Advanced Tools for Computer Assisted Orthopaedic Surgery

计算机辅助骨科手术的先进工具

• 批准号: RGPIN-2014-03826
• 负责人: Hodgson, Antony
• 金额: $ 1.97万
• 依托单位: University of British Columbia
• 依托单位国家: 加拿大
• 项目类别: Discovery Grants Program - Individual
• 财政年份: 2017
• 资助国家: 加拿大
• 起止时间: 2017-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://www.nserc-crsng.gc.ca/ase-oro/Details-Detailles_eng.asp?id=638454
• 关键词: Advanced; Tools; Computer; Assisted; Orthopaedic

ObjectivesI propose to develop three complementary and innovative technologies –local-phase-enhanced 3D ultrasound, bracing and small robots, and quantitative analysis of pre- and post-operative kinematics and implant motion – in order to significantly improve the performance, safety and cost-effectiveness of high-impact orthopaedic interventions in joint repair, joint replacement and trauma.BackgroundArthritis and trauma are two of the most prevalent conditions requiring surgery in our society, with millions of procedures expected to be performed annually in North America by 2030 with costs in the tens of billions of dollars. Computer-Assisted Orthopaedic Surgery (CAOS) techniques, along with robotic devices, have been developed to try to optimize surgical results by using advanced imaging and guidance technologies to improve the accuracy and precision of surgical procedures, but there has not yet been strong evidence of benefits in terms of functional improvement, pain reduction or reduced need for revision surgery, so a number of health insurance organizations classify CAOS as still investigational. Scientific ApproachMy overall program seeks to build on three core strengths in our lab to achieve clear gains in reducing use of radiation, quickly and cheaply implementing bone cuts for bone-conserving implants, and accelerating our understanding of the fundamental mechanisms of implant failure. These broad thrusts will serve as the basis for a suite of independently funded translational and commercialization-related follow-on projects. The three main program areas in this proposal are:1. Local-Phase-Enhanced 3D Ultrasound: We plan to port our current local-phase processing algorithms to a common platform suitable for use in developing live applications. In the longer term, we will incorporate principles of elastography to make estimating bone surfaces in ultrasound images more reliable.2. Bracing and Small Robots: We will extend our Dynamic Physical Constraint concept to a 3D prototype robot suitable for cadaveric testing. We will also validate and apply a framework for designing bracing systems (which are intended to be faster to set up than robots, but with better accuracy than conventional techniques) to enhance bone-shaping performance in key selected surgical tasks.3. Quantitative Analysis of Pre- and Post-Operative Kinematics and Implant Motion: We will lay the foundations for accurate quantitative study of function and early implant failure using a Roentgen Stereophotogrammetric Analysis (RSA) protocol for assessing joint and implant motion using clinically-available imaging equipment. We will then use this technique to conduct pilot studies to assess joint and implant motion in patients experiencing loosening. We will also complete our current Open-MRI-based evaluation of femoroacetabular impingement. Anticipated SignificanceCollectively, the projects proposed here focus on addressing the most significant barriers to widespread acceptance of computer- and robot-assisted techniques by reducing radiation exposure for the surgical team, simplifying and shortening the bone shaping process and improving its accuracy (particularly for the newer bone-conserving implants being used in unicompartmental knee arthroplasties) and providing a faster and more direct process for evaluating claims of improved outcomes for new CAOS procedures. We anticipate that surgeons will benefit from these technologies by being able to quantify key aspects of their surgical performance and using the measured results to improve their practice. Patients will benefit from fewer complications, shorter recovery times and hopefully longer lifespans of their implants, and society will benefit from reduced costs.

目的我提议开发三项互补和创新的技术-局部相位增强3D超声、支撑和小型机器人，以及手术前和手术后运动学和植入运动的定量分析-以显著提高关节修复、关节置换和创伤方面的高影响力骨科干预措施的性能、安全性和成本效益。背景关节炎和创伤是我们社会最常见的两种需要手术的疾病，到2030年，北美每年预计会进行数百万例手术，费用高达数百亿美元。计算机辅助矫形外科(CAOS)技术与机器人设备一起被开发出来，试图通过使用先进的成像和引导技术来优化手术结果，以提高手术的准确性和精确度，但尚未有强有力的证据表明在功能改善、减轻疼痛或减少翻修手术方面有好处，因此一些医疗保险组织将CAOS归类为仍在研究中。科学方法我的整个计划寻求建立在我们实验室的三个核心优势的基础上，以在减少辐射使用、快速且廉价地实施用于骨保存的植入物的骨切削以及加速我们对植入物失败的基本机制的理解方面取得明显的成果。这些广泛的推动力将作为一套独立资助的翻译和商业化相关后续项目的基础。这项建议中的三个主要计划领域是：1.局部相位增强三维超声：我们计划将我们现有的局部相位处理算法移植到一个适合开发实时应用程序的通用平台上。从长远来看，我们将结合弹性成像的原理，使超声图像中的骨表面估计更可靠。支撑和小型机器人：我们将把我们的动态物理约束概念扩展到适合身体测试的3D原型机器人。我们还将验证和应用用于设计支撑系统的框架(旨在比机器人更快地设置，但具有比传统技术更好的准确性)，以在关键的选定外科任务中提高骨成形性能。术前和术后运动学和种植体运动的定量分析：我们将使用伦琴立体摄影分析(RSA)协议，使用临床可用的成像设备评估关节和种植体的运动，为准确地定量研究功能和早期种植体失败奠定基础。然后，我们将使用这项技术进行先导性研究，以评估松动患者的关节和植入物运动。我们还将完成目前基于Open-MRI的髋臼撞击的评估。总体而言，这里提出的项目集中于解决计算机和机器人辅助技术被广泛接受的最重要障碍，方法是减少手术团队的辐射暴露，简化和缩短骨成形过程并提高其准确性(特别是对于用于单室膝关节成形术的较新的骨保护植入物)，并提供一个更快、更直接的过程来评估新的CAOS手术改善的结果。我们预计外科医生将从这些技术中受益，因为他们能够量化手术性能的关键方面，并使用测量结果来改进他们的实践。患者将受益于更少的并发症，更短的恢复时间，希望他们的植入物的寿命更长，社会将从降低成本中受益。