Research Proposal: Investigation into the Use of Laser Tools in Orthopaedic Surgery

对更严格的制造公差的要求已经在激光烧蚀精度方面取得了实质性进展，最近通过转向飞秒超短脉冲激光。通过在热和电子扩散中将能量分散在整个材料中，来自这种设备的局部加热的减少使得能够实现更高的精度和减少的微结构损伤（He埃塔尔，2015）。在金属、半导体、晶体、玻璃和陶瓷的消融中已经观察到亚微米精度，激发了它们在骨消融中的应用潜力（Wang等人，2015).这种手术应用的最大风险是脆性材料中的高热诱导应力导致的骨折;因此，必须将这种局部加热减少用于活骨组织。骨科激光手术提供的机会与其他手术相同;激光消融能够精确、操作简便和烧灼受损血管，因此有望提高手术能力和改善患者恢复。本提案描述了研究该过程的众多机会以及飞秒激光消融在骨科手术中的潜在实施。第一个衡量其适用性的标准是通过模拟骨表面的热生成，这些热生成是由不同的脉冲持续时间产生的：纳秒、皮科和飞秒。初步研究将明确局部和整体加热对变形和机械失效的影响，由此可以建立脉冲持续时间、功率和机械完整性之间的关系。假设模拟结果令人满意，进一步研究将提供光束强度和骨密度之间的相关性，表明该方法在各种位置和患者条件下的适用性。下一个计算将调查适当的切割表面。激光手术可以是直接的，其中激光辐射直接处理组织;或者是间接的，其中辐射通过加热附接到光纤末端的涂覆尖端、加热的手术刀来改变组织（Bredikhin等人，2016）。在进行实验室研究之前，将通过建模比较合适的切割表面。建模阶段完成后，将进行实验室测试;初步研究将在生物组织上测试激光。通过测试小的组织样本，将对较大的死亡组织进行调查。为了进行可靠的测试，初次骨消融将使用生理盐水Joseph Burnford 14/08/2020流经整个材料，复制活组织中血流提供的热传输。随着程序的反复修改和改造，随着测试对象越来越接近活组织，最终的非临床测试，从最近去世的捐赠，将被进行。如果所有的测试阶段都是成功的，并获得伦理批准，可能有机会通过临床试验完成程序测试。

The desire for tighter manufacture tolerances have seen substantial progress in laser ablationprecision, most recently through shifts to femtosecond ultrashort pulse lasers. The reduction inlocalised heating from such equipment has enabled greater precision and reduced microstructuredamage, by dispersing energy throughout the material in both thermal and electron diffusion (He etal., 2015). Sub-micrometre precision has been observed in the ablation of metals, semiconductors,crystals, glasses and ceramics, inspiring potential for their use in bone ablation (Wang et al., 2015).The greatest risk from such surgical application is that of fracture through high thermal-inducedstresses in the brittle material; it is therefore imperative that this localised heating reduction carriesover to use in live bone tissue. The opportunities offered by orthopaedic laser surgery are commonwith other operations; laser ablation enables precision, operative ease and cauterisation of damagedvessels, consequently promising increased surgical capabilities and improved patient recovery.This proposal describes numerous opportunities for studying this process and the potentialimplementation of femtosecond laser ablation in orthopaedic surgery. The first gauge of suitabilitywould come through the modelling of heat generation at the bone surface, resultant from variouspulse durations: nano-, pico- and femtosecond. This primary investigation would offer clarity to theeffect of localised and overall heating on deformation and mechanical failure, from which arelationship between pulse duration, power and mechanical integrity could be established.Presuming a satisfactory simulation outcome, further investigations would provide correlationbetween beam intensity and bone density, indicating the suitability of the method in a variety oflocations and patient conditions.With heating analysed, the next computation would investigate appropriate cutting surfaces. Lasersurgery can be either direct, where the laser radiation directly processes the tissue; or indirect,where radiation modified the tissue through heating a coated tip attached to the end of the opticalfibre, a heated scalpel (Bredikhin et al., 2016). Appropriate cutting surfaces would be compared,through modelling, before laboratory investigations are conducted.With modelling phases complete, laboratory testing would follow; primary investigations would testthe laser on biological tissues. With small tissue samples tested, investigations into larger deadtissue would be conducted. For reliable testing, primary bone ablation would be assisted with saline Joseph Burnford 14/08/2020flow throughout the material, replicating the thermal transport afforded by blood flow in livingtissue. With procedures iteratively modified and remodelled, as the test subject becomes closer toliving tissue, a final non-clinical test, with donations from the recently deceased, would beconducted. If all testing phases are successful and ethical approval is acquired, there may be anopportunity for the procedural testing to be finalised through clinical trial.