OsteoMark: A Navigation Aid for Endoscopic Orthognathic Surgery

描述（由申请人提供）：物理科学公司与我们在麻省总医院口腔颌面外科的临床合作伙伴，提议开发一种在正颌手术中导航的标记系统。该设备既可用于内窥镜手术，也可用于开放式手术。它可用于将基于计算机的3D手术计划工具或头部测量追踪的治疗计划转移到骨骼上。该系统将为患者提供术中图像注册，不需要术前图像中的基准标记，也不需要头部固定框架。应用OsteoMark的手术包括微创（内窥镜）重建和牵张成骨。一旦做了标记，外科医生将使用器械完成手术，没有任何跟踪，使用标记来指导骨骼的修改。与在手术过程中跟踪多个手术器械运动的系统相比，该设备将更便宜、更简单。我们建议开发基于2D和3D术前图像的导航，尽管第一阶段将只处理3D图像。OsteoMark将与开源医学成像软件Slicer/Osteoplan进行交互。在第一阶段，我们将制造原型标记，开发切片机的基本软件界面，并在一系列台架测试中表征其性能。最重要的可行性演示将是在猪尸体头部进行的一组内窥镜手术，我们将在类似于手术室的环境中量化标记装置的性能。公共卫生意义：微创手术越来越广泛地应用于面部骨骼重建，因为它比开放手术恢复时间更快，疼痛和不适更少，疤痕更少。最近的另一项进展是使用计算机图形工具来规划复杂的重建操作。我们正在提议开发一种设备，使外科医生能够通过一个非常小的切口将计算机治疗方案复制到骨头上，从而使外科医生能够以更小的难度为患者进行更复杂的手术。

DESCRIPTION (provided by applicant): Physical Sciences Inc., with our clinical partners in the Dept of Oral and Maxillofacial Surgery at the Massachusetts General Hospital, propose to develop a marking system for navigation during orthognathic surgery. The device can be used for both endoscopic and open procedures. It can be used to transfer treatment plans from computer-based 3D surgical planning tools or cephalometric tracings onto the bone. The system will provide for intraoperative registration of the image to the patient, with no requirement for fiducial markers in the pre-operative images and no fixation frame attached to the head. Examples of procedures where OsteoMark might be used include minimally-invasive (endoscopic) reconstruction and distraction osteogenesis. Once the marks are made, the surgeon will complete the procedure using instruments without any tracking, using the marks to guide the modification of bone. The proposed device will be less expensive and less complex than a system that tracks the motion of multiple surgical instruments as procedures are performed. We are proposing to develop navigation based on both 2D and 3D pre-operative images, though Phase I will address only the 3D images. OsteoMark will be developed to interact with the open-source medical imaging software Slicer/Osteoplan. In Phase I, we will fabricate the prototype marker, develop a rudimentary software interface for Slicer, and characterize its performance in a series of bench tests. The capstone feasibility demonstration will be a set of endoscopic procedures performed in porcine cadaver heads, from which we will quantify the performance of the marking device in an environment that closely resembles an operating-room. Public Health Significance: Minimally-invasive surgery is becoming more widely used in reconstruction of bones in the face because it results in faster recovery times, less pain and discomfort, and less scarring than open procedures. Another recent advancement has been the use of computer graphics tools to plan complex reconstruction operations. We are proposing to develop a device that will enable surgeons to copy computer treatment plans to the bone even through a very small incision, allowing surgeons to perform more sophisticated procedures with less difficulty for the patient.