Image-Guided Workstation and Tools for the Treatment of Bone Defects

总结 我们的目标是开发新的图像引导，微创髋关节翻修技术 手术从2005年9月到2006年12月，约有51300例全髋关节翻修 关节成形术（THA）是在美国进行的，平均费用为54500美元， 每次翻修手术。初次和翻修髋关节置换术的数量预计将 在2005年到2030年之间几乎翻了一番。THA翻修手术的一些目标是 清除颗粒碎片，从骨和其他组织中清除所有溶骨性病变， 更换关节头聚乙烯内衬。微创方法试图保留 THA的髋臼和股骨部件，只要它们牢固地固定在骨上， 仅替换髋臼聚乙烯内衬。在微创方法中， 通过固定良好的金属髋臼部件的现有螺孔进入。在此为 外科医生面临的主要挑战是确定病变完全清创， 病变完全植骨。一项研究表明，平均而言，不到50%的病变是 由于难以进入髋臼后面的骨质溶解区域， 成分标准的外科手术器械无法进入 组件（有时一直延伸到骶髂关节）。因为直接视觉 检查和进入需要清创的区域并不总是可能的， 外科医生不得不完全移除THA组件，因为他们不能以其他方式清洁 溶骨性病变。组件移除增加了骨折和骨盆分离的风险， 使得非常长的（即手术后4-6个月）恢复和卧床休息时间， 老年患者。采用微创方法，患者可以开始正常负重 在手术后立即。因此，这一程序将大大受益于使用 微创方法和高度灵巧的（机器人辅助）器械 这些很难到达体内的区域。 据我们所知，机器人辅助的微创翻修技术治疗 溶骨性骨不发育。特别是，设计适当的工具和 用于治疗和清除溶骨性病变的灵巧操作器构成了独特的 由于对结构强度和柔性的要求，我们提出 开发用于术前计划的原型手术工作站， 翻修手术期间的术中监测、导航和计划更新。

Summary Our objective is to develop novel image-guided, less-invasive techniques for hip revision surgery. From September 2005 to December 2006 approximately 51300 revision Total Hip Arthroplasties (THAs) were performed in the United States with an average cost of $54500 per each revision surgery. The number of both primary and revision hip arthroplasty is projected to almost double between 2005 and 2030. Some of the goals of THA revision surgery are to eliminate the particle debris, remove all osteolytic lesions from the bone and other tissues, and replace the articulating polyethylene liner. The less-invasive approach attempts to preserve acetabular and femoral components of the THA, as long as they are firmly fixed to the bone, and only replaces the acetabular polyethylene liner. In the less-invasive approach, lesions are accessed through existing screw holes of the well-fixed metal acetabular component. Here, a major challenge for the surgeon is determining that the lesion is fully debrided and that the lesion is fully bone grafted. One study suggests that, on average, less than 50% of the lesion is actually grafted due to difficulty in accessing the areas of osteolysis behind the acetabular component. Standard surgical instruments are unable to access the cavities deep behind the component (sometimes extending all the way to the sacro-iliac joint). Because direct visual inspection and access to the areas requiring debridment is not always possible, many times surgeons have to completely remove THA components because they cannot otherwise clean the osteolytic lesions. Component removal increases risk of fracture and pelvic dissociation, and makes for remarkably long (i.e. 4-6 months after surgery) recovery and bed-rest periods in elderly patients. With less-invasive approaches patients may start normal weight bearing immediately after the surgery. This procedure, therefore, would highly benefit from the use of less-invasive approaches and highly dexterous (robotically-assisted) instruments to access these very difficult to reach areas within the body. To our knowledge, robotically-assisted, less-invasive revision techniques for treatment of osteolytic bone are not developed. In particular, the design of the appropriate tools and dexterous manipulators for the treatment and removal of the osteolytic lesions poses unique challenges because of the requirements for both structural strength and flexibility. We propose to develop a prototype surgical workstation for preoperative planning, and real-time intraoperative monitoring, navigation, and updating of plans during the revision surgery.