Computer Vision-Based Navigation System for High-Precision Orthopedic Trauma Surgery

项目摘要/摘要 闭合或开放骨折复位内固定是治疗骨盆骨折的标准手术方法， 目前的临床实践使用透视引导、导丝插入和空心钉放置。这个 在计算2D透视中复杂的3D形态方面的挑战是不确定的主要来源，试验和 错误，结果很差，20%-30%的螺钉放置不佳，透视时间长(平均透视 时间&gt；123 S)使操作人员受到高水平的辐射照射。尽管存在这些挑战，但主流 手术方法35年来基本保持不变，手术导航系统(尽管越来越多 神经外科中常见的)存在成本和工作流程障碍，限制了其在创伤外科的广泛应用。 我们提出了一种基于计算机视觉的导航方法，该方法与常规创伤手术流程兼容， 提供与立体定向导航相当的精确度的实时制导，将辐射减少十分之一 暴露，并使用创伤外科武器库中已经很常见的工具。拟议的系统使用了一个微型 安装在手术钻上的立体摄像机与透视视图的3D-2D配准相结合 与患者解剖结构相关的器械轨迹的直接实时配准。仪器的实时覆盖 透视图和/或CT中的轨迹允许准确识别导丝入口点、方向和 在骨走廊内的遵从性，并将减少对“荧光探查”和试错式导丝的依赖 放置。以下目的是开发和评估该系统在骨盆创伤手术中的应用，包括 临床前研究中准确性、工作流程和辐射剂量的定量评估。 目的1.创伤手术中基于计算机视觉的导航系统。硬件和软件组件 将开发一种标准的手术钻头，提供实时轨迹，以实现船上基于视觉的跟踪 在透视和/或术前CT中进行叠加。将开发一种自动钻头轴线的快速标定方法 校准。基于特征的视频和透视帧的自动配准能够实时覆盖 透视视图中的仪器轨迹(透视导航)以及CT和透视之间的3D-2D配准将 在CT(CT导航)中启用仪器轨迹的实时覆盖。 目的2：临床前研究中的评价。基于视觉的导航系统将在临床前实施 (身体)评估准确性和工作流程的实验。这些研究将评估几何精度和 与重复插入尝试次数、手术时间和辐射剂量相关的工作流程因素，评估 基于视觉的透视导航和CT导航与传统徒手透视导航的比较。 AIMS的成功完成将建立一个适合于基于计算机视觉的导航系统进行翻译 在今后的工作中进行临床研究。这样的系统在常规创伤外科手术中提供了潜在的重大进步，带来了 可与最先进的立体定向导航相媲美的功能，无需成本、复杂性和额外的工作流程 传统航海的一部分。

PROJECT SUMMARY / ABSTRACT Closed or open fracture reduction and internal fixation is the standard surgical approach in treating pelvic fractures, with current clinical practice using fluoroscopic guidance, guidewire insertion, and cannulated screw placement. The challenge in reckoning complex 3D morphology in 2D fluoroscopy presents a major source of uncertainty, trial-and- error, and poor outcomes, with 20-30% rate of suboptimal screw placement and long fluoroscopic runtime (mean fluoro time > 123 s) exposing operating personnel to high levels of radiation exposure. Despite these challenges, mainstream surgical approach has remained largely unchanged for 35 years, and surgical navigation systems (though increasingly common in neurosurgery) present cost and workflow barriers that limit their broad applicability in trauma surgery. We propose a computer vision-based navigation approach that is compatible with routine trauma surgery workflow, offers real-time guidance with accuracy comparable to stereotactic navigation, gives ten-fold reduction in radiation exposure, and works with tools already common in the trauma surgery arsenal. The proposed system uses a miniature stereoscopic camera mounted onboard the surgical drill in combination with 3D-2D registration of fluoroscopic views for direct, real-time registration of the instrument trajectory relative to patient anatomy. Real-time overlay of instrument trajectory in fluoroscopic views and/or CT permits accurate identification of guidewire entry point, orientation, and conformance within bone corridors and will reduce reliance on “fluoro hunting” and trial-and-error guidewire placement. The following aims develop and evaluate the system for application in pelvic trauma surgery, including quantitative assessment of accuracy, workflow, and radiation dose in pre-clinical studies. Aim 1. System for computer vision-based guidance in trauma surgery. The hardware and software components required for vision-based tracking onboard a standard surgical drill will be developed, providing real-time trajectory overlay in fluoroscopy and/or preoperative CT. A fast calibration method will be developed for automatic drill axis calibration. Automatic feature-based registration of the video and fluoroscopic frames enables real-time overlay of instrument trajectory in fluoroscopic views (Fluoro Navigation), and 3D-2D registration between CT and fluoroscopy will enable real-time overlay of the instrument trajectory in CT (CT Navigation). Aim 2: Evaluation in preclinical studies. The vision-based navigation system will be implemented in pre-clinical (cadaver) experiments to evaluate accuracy and workflow. These studies will evaluate the geometric accuracy and workflow factors relating to the number of repeated insertion attempts, procedure time, and radiation dose, evaluating vision-based Fluoro Navigation and CT Navigation in comparison to conventional freehand fluoroscopy guidance. Successful completion of the aims will establish a system suitable for computer vision-based navigation to be translated to clinical studies in future work. Such a system offers a potentially major advance in routine trauma surgery, bringing capabilities comparable to state-of-the-art stereotactic navigation without the cost, complexity, and additional workflow of conventional navigation.