Advanced Tools for Computer Assisted Orthopaedic Surgery

*我建议开发三种互补的创新技术——局部相位增强的3D超声、支具和小型机器人，以及术前和术后运动学和植入物运动的定量分析——以显著提高关节修复、关节置换和创伤的高冲击骨科干预的性能、安全性和成本效益。*背景*关节炎和创伤是我们社会中最常见的两种需要手术的疾病，预计到2030年，北美每年将进行数百万例手术，费用将达到数百亿美元。计算机辅助骨科手术（CAOS）技术以及机器人设备已经被开发出来，试图通过使用先进的成像和引导技术来优化手术结果，以提高手术过程的准确性和精度，但在功能改善、疼痛减轻或减少翻修手术需求方面尚未有强有力的证据，因此许多健康保险组织将CAOS归类为仍处于研究阶段。*科学方法*我的总体计划旨在建立在我们实验室的三个核心优势上，以在减少辐射使用，快速和廉价地实施骨切割以保存骨种植体，以及加速我们对种植体失效基本机制的理解方面取得明显进展。这些广泛的推动将作为一系列独立资助的转化和商业化相关后续项目的基础。*本提案的三个主要方案领域是：*1。局部相位增强3D超声：我们计划将当前的局部相位处理算法移植到一个适合开发实时应用的通用平台上。从长远来看，我们将结合弹性成像的原理，使超声图像中骨表面的估计更加可靠。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一个适合尸体测试的3D原型机器人。我们还将验证并应用支撑系统设计框架（其目的是比机器人更快地设置，但比传统技术具有更好的准确性），以提高关键手术任务中的骨成型性能。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运动，为功能和早期种植体失败的准确定量研究奠定基础。然后，我们将使用该技术进行初步研究，以评估出现松动的患者的关节和植入物运动。我们还将完成目前基于开放mri的股髋臼撞击评估。*预期意义*总的来说，这里提出的项目侧重于通过减少手术团队的辐射暴露来解决广泛接受计算机和机器人辅助技术的最重要障碍。简化和缩短骨成形过程并提高其准确性（特别是用于单室膝关节置换术的新型保骨植入物），并为评估新CAOS手术改善结果的声明提供更快、更直接的过程。我们预计外科医生将从这些技术中受益，因为他们能够量化他们手术表现的关键方面，并利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，并有望延长他们的植入物的寿命，社会将受益于降低成本。

Objectives*I 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.*Background*Arthritis 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 Approach*My 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 Significance*Collectively, 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.