電腦輔助系統用於脊椎後融合骨釘植入手術之臨床應用評估;Clinical evaluation of computer-assisted surgery in spinal pedicle screws insertion

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題名:	電腦輔助系統用於脊椎後融合骨釘植入手術之臨床應用評估;Clinical evaluation of computer-assisted surgery in spinal pedicle screws insertion
作者:	張志儒;Chang,Chih-ju
貢獻者:	機械工程學系在職專班
關鍵詞:	電腦輔助手術;導航手術;脊椎手術;Computer assisted surgery;Navigation;Spinal surgery
日期:	2016-01-11
上傳時間:	2016-03-17 20:48:59 (UTC+8)
出版者:	國立中央大學
摘要:	植入椎莖螺釘的脊椎手術需要相當高的精確度及豐富的臨床經驗。因為脊椎結構，椎莖與脊髓神經毗鄰而居，所以只要稍有誤差，就可能傷害到脊椎神經而造成嚴重的神經缺損。傳統的手術，醫師於術前藉由二維的影像學檢例作為病情的診斷與手術治療計畫的基礎；然而每一病人的解剖位置不盡相同。所以手術順利、成功端賴於醫師本身專業的判斷與豐富的臨床經驗，但也顯現手術的不確定性與困難性。所以基於以上傳統手術的缺點，本研究希望利用電腦輔助手術的概念，發展一套應用於椎莖螺釘植入之脊椎手術導引方式，且確實運用於臨床。進而發展出實用的導引系統，用以縮短醫師養成的時間，也使椎莖螺釘植入之脊椎手術更加安全。本篇論文爲一連續性的實驗。以本實驗室原有的導航設備爲基礎，首先執行以電腦斷層為基礎的導航系統，用於實際手術的操作，來評估導航手術用於脊椎椎莖螺釘植入手術的可行性。雖然實驗得到肯定的結果，但臨床上已進展至微創手術。所以將本實驗室所發展的C-arm導引系統上加以改良，並以模型及實際手術應用來評估其精準度。結果顯示於實際手術時，將病人呼吸與影像擷取同步化即可得到很好的準確度。此種導引方式於實際手術操作時，確實可以提供器械即時的位置並減少C-arm的照射次數與幅射線的暴露量。又實際手術也很需要正確的手術路徑規劃，因此根據實驗室對於2D-3D方位校準的研究，提出計算較為省時及路徑規劃準確的方式。包括路徑規劃所需要的矢向面丶軸向面等三維的資訊。 ;The spine surgery of pedicle screws implantation requires relatively high accuracy and rich clinical experience. Due to the fact that the spinal structure, pedicle and spinal nerves are so close to each other, even the slightest error occurred may induce spinal nerves damage and cause severe neurologic deficits. Thus, how to implant pedicle screws successfully has become a vital issue. In traditional surgery, doctors acquire patients’ imange before surgery by two-dimensional images for the diagnosis and surgical planning. However, every patient is an independent individual so as to its anatomical position, hence ,wheather making operation smooth and successful depends on surgeon’s professional judgment and extensive clinical experience. All the above factors have shown the uncertainty and difficulty of traditional surgery. Based on the above shortcomings of traditional surgery, we hope to develop computer-assisted navigation system that can be applied in clinical practice with pedicle screw implantation. And the system can not only shorten the time of surgeon’s cultivation but also makes the operation safer. This study consists of a series of experiments based on our original navigation equipment in our laboratory. At first, we used CT-based navigation system for the actual surgical operation to evaluate the practicability of navigation surgery for the operation of pedicle screw implantation. Although the results of experiments seems positive, when compared with minimally invasive surgery, this navigation mode is out of date.Thus,the following laboratory and practical operation was then replaced with the C-arm guidance system, which is developed by our own laboratory to evaluate its accuracy. The outcome showed when we synchronize the patient’s breathing and image capturing during the surgery, the accuracy of the operation is relatively perfect. Our navigation system can provide real time position of tools in order to reduce the radiation exposure. The planning of screws pathway is also important. Therefore, according to the research of 2D-3D calibration made by our laboratory, we offer a more time-saving and accurate calculation to provide three-dimensional information about sagittal and axial plane for planning the surgery pathway.
顯示於類別:	[機械工程學系碩士在職專班 ] 博碩士論文

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