Image-Guided Osteoporotic Bone Augmentation with Intraoperative Biomechanical Gui

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。已经进行的少数临床病例研究表明，成功的结果需要详细的计划、生物力学分析和对增强过程的精确控制，以避免因增强而产生高应力区域。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。在这个项目中，我们将开发一个近端股骨增强手术试验台并证明其可行性。为此，我们提出三个目标：开发一个几何和生物力学规划模块，用于使用术前CT扫描对骨增强程序进行患者特异性优化。2. 开发一个综合的手术执行系统，包括术前模型和手术工具的联合注册，以及为该项目专门开发的荧光镜和光学导航系统。3. 验证功能性能和整体系统的准确性。在这个项目中开发的技术可能会导致一种非常需要的替代治疗方法，这可能对有骨质疏松症导致骨折风险的患者至关重要。该项目开发的技术将为骨质疏松症导致骨折的患者提供急需的替代治疗方法。

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 few 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 testbed for proximal femur augmentation and demonstrate its feasibility. Towards this goal, we propose three aims: 1. Develop a geometrical and biomechanical planning module for patient-specific optimization of the bone augmentation procedures using preoperative CT scans. 2. Develop an integrated surgical execution system that will involve co-registration of the preoperative model and surgical tools with a fluoroscope and an optical navigation system specifically developed for this project. 3. Validate functional performance and overall system accuracy. 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. The technology developed in this project, will provide a highly needed alternative treatment for patients highly susceptible to bone fracture due to osteoporosis.