Severe Acetabular Defects: Image-Guided Reconstruction

描述（由申请人提供）： 全髋关节置换术（THR）的髋臼翻修是当今骨科手术中最具挑战性的问题之一。尽管成像技术取得了巨大进步，但即使是最困难的病例的术前可视化和评估仍然像四十多年前的第一次翻修一样，使用前后位（AP）X线片的主观检查。这为改善临床结果提供了机会，特别是考虑到广泛持有的骨科手术原则，即临床成功与术前计划的彻底性和准确性直接相关。理想情况下，翻修手术计划应确定缺损类型，描述剩余骨的数量和位置（以选择最佳机械声重建选项），并确认是否应进行重建。缺乏提供结构信息的经验证的定量评估限制了当前系统的有用性，并导致更差的临床结局、增加的成本以及在选择重建选项时外科医生内和外科医生间的广泛差异。因此，生物医学成像的下一步是超越过时的基于X光片的评估，并转向机械和临床相关的结构成像。我们的目标是用结构成像取代传统的基于X线片的计划，以指导手术重建并改善髋臼骨缺损患者的临床结局。我们广泛的假设是，先进的CT技术提高了术前评估的预测能力，将缺损类型与机械效应联系起来，并改善临床结局。我们寻求开发与机械相关并基于现有成像技术的图像引导技术。该R21提案的具体目标是：目标1：开发和验证客观的基于CT的结构成像技术，通过描述宿主骨及其力学环境来指导手术。假设：基于CT的结构成像准确（± 2mm线性测量，± 3%体积测量，<15%骨密度误差）和可靠（观察者间，kappa >0.80）定义了3D结构和机械后果。未来的研究目标包括临床实施，结果和成本效益分析，以及微创手术的发展。该项目的完成将创建一个精确的基于CT的技术，通过结构评估髋臼缺损的形态、密度和力学来指导手术。这是改善这些困难病例的手术计划、执行和临床结果的第一步，也是重要的一步。

DESCRIPTION (provided by applicant): Acetabular revision of total hip replacements (THR) is one of the most challenging problems in orthopedic surgery today. Despite great advances in imaging, preoperative visualization and assessment of even the most difficult cases is still performed just like the first revision over forty years ago, using subjective examination of anteroposterior (AP) radiographs. This presents an opportunity for improving clinical out-come, especially given the widely-held orthopaedic surgery tenet that clinical success is directly related to the thoroughness and accuracy of preoperative planning. Ideally, revision surgical planning should determine defect type, describe amount and location of remaining bone (to select the best mechanically-sound reconstruction option), and confirm whether reconstruction should be performed. Lack of a validated, quantitative assessment that provides structural information limits the usefulness of current systems and leads to worse clinical outcomes, added cost, and wide intra- and inter-surgeon variability in selecting reconstruction options. Therefore, the next step for biomedical imaging is to move beyond outdated radiograph-based evaluations and onto mechanically and clinically relevant structural imaging. Our goal is to replace conventional radiograph-based planning with structural imaging in order to guide surgical reconstruction and improve the clinical outcomes of individuals with deficient acetabular bone. Our broad hypothesis is that advanced CT techniques increase the predictive power of preoperative assessments, link defect type with mechanical effects, and improve clinical outcomes. We seek to develop image-guided techniques that are mechanically-relevant and based on existing imaging technologies. This R21 proposal's specific aim is: Aim 1: Develop and validate objective CT-based structural-imaging techniques to guide surgery by describing host bone and its mechanical environment. Hypothesis: CT-based structural-imaging accurately (+ 2mm linear measurements, + 3% volume measurements, <15 % bone density errors) and reliably (inter-observer, kappa >0.80) define 3D structure and mechanical consequence. Future research aims include clinical implementation, outcome and cost benefit analyses, and development of minimally invasive surgery. Completion of this project will create an accurate CT-based technique to guide surgery by structurally assessing the morphology, density, and mechanics of the deficient acetabulae. This is the first and important step toward improving surgical planning, execution, and clinical outcomes of these difficult cases.