Computer-Assisted Orthopaedic Surgery with Intra-Operative Biomechanical Guidance

描述（由申请人提供）：拟议研究的目的是推进和评价实时术中生物力学引导系统（BGS），该系统可改善关节手术期间的决策。该系统将由外科医生在髋臼周围截骨术（PAO）期间使用。BGS将在手术过程中与外科医生互动，并显示关节的当前生物力学状态。它将使用来自导航系统图像的信息，并在术中修改关节对线时显示髋关节中的关节方向和接触压力分布。拟议的研究将通过开发新的软骨分割和变形配准技术以及外科医生-BGS交互的新工具和界面（目标1）来进一步增强BGS原型技术。将扩展BGS的理论基础，以模拟半脱位、髋关节发育不良中的关节不一致和非线性（目标4）。基于现有的传统技术，将设计PAO手术期间成功关节重新对准的最低解剖标准。系统的可靠性将通过测试系统是否持续满足联合重新调整的标准来确定。外科医生将使用BGS的生物力学和虚拟放射学反馈来补充传统的PAO技术，以便将发育不良髋关节的解剖角度重新对准正常髋关节的解剖角度。为了比较采用实时BGS的截骨术与不采用BGS的截骨术的临床结局，将进行年度临床随访，并将临床结局与生物力学和影像学结局进行比较（目标5）。虽然这项工作的重点是髋臼周围截骨术，但这项研究的应用可以扩展到其他类型的髋关节截骨术、其他关节截骨术和全关节置换技术。

DESCRIPTION (provided by applicant): The objective of the proposed research is to advance and evaluate a real-time, intra-operative biomechanical guidance system (BGS) that may improve decision making during joint surgeries. The system will be used by the surgeon during periacetabular osteotomies (PAO). The BGS will interact with the surgeon during the operation and display the current biomechanical state of the joint. It will use the information from the imagery of the navigation system and display the joint orientation and contact pressure distribution in the hip joint as the joint alignment is modified intraoperatively. The proposed research will further enhance the BGS prototype technology by developing new cartilage segmentation and deformable registration techniques as well as novel tools and interfaces for surgeon-BGS interaction (Aim 1). The theoretical foundation of the BGS will be extended in order to model subluxation, joint incongruency in hip dysplasia, and nonlineaavers (Aim 4). Based on available conventional techniques, the minimum anatomical criteria for successful joint realignment during PAO surgery will be devised. The reliability of the system will be determined by testing whether the system continuously satisfies those criteria for joint realignment. The surgeon will use the biomechanical and virtual-radiographic feedback of the BGS to supplement the conventional PAO techniques in order to realign the anatomical angles of the dysplastic hip to that of the normal hip. In order to compare the clinical outcomes of the osteotomy with real-time BGS to osteotomy without BGS, annual clinical follow-ups will be performed and the clinical outcomes will be compared to the biomechanical and radiological outcomes (Aim 5). While the focus of this work will be on periacetabular osteotomy, applications of this research can be extended to other types of hip osteotomies, other joint osteotomies, and total joint replacement techniques.