Image-Guided Workstation and Tools for the Treatment of Bone Defects

描述（由申请人提供）：我们的目标是开发用于髋关节翻修手术的新型图像引导、微创技术。从2005年9月至2006年12月，美国共施行了约51300例翻修型全髋关节置换术（THA），每次翻修手术的平均费用为54500美元。初次和翻修髋关节置换术的数量预计在2005年至2030年期间几乎翻一番。THA翻修手术的一些目标是清除颗粒碎片，从骨和其他组织中清除所有溶骨性病变，并更换关节面聚乙烯内衬。微创方法试图保留THA的髋臼和股骨部件，只要它们牢固地固定在骨上，并且仅更换髋臼聚乙烯内衬。在微创入路中，通过固定良好的金属髋臼部件的现有螺孔进入病变。这里，外科医生面临的主要挑战是确定病变完全清创并且病变完全植骨。一项研究表明，平均而言，由于难以进入髋臼部件后面的骨质溶解区域，实际移植的病变不到50%。标准手术器械无法进入组件后方深处的腔体（有时一直延伸到骶髂关节）。由于直接目视检查和进入需要清创的区域并不总是可能的，所以很多时候外科医生不得不完全移除THA组件，因为他们无法清洁溶骨性病变。部件移除增加了骨折和骨盆分离的风险，并且使老年患者的恢复和卧床时间显著延长（即术后4-6个月）。通过微创方法，患者可以在手术后立即开始正常负重。因此，该手术将非常受益于使用侵入性较小的方法和高度灵巧的（机器人辅助的）器械来进入这些非常难以到达的体内区域。据我们所知，用于治疗溶骨性骨的机器人辅助微创翻修技术尚未开发。特别是，由于对结构强度和柔性的要求，用于治疗和去除溶骨性病变的适当工具和灵巧操纵器的设计提出了独特的挑战。我们建议开发一个原型手术工作站，用于术前计划，术中实时监测，导航和翻修手术期间的计划更新。

DESCRIPTION (provided by applicant): Our objective is to develop novel image-guided, less-invasive techniques for hip revision surgery. From September 2005 to December 2006 approximately 51300 revision Total Hip Arthroplasties (THAs) were performed in the United States with an average cost of $54500 per each revision surgery. The number of both primary and revision hip arthroplasty is projected to almost double between 2005 and 2030. Some of the goals of THA revision surgery are to eliminate the particle debris, remove all osteolytic lesions from the bone and other tissues, and replace the articulating polyethylene liner. The less-invasive approach attempts to preserve acetabular and femoral components of the THA, as long as they are firmly fixed to the bone, and only replaces the acetabular polyethylene liner. In the less-invasive approach, lesions are accessed through existing screw holes of the well-fixed metal acetabular component. Here, a major challenge for the surgeon is determining that the lesion is fully debrided and that the lesion is fully bone grafted. One study suggests that, on average, less than 50% of the lesion is actually grafted due to difficulty in accessing the areas o osteolysis behind the acetabular component. Standard surgical instruments are unable to access the cavities deep behind the component (sometimes extending all the way to the sacro-iliac joint). Because direct visual inspection and access to the areas requiring debridment is not always possible, many times surgeons have to completely remove THA components because they cannot otherwise clean the osteolytic lesions. Component removal increases risk of fracture and pelvic dissociation, and makes for remarkably long (i.e. 4-6 months after surgery) recovery and bed-rest periods in elderly patients. With less-invasive approaches patients may start normal weight bearing immediately after the surgery. This procedure, therefore, would highly benefit from the use of less-invasive approaches and highly dexterous (robotically-assisted) instruments to access these very difficult to reach areas within the body. To our knowledge, robotically-assisted, less-invasive revision techniques for treatment of osteolytic bone are not developed. In particular, the design of the appropriate tools and dexterous manipulators for the treatment and removal of the osteolytic lesions poses unique challenges because of the requirements for both structural strength and flexibility. We propose to develop a prototype surgical workstation for preoperative planning, and real-time intraoperative monitoring, navigation, and updating of plans during the revision surgery.