋臼撞击、转移性骨 骨盆/髋臼、股骨颈、周围和亚部位的严重骨质疏松症 粗隆部位，以及胫骨和足部，最后是创伤性骨折修复。近期的重点是 这一应用是核心减压术治疗股骨头缺血坏死(AVN) 骨盆骨折复位术。我们提出了一种图像制导的机器人辅助原型的开发 用于计划、术中实时监测、导航和计划更新的外科系统。 在美国，股骨头的缺血性坏死(AVN，也称为骨坏死)发生在 每年10000-20000的患者年龄在20-50岁之间。房室结节的发生率是均匀的。 中东和亚洲国家的失业率较高。AVN的发生是由于失去了对骨骼的血液供应，导致 骨小梁的自发性死亡，进而可能导致骨小梁的微骨折 骨头。根据受累股骨头的数量，关节面会发生塌陷。 疾病的发展。一旦这些患者发生股骨头塌陷，病程很少。 回归。全髋关节置换术(THA)将是首选的主要手术，将提供疼痛缓解 那些AVN患者。然而，由于AVN患者年龄较小，THA并不是最可取的。 选择。岩心减压术是一种常规技术，用于治疗房室结术前的 股骨头塌陷。通常情况下，在核心减压术中，病变区域(死骨)由 钻探和清创。清创后，植骨将被插入和/或生物可吸收材料，如 磷酸钙将被注入核心，以填补空洞并提供稳定性。 核心解压的长期成功取决于许多可能超出 在现有工具和技术的情况下控制外科医生。当前常规的一些问题 髓核减压术不能解决的问题是：1)完全清创死骨需要 清创工具的灵活性显著提高，目前外科医生无法使用；2)虽然它是理想的 为了完全去除死骨，骨去除的程度可能受到稳定性的限制 要求防止股骨头在负重状态下坍塌。生物力学 因此，结构的稳定性分析必须是规划的重要组成部分。此外， 该计划的成功实施将需要机器人辅助的图像制导导航技术，以 我们的知识，目前还不为外科医生所知。 据我们所知，手术后维持髋关节稳定性的生物力学规划工具和 用于微创治疗骨坏死的机器人平台还没有开发出来。尤其是它的设计 完全清扫AVN的操纵者构成了独特的挑战，因为相反的 对结构强度和灵活性的要求。我们建议开发和测试一个机器人辅助的原型 微创治疗动静脉络膜瘤的外科工作站。在规划阶段，工作站 将在患者的MRI图像中突出显示病变部位，并创建优化的手术计划。在.期间 在手术过程中，外科医生将使用连续灵巧操纵器(CDM)和 定位机器人和各种工具，以移除死骨和执行结构增强。我们的目标是 证明所提出的系统可以显著提高动静脉络膜结节的治疗效果和稳定性 因此，髋关节减少了在早期进行多次后续手术和/或全髋关节手术的需要。

Summary Our long range goal is to develop an image-guided workstation that uses a novel Continuum Dexterous Manipulator (CDM) and tools to enable next generation of minimally- and less-invasive procedures allowing access to regions not currently accessible with conventional surgical tools in orthopaedic surgery. The system and devices will enable treatment of bone defects such as femoroacetabular impingement, metastatic bone disease, severe osteoporosis in areas including the pelvis/acetabulum, femoral neck, peri- and sub- trochanteric regions, as well as the shin and foot, and finally traumatic fracture repair. The near-term focus of this application is the core decompression for the treatment of Avascular Necrosis (AVN) of the femoral head and reduction of pelvis fracture. We propose the development of an image-guided prototype robot-assisted surgical system for planning, real-time intraoperative monitoring, navigation, and updating of the plans. In the United States, avascular necrosis (AVN, also known as osteonecrosis) of the femoral head occurs in 10000-20000 of patients per year between the ages of 20-50 years old. The incidence of the AVN is even higher in Middle Eastern and Asian countries. AVN occurs due to the loss of blood supply to the bone, leading to the spontaneous death of the trabecular bone, which in turn may cause microfractures in the trabecular bone. Depending on the amount of femoral head involved, collapse of the articular surface will occur as the disease advances. Once collapse of the femoral head occurs in these patients, the disease course rarely regresses. Total Hip Arthroplasty (THA) will be the primary surgery of choice and will provide pain relief to those AVN patients. However, because of the young age of the AVN patients, THA is not the most desirable choice. Core decompression is a conventional techniques used for the treatment of the AVN prior to the collapse of the femoral head. Typically in core decompression the lesion area (death bone) is removed by drilling and debriding. After debriding the bone graft will be inserted and/or bioresorbable material such as calcium phosphates will be injected into the core to fill the void and provide stability. The long-term success of core decompression is dependent on many parameters that may be out of the control of surgeons given the existing tools and techniques. Some of the issues that the current conventional techniques for core decompression does not answer are: 1) complete debriding of the death bone requires significant increase in dexterity of the debriding tools, currently not available to the surgeons; 2) While it is ideal to completely remove the death bone, the extent of the bone removal may be limited by the stability requirements of the femoral head to prevent its collapse underweight bearing conditions. Biomechanical analysis of the stability of the structure, therefore, must be important part of the planning. Further, the successful implementation of the plan will require robot-assisted, image-guided navigation technology that, to our knowledge, is currently not available to the surgeons. To our knowledge, tools for biomechanical planning to maintain the stability of the hip after the surgery and robotic platforms for minimally-invasive treatment of osteonecrosis are not developed. In particular, the design of the manipulators for the full debriding of the AVN poses unique challenges because of the opposing requirements for structural strength and flexibility. We propose to develop and test a prototype robot-assisted surgical workstation for minimally-invasive treatment of the AVN. The workstation, during the planning phase, will highlight the site of the lesion in MRI images of the patient and create an optimized surgical plan. During the procedure, the surgeon will use a Continuum dexterous manipulator (CDM) in conjunction with a positioning robot and various tools to remove the death bone and perform structural augmentation. Our goal is to demonstrate that the proposed system can significantly improve the treatment of the AVN and the stability of the hip, therefore, reducing the need for multiple follow-up surgeries and/or THA surgeries at early ages.