Preoperative Planning of Femoroplasty

描述（由申请人提供）：关于骨质流失可能在多大程度上损害力量并增加骨折风险的研究非常丰富。老年骨质疏松患者髋部骨折后的死亡率据报道高达30%。提示股骨增粗是降低高骨质疏松髋部骨折风险的有效对策。这项技术对于那些有高跌倒风险的病人尤其有价值，如果他们持续跌倒，死亡率和发病率的风险最高。已进行的关于股骨增强术的临床病例研究表明，成功的结果需要详细的计划、生物力学分析和对增强术的精确控制，以避免因增强术而产生高应力区域。我们的长期目标是开发一种技术，使外科医生能够精确地确定骨质疏松和骨折风险水平的程度，基于计算机力学分析获得优化的手术计划，在术中生物力学反馈的情况下进行快速微创髋关节增强术，并最终在一次患者就诊中验证结果。在

DESCRIPTION (provided by applicant): There is a wealth of research on the extent to which bone loss may impair strength and increase the risk of fracture. The rate of mortality after hip fracture in elderly patients with osteoporosis is reported to be as high as 30%. It is suggested that augmentation of the femur is an effective countermeasure to reduce the risk of fracture in highly osteoporotic hips. This technique would be especially valuable for those patients at high risk of falls and the highest risk of mortality and morbidity if they were to sustain a fall. The fw clinical case studies that have been performed on augmentation of the femur suggest that a successful outcome requires detailed planning, biomechanical analysis, and precise control of the augmentation procedure to avoid generation of areas of high stress due to augmentation. Our long term goal is to develop a technology that enables the surgeon to precisely determine the extent of osteoporosis and fracture risk level, obtain an optimized surgical plan based on computerized mechanical analysis, perform a rapid and minimally invasive hip augmentation with intraoperative biomechanical feedback, and finally verify the outcome in one patient visit. In this project, we will develop a surgical test bed for planning proximal femur augmentation and demonstrate its feasibility. Towards this goal, we propose two aims: 1. Optimal planning of the femoroplasty: We propose to develop a novel framework involving a computational diffusion model applied to patient-specific CT scans of the osteoporotic femora. The model will be suitable for the ubiquitous problem of predicting an optimal pattern and strategy for cement injection using input from both patient-specific CT and another computational model for assessment and reduction of the fracture risk. 2. Validation of the preoperative planning strategy: We will perform a series of controlled nondestructive cadaver tests to verify the accuracy of our model in predicting the diffusion geometry of the augmentation material. We will also perform a series of destructive cadaver tests on osteoporotic femora to verify the abiliy of the planning framework to strengthen the bone with a relatively low injection volume of the augmentation material. The technology developed in this project may lead to a highly needed alternative treatment that may be pivotal for patients at the risk of bone fracture due to osteoporosis as well as demonstrating the importance of incorporating biomechanics-based planning in end-to-end surgical treatment.