Image-Guided Workstation and Tools for Bone Defects

总结 我们的长期目标是开发一种图像引导工作站， 操作器（CDM）和工具，以实现下一代微创和微创手术， 在整形外科手术中，进入目前用传统手术工具无法进入的区域。系统 并且装置将能够治疗骨缺损，例如股骨髋臼撞击、转移性骨 疾病，严重的骨质疏松症，包括骨盆/髋臼，股骨颈， 转子区域，以及胫骨和足部，最后是创伤性骨折修复。近期重点 该应用是用于治疗股骨头缺血性坏死（AVN）的核心减压术 骨盆骨折复位。我们建议开发一个图像引导的原型机器人辅助 用于计划、实时术中监测、导航和计划更新的手术系统。 在美国，股骨头缺血性坏死（AVN，也称为骨坏死）发生在 每年有10000-20000名20-50岁的患者。AVN的发生率甚至 在中东和亚洲国家更高。AVN的发生是由于骨骼的血液供应丧失， 骨小梁的自发死亡，这反过来又可能导致骨小梁中的微骨折， 骨头根据涉及的股骨头数量，关节面塌陷将随着 疾病进展。这些患者一旦发生股骨头塌陷， 退化全髋关节置换术（THA）将是首选手术，并将为以下患者提供疼痛缓解： 那些AVN患者然而，由于AVN患者的年龄较小，THA不是最理想的 选择核心减压是一种传统的技术，用于治疗的AVN之前， 股骨头塌陷。典型地，在核心减压中，病变区域（死骨）通过以下方式去除： 钻孔和清创。清创后，将插入骨移植物和/或生物可吸收材料， 磷酸钙将被注入核心以填充空隙并提供稳定性。 核心减压的长期成功取决于许多参数， 在现有工具和技术的情况下，对外科医生的控制。目前的常规武器所面临的一些问题 核心减压技术无法回答：1）死亡骨的完全清创需要 清创工具的灵活性显著增加，目前外科医生无法获得; 2）虽然理想 为了完全去除死骨，骨去除的程度可能受到稳定性的限制， 股骨头的要求，以防止其崩溃的重量不足的轴承条件。生物力学 因此，对结构稳定性的分析必须是规划的重要部分。此夕h 该计划的成功实施将需要机器人辅助的图像导航技术， 我们的知识，目前还不能提供给外科医生。 据我们所知，生物力学计划的工具，以维持手术后髋关节的稳定性， 没有开发用于骨坏死的微创治疗的机器人平台。特别是，设计 完全清创AVN的操作器构成了独特的挑战，因为 对结构强度和灵活性的要求。我们建议开发和测试一个原型机器人辅助 用于AVN微创治疗的手术工作站。工作站在规划阶段， 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。期间 在手术中，外科医生将使用Continuum灵巧操纵器（CDM）与 定位机器人和各种工具来移除死亡骨头并进行结构增强。我们的目标是 以证明所提出的系统可以显着改善AVN的治疗和稳定性， 因此，减少了在早期进行多次后续手术和/或THA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.