| 摘要: | 一般人體受力較大的部位都集中在膝關節、髖關節與脊椎等位置，也因此在骨科門診、住院開刀的病例裡，這類的病患往往就占了絕大多數。加上近來台灣人口平均年齡已逐漸老化，相關的退化性關節病症或因骨質疏鬆導致的骨折病例也在急劇地增加中。而在手術方法的發展方面，為了改善傳統開放式手術的缺點，「微創手術」已普遍受到重視，不僅手術的過程可簡化、時間可縮短，更重要的是，病患在術中受到破壞的身體組織將大幅減少，可有效避免可能引發的後遺症，而術後復原的時間也可以相對地縮短。然而，微創手術由於傷口視野較小，卻也相對地提高了手術執行的困難度，其中又以脊椎相關的手術更為複雜，乃因其緊鄰人體的中樞神經系統與動脈血管，因此過程中醫生通常必須大量仰賴 C-arm的拍攝影像，雖然可以提升手術流程的安全性，卻也導致幅射曝曬劑量的增加，對醫生和病患將來的健康造成不良的影響。為了降低微創手術的風險，本計畫將發展一個具有術前評估模組的醫學影像軟體平台，可提供醫師更多病灶區的相關資訊，藉此增加醫師手術過程的自信心與正確性，並可減少手術過程中C-arm拍攝的次數，降低醫生與病人累積的幅射劑量，以落實更健康、安全的醫療行為。本計畫將以一般風險等級較高的脊椎手術為實施例，並規劃其術前評估系統主要包含四大部份：(1)組織區域分離與三維模型(含病患、植體、手術器械)之建構與顯示，(2)「椎體修補融合手術」術前評估，(3)「內固定手術」術前評估，(4)術前評估與術中資訊整合與驗證，分三年進行之。在預期效益方面，本計畫發展之脊椎手術術前評估系統，將建立以三維醫學影像為主之顯示與操作系統，可提供完整之病患三維模型包括皮膚、骨骼、血管與神經之三維模型顯示，並結合手術器械與植體模型，以及進行術中 C-arm二維影像之模擬、比較與分析，以提供醫師術前評估所需之各種資訊。由於脊椎手術種類繁多，本計畫乃先以椎體修補融合手術與內固定手術之術前評估為研究重點，針對兩種手術的術前評估、分析與模擬功進行發展，並期待本研究所產出的成果可改善目前因術前資訊不足而需大量仰賴醫師經驗的困境。Generally, knees, hips and spines are subjected to most compressive stress in human body, which results in most outpatients to receive orthopedic clinics and surgical operations as well. In addition, the increase in aging population also induces the growing cases of degenerative joint disease and bone fracture from osteoporosis. The minimally invasive surgery (MIS) with concise procedures and less time spent can improve the weaknesses of traditional operations with large incisions and has becomes more and more popular. Most important of all, it can reduce the damage of the tissues and organs neighboring the nidus and the time spent for rehabilitation. However, because of the narrowed filed of view on the nidus, MIS generally consists of the procedures of high-skilled and even difficult techniques, especially for spine surgery. Owing to its nearby nerves and arteries, it is necessary for surgeons to take plenty of C-arm images to obtain in-time information. Although it can ensure the patient safety in surgery to certain degree, the increasing radiation exposure will probably bring the patients and surgeons some diseases in the future, like cancers. To reduce the risks of MIS, this sub-project intends to develop a medical image software platform with the preoperative evaluation module, which reveals more information about the nidus to enhance the surgeons’ confidence and the success rate of surgery. Also, the quantities of C-arm images and the radiation exposure to patients and surgeons can then be decreased. In this sub-project, the preoperative evaluation system is mainly composed of four sections: (1) structure segmentation of medical images and construction and display of 3D models, (2) preoperative evaluation for Vertebroplasty, (3) preoperative evaluation for spine internal fixation, and (4) system integration and verification for preoperative evaluation and Intraoperative navigation, which will be proceeded in three years. In respect of potential benefits, this integration platform will be able to display and operate medical images in both 2D and 3D views and the 3D models of skin, bones, vessels and nerves. Some algorithms for the assembly simulation of instruments, implants and bones, the analysis of component parts and the imitative radiographs are also investigated and implemented to provide surgeons with more intuitive information for preoperative evaluation. Two common surgery types are selected from numerous spine surgery categories and processed in this sub-project. It is believed that MIS or general surgery over dependent on surgeons’ experience can then be improved with more nidus information provided by the platform developed in this sub-project 研究期間：10008 ~ 10107 |
