ShoulderNav: Computer Assisted Total Shoulder Arthroplasty

描述(申请人提供)：在美国，每年约有400万人因肩部问题寻求医疗护理，肩关节炎是最常见的问题之一。肩关节置换手术，也被称为全肩关节置换术或“TSA”，通常是影响这些患者的严重、持续疼痛的唯一有效治疗方法。TSA是一种困难的外科手术，需要通过一个小而深的切口准确放置假体，这对受影响的解剖结构几乎没有可见性。关节窝表面的替换是手术中最困难的部分，而关节窝植入物的错位可能会导致种植体松动，加速种植体磨损，并最终进行翻修手术。该项目的总体目标是开发一个完整的计算机辅助全肩关节置换手术规划和导航系统。这将允许外科医生以更低的风险和成本更快、更准确地执行针对患者的优化计划。阶段I假设：基于图像的计划和手术导航的结合将提高关节突定位的准确性。具体目标1-为TSA开发概念验证的术前计划器，允许根据患者的术前CT数据确定植入物的大小和方向，并基于简化的关节模型进行模拟。具体目标2-开发用于TSA导航的电磁跟踪兼容工具，以取代通常用于计算机辅助关节置换的较笨重的光学跟踪器。具体目标3-开发一种术中TSA导航系统的概念验证，以帮助进行关节镜表面准备和种植体植入，包括纳入最佳的骨注册参数。具体目标4：通过在泡沫骨模型上的一系列模拟手术中将新系统与标准手术实践进行比较，显示TSA计划/导航在关节臼置入术中的可行性和益处。这项拟议的工作将验证计算机辅助技术在全肩关节置换术中的应用。目前提出的技术将使外科医生能够准确地计划和执行假体肩窝的植入，从而提高假体的效率并降低术后并发症的风险。

DESCRIPTION (provided by applicant): About 4 million people in the U.S. seek medical care each year for shoulder problems, with shoulder arthritis as one of the most common. Shoulder replacement surgery, also called total shoulder arthroplasty or "TSA", is often the only effective treatment for the severe, unrelenting pain that affects these patients. TSA is a difficult surgical procedure, which requires accurate placement of prostheses through a small, deep incision, which offers very little visibility of the affected anatomy. Replacement of the glenoid surface is the most difficult part of the procedure, and misalignment of the glenoid implant can lead to implant loosening, accelerated implant wear, and eventual revision surgery. The Overall Aim of this project is to develop a complete computer assisted surgical planning and navigation system for total shoulder arthroplasty. This will allow a surgeon to execute a patient-optimized plan more quickly and more accurately with fewer risks and costs. Phase I Hypothesis: The combination of image-based planning and surgical navigation will improve the accuracy of glenoid placement. Specific Aim 1 - Develop proof of concept preoperative planner for TSA allowing implant sizing and orientation against the patient's preoperative CT data and simulation based upon a simplified joint model. Specific Aim 2 - Develop electromagnetic tracking-compatible tooling for TSA navigation in order to replace bulkier optical trackers that are typically used in computer-assisted joint replacement. Specific Aim 3 - Develop a proof of concept intraoperative TSA navigation system to aid in glenoid surface preparation and implant placement, including incorporation of optimal bone registration parameters. Specific Aim 4: Show the feasibility and benefits of TSA planning/navigation for glenoid placement by comparing the new system against standard surgical practice in a series of mock surgeries on foam bone models. The proposed work will validate computer-assisted techniques in total shoulder replacement. The presented technology will allow surgeons to accurately plan and execute implantation of the prosthetic shoulder socket, thereby improving effectiveness of the prosthesis and lowering the risk of postoperative complications.