Research Proposal: Investigation into the Use of Laser Tools in Orthopaedic Surgery

由于要求更严格的制造公差，在激光烧蚀精度方面取得了实质性进展，最近一次是通过向飞秒超短脉冲激光的转变。这类设备减少了局部加热，通过在热扩散和电子扩散中将能量分散到整个材料中，从而实现了更高的精度，并减少了微结构损伤(他等，2015)。在金属、半导体、晶体、玻璃和陶瓷的消融中观察到了亚微米的精度，激发了它们在骨消融中的应用潜力(Wang等人，2015)。这种外科应用的最大风险是通过脆性材料中的高热致应力而发生骨折；因此，这种局部热还原应用于活骨组织是势在必行的。矫形外科激光手术提供的机会与其他手术相同；激光消融使损伤血管的精确度、操作简便性和烧灼，从而有望提高手术能力和改善患者恢复。本提案描述了许多研究这一过程的机会和飞秒激光消融在骨科手术中的实施潜力。合适的第一个标准将通过模拟骨表面的热产生，产生不同的脉冲持续时间：纳秒，皮秒和飞秒。这一初步研究将澄清局部和整体加热对变形和机械故障的影响，由此可以建立脉冲持续时间、功率和机械完整性之间的关系。在获得令人满意的模拟结果之前，进一步的研究将提供束强度和骨密度之间的相关性，表明该方法在不同位置和患者条件下的适用性。随着加热分析，下一步计算将研究合适的切割面。激光手术可以是直接的，即激光辐射直接处理组织；也可以是间接的，即辐射通过加热连接到光纤末端的涂层尖端(加热的手术刀)来修改组织(Bredikhin等人，2016)。在进行实验室研究之前，将通过建模来比较合适的切割面。建模阶段完成后，随后将进行实验室测试；初步调查将测试激光对生物组织的作用。随着小组织样本的检测，将对较大的死亡组织进行调查。为了可靠的测试，一次骨消融将用生理盐水约瑟夫·伯恩福德14/08/2020在整个材料中流动，复制活组织中血液流动所提供的热传输。随着程序的反复修改和重塑，随着测试对象与活组织的距离变得更近，最后的非临床测试将由最近去世的人捐赠进行。如果所有测试阶段都是成功的，并获得伦理批准，则可能有机会通过临床试验最终完成程序性测试。

The desire for tighter manufacture tolerances have seen substantial progress in laser ablationprecision, most recently through shifts to femtosecond ultrashort pulse lasers. The reduction inlocalised heating from such equipment has enabled greater precision and reduced microstructuredamage, by dispersing energy throughout the material in both thermal and electron diffusion (He etal., 2015). Sub-micrometre precision has been observed in the ablation of metals, semiconductors,crystals, glasses and ceramics, inspiring potential for their use in bone ablation (Wang et al., 2015).The greatest risk from such surgical application is that of fracture through high thermal-inducedstresses in the brittle material; it is therefore imperative that this localised heating reduction carriesover to use in live bone tissue. The opportunities offered by orthopaedic laser surgery are commonwith other operations; laser ablation enables precision, operative ease and cauterisation of damagedvessels, consequently promising increased surgical capabilities and improved patient recovery.This proposal describes numerous opportunities for studying this process and the potentialimplementation of femtosecond laser ablation in orthopaedic surgery. The first gauge of suitabilitywould come through the modelling of heat generation at the bone surface, resultant from variouspulse durations: nano-, pico- and femtosecond. This primary investigation would offer clarity to theeffect of localised and overall heating on deformation and mechanical failure, from which arelationship between pulse duration, power and mechanical integrity could be established.Presuming a satisfactory simulation outcome, further investigations would provide correlationbetween beam intensity and bone density, indicating the suitability of the method in a variety oflocations and patient conditions.With heating analysed, the next computation would investigate appropriate cutting surfaces. Lasersurgery can be either direct, where the laser radiation directly processes the tissue; or indirect,where radiation modified the tissue through heating a coated tip attached to the end of the opticalfibre, a heated scalpel (Bredikhin et al., 2016). Appropriate cutting surfaces would be compared,through modelling, before laboratory investigations are conducted.With modelling phases complete, laboratory testing would follow; primary investigations would testthe laser on biological tissues. With small tissue samples tested, investigations into larger deadtissue would be conducted. For reliable testing, primary bone ablation would be assisted with saline Joseph Burnford 14/08/2020flow throughout the material, replicating the thermal transport afforded by blood flow in livingtissue. With procedures iteratively modified and remodelled, as the test subject becomes closer toliving tissue, a final non-clinical test, with donations from the recently deceased, would beconducted. If all testing phases are successful and ethical approval is acquired, there may be anopportunity for the procedural testing to be finalised through clinical trial.