Preoperative Planning of Femoroplasty

描述（由申请人提供）：有大量关于骨丢失可能损害强度并增加骨折风险的研究。据报道，老年骨质疏松症患者髋部骨折后的死亡率高达30%。提示股骨加固是降低高度髋关节脱位骨折风险的有效对策。这种技术对于那些有高福尔斯跌倒风险的患者尤其有价值，如果他们要承受跌倒，死亡率和发病率的风险最高。已经进行的股骨增强的fw临床病例研究表明，成功的结果需要详细的计划，生物力学分析和精确控制增强程序，以避免由于增强而产生高应力区域。 我们的长期目标是开发一种技术，使外科医生能够精确地确定骨质疏松症的程度和骨折风险水平，根据计算机力学分析获得优化的手术计划，在术中生物力学反馈下进行快速微创髋关节增强，并最终在一次患者访视中验证结果。在 在本计画中，我们将开发一个手术试验台，以规划股骨近端的隆乳，并证明其可行性。为了实现这一目标，我们提出了两个目标：1。股骨成形术的最佳规划：我们建议开发一种新的框架，包括应用于患者特定的CT扫描的计算扩散模型的骨质疏松股骨。该模型将适用于普遍存在的问题，预测最佳模式和策略，骨水泥注射使用输入从患者特定的CT和另一个计算模型的评估和减少骨折的风险。2.术前计划策略的验证：我们将进行一系列受控的无损尸体测试，以验证我们的模型在预测增强材料扩散几何形状方面的准确性。我们还将对骨质疏松股骨进行一系列破坏性尸体测试，以验证计划框架在相对较低的填充材料注射量下加强骨的能力。 该项目中开发的技术可能会导致一种非常需要的替代治疗，这对骨质疏松症导致骨折风险的患者可能是关键的，并证明了在端到端手术治疗中纳入基于生物力学的计划的重要性。

DESCRIPTION (provided by applicant): There is a wealth of research on the extent to which bone loss may impair strength and increase the risk of fracture. The rate of mortality after hip fracture in elderly patients with osteoporosis is reported to be as high as 30%. It is suggested that augmentation of the femur is an effective countermeasure to reduce the risk of fracture in highly osteoporotic hips. This technique would be especially valuable for those patients at high risk of falls and the highest risk of mortality and morbidity if they were to sustain a fall. The fw clinical case studies that have been performed on augmentation of the femur suggest that a successful outcome requires detailed planning, biomechanical analysis, and precise control of the augmentation procedure to avoid generation of areas of high stress due to augmentation. Our long term goal is to develop a technology that enables the surgeon to precisely determine the extent of osteoporosis and fracture risk level, obtain an optimized surgical plan based on computerized mechanical analysis, perform a rapid and minimally invasive hip augmentation with intraoperative biomechanical feedback, and finally verify the outcome in one patient visit. In this project, we will develop a surgical test bed for planning proximal femur augmentation and demonstrate its feasibility. Towards this goal, we propose two aims: 1. Optimal planning of the femoroplasty: We propose to develop a novel framework involving a computational diffusion model applied to patient-specific CT scans of the osteoporotic femora. The model will be suitable for the ubiquitous problem of predicting an optimal pattern and strategy for cement injection using input from both patient-specific CT and another computational model for assessment and reduction of the fracture risk. 2. Validation of the preoperative planning strategy: We will perform a series of controlled nondestructive cadaver tests to verify the accuracy of our model in predicting the diffusion geometry of the augmentation material. We will also perform a series of destructive cadaver tests on osteoporotic femora to verify the abiliy of the planning framework to strengthen the bone with a relatively low injection volume of the augmentation material. The technology developed in this project may lead to a highly needed alternative treatment that may be pivotal for patients at the risk of bone fracture due to osteoporosis as well as demonstrating the importance of incorporating biomechanics-based planning in end-to-end surgical treatment.