| 摘要: | 由於國內人口的老化，脊椎疾病也急速增加，據統計，臺灣每年至少有兩萬件脊椎侵入性治療的病例，主要成因是退化性或骨質疏鬆症，嚴重時皆易造成脊椎骨折。過去十年中，微創手術已成為外科技術的主流，由於無侵入性治療的併發症與縮短病患恢復期等功效，為病患帶來更好的福利，在脊椎手術領域中也特別重要。然而，脊椎微創手術需大幅使用C-arm X光影像，為病患與外科醫生帶來潛在性的放射性傷害。此外，新進外科醫師學習脊椎手術的時間相當長，此是由於脊椎手術相較於其它外科手術更為困難所導致。本計畫的目的在研發一結合擴增實境與三維醫學影像的脊椎手術術前評估與術中導航系統，並能夠與現存之脊椎手術流程相結合，一方面增加脊椎手術的精度，另一方面降低手術中C-arm拍攝的頻率，對病患而言能夠達到更安全與更為精確的脊椎手術。首先，發展CT、MRI、STIR-MRI等醫學影像快速分離軟、硬組織的技術，並發展不同類影像之座標定位技術，使得各類組織模型得以整合在一起，以建構患部三維模型。其次，發展脊椎手術術前評估系統，提供完整之三維模型包括皮膚、骨骼、血管與神經之顯示與操作，並結合手術器械與植體模型與C-arm二維影像之模擬，提供術前評估所需之各種資訊。第三，藉由擴增實境技術結合Video影像，將C-arm影像、Video影像與病患三維模型於術中顯示，並追蹤手術器械位置即時回饋，以降低C-arm之使用量。最後，將整個術前與術中導航系統裝置在手術室中，藉由假體的實驗以驗證此一系統的可行性。深信本系統的發展可解決資深醫師在手術前因資訊不足引起的不確定性，於手術過程中有手術器械之導航資料輔助判斷，以加快手術流程，並能夠讓年輕醫師藉由此一系統縮短脊椎手術的學習過程。 Owing to the growing of elderly people, spinal diseases have been increased substantially for the past several years. In Taiwan alone, there are more than twenty thousands spine interventions performed per year. Two primary reasons of spinal diseases are degenerative and osteoporotic, which may easily result in spinal fractures when the situation is serious. In the course of last decade, minimally invasive surgery (MIS) has presented itself as one of the major evolutions in surgical techniques. As a greater benefit to the patients, it has reduced morbidity and recovery time after an intervention. This is a very significant advantage for MIS for the spine. During MIS for the spine, C-arm images are required. However, this introduces a major radiation hazard to both the patient and the surgeon. Another difficulty is the learning curve associated with this procedure. Currently, a novice surgeon requires many years of practice with an expert surgeon to perform interventions with high degree of accuracy and safety. The purpose of the proposed project is to develop a novel guidance system for spinal surgery to facilitate in surgical procedures and through the process reduce the radiation exposure. First, various segmentation techniques would be developed to extract soft and hard tissues from CT, MRI and STIR-MRI images, respectively. Appropriate registration techniques would also be developed so that tissue models form different types of images can be integrated as a unified model for the patient. Second, a pre-operative planning system capable of displaying various models, including the patient, surgical tools, implants and virtual C-arm images, would be presented to provide whichever information needed for pre-operative analysis. Third, an augmented reality system would be presented to be able to merge C-arm image with an external video view of the patient. It also provides an augmented reality view of a preoperative patient model in the video and X-ray view. The surgical instrument position would be tracked in video view, and its position displayed in X-ray image in real-time. Finally, the entire preoperative and intra-operative system would be implemented on a spine phantom to demonstrate the feasibility of the proposed system. Experiments would also be conducted on patients using passive protocol without any danger to the patients. It would be shown how each one of these incremental features would allow reducing radiation exposure and providing higher accuracy. Particularly patient safety would be considerably increased. 研究期間：10008 ~ 10107 |
