【摘要】：背景：手術(shù)導(dǎo)航系統(tǒng)在現(xiàn)代外科手術(shù)學(xué)中扮演著越來越重要的角色。導(dǎo)航系統(tǒng)的應(yīng)用提高了手術(shù)的安全性,有助于減小不必要的損傷。但手術(shù)導(dǎo)航系統(tǒng)在我國的發(fā)展尚處于起步階段,主要原因是其昂貴的價格國內(nèi)大多數(shù)醫(yī)院無法承受。另外,目前主流導(dǎo)航產(chǎn)品主要提供實時位置信息,針對專科醫(yī)生需求的定制功能仍很不完善。 目的：設(shè)計和研制一款擁有自主知識產(chǎn)權(quán)的光學(xué)手術(shù)導(dǎo)航系統(tǒng),并加入專為耳科手術(shù)設(shè)計的報警功能模塊。 方法：我們與北京航空航天大學(xué)機械工程及自動化學(xué)院合作研發(fā)了一套3D手術(shù)導(dǎo)航軟件系統(tǒng),并在其中加入了專為耳科手術(shù)設(shè)計的乙狀竇、腦膜、外耳道、面神經(jīng)、半規(guī)管等結(jié)構(gòu)的三維建模和術(shù)中報警系統(tǒng),可以在導(dǎo)航中實時計算鉆頭至面神經(jīng)等結(jié)構(gòu)的最近距離,并在小于設(shè)定的報警距離時開啟聲音和圖像報警。導(dǎo)航圖像統(tǒng)一采用了標(biāo)準(zhǔn)顳骨高分辨CT。為了盡可能減小配準(zhǔn)誤差,我們使用鈦釘進(jìn)行標(biāo)記點配準(zhǔn),并在兩個顱骨模型和一個尸頭顳骨標(biāo)本上測量了配準(zhǔn)誤差和追蹤誤差。為了驗證系統(tǒng)的有效性,我們在一個真實顳骨標(biāo)本上進(jìn)行了乳突根治術(shù),術(shù)中使用了導(dǎo)航系統(tǒng)的報警模塊,實時計算鉆頭至外耳道后壁、面神經(jīng)、腦膜和乙狀竇的距離。術(shù)后我們在復(fù)查CT圖像上進(jìn)行了誤差測量,并實際測量術(shù)后手術(shù)腔表面對應(yīng)位置的骨壁厚度進(jìn)行誤差比對和精度分析。 結(jié)果：導(dǎo)航系統(tǒng)的精度在標(biāo)本手術(shù)中達(dá)到了亞毫米級。在顱骨模型試驗中,采用四點、六點和八點配準(zhǔn)的靶點配準(zhǔn)誤差分別為0.81±0.05mm.0.56±0.04mm和0.40±0.04mm,在尸頭標(biāo)本試驗中的應(yīng)用誤差為0.43±r0.02mm,精度基本滿足實際需求CT圖像測量結(jié)果與實際測量的差值△Dimg=0.45±0.54mm.手術(shù)導(dǎo)航系統(tǒng)測量的最近距離與游標(biāo)卡尺測量的實際骨壁厚度的差值△Dnav=0.47±0.89mm.我們順利完成了CT圖像的三維建模、距離測算和基本報警功能的開發(fā),導(dǎo)航報警系統(tǒng)在手術(shù)中運行順利,可行性得到了驗證。 結(jié)論：我們開發(fā)的手術(shù)導(dǎo)航系統(tǒng)能為耳科手術(shù)提供醫(yī)生需要的定制導(dǎo)航功能,協(xié)助醫(yī)生在手術(shù)中保護(hù)重要的組織結(jié)構(gòu),有助于提升手術(shù)安全性。
文內(nèi)圖片：
圖片說明手術(shù)導(dǎo)航報警系統(tǒng)結(jié)構(gòu)
[Abstract]:BACKGROUND: The surgical navigation system plays a more and more important role in modern surgery. The application of the navigation system improves the safety of the operation and helps to reduce unnecessary damage. But the development of the surgical navigation system in our country is still in the initial stage, the main reason is its expensive price, most of the hospitals can't bear. In addition, that current mainstream navigation product mainly provide real-time position information, and the customization function aiming at the needs of the specialist is still not perfect. Objective: To design and develop an optical surgical navigation system with independent intellectual property, and to add an alarm function module designed for ear surgery. Block. Method: We developed a set of 3D surgical navigation software system in cooperation with the Mechanical Engineering and Automation College of the Beijing University of Aeronautics and Astronautics, and in which a sigmoid, meninges, and external auditory meatus designed for ear surgery were added. The three-dimensional modeling and intraoperative alarm system of the structure such as the facial nerve and the semicircular canal can calculate the most recent distance of the drill to the facial nerve and the like in real time in the navigation, and turn on the sound and the image when the alarm distance is less than the set alarm distance. It's like an alarm. The navigation image's unified with a standard high-bone high score. In ord to reduce that registration error as much as possible, we use the titanium nail for mark-point registration and measure the registration error and the chase on both the skull model and a cadaver bone specimen. In order to verify the effectiveness of the system, we performed the mastoidectomy on a real bone specimen, and the alarm module of the navigation system was used in the operation, and the drill bit to the posterior wall of the external auditory canal, the facial nerve, the meninges and the sigmoid were calculated in real time. After operation, we performed the error measurement on the CT image and measured the thickness of the bone wall in the corresponding position on the surface of the operation cavity after the operation. Degree analysis. Results: The accuracy of the navigation system was achieved in the specimen operation. The target registration error of four-point, six-point and eight-point registration was 0.81-0.05 mm, 0.56-0.04 mm and 0.40-0.04 mm respectively in the skull model test. The application error in the body-head specimen test was 0.43-r0.02mm, and the precision basically met the difference of the real-demand CT-image measurement result and the actual measurement. .54 mm. The difference between the most recent distance measured by the surgical navigation system and the actual bone wall thickness measured by the vernier caliper is Dnav = 0.47%0 .89 mm. We successfully completed the three-dimensional modeling, distance measurement and basic alarm function of the CT image, and the navigation and alarm system was successful in operation and feasibility. Conclusion: The surgical navigation system developed by us can provide the customized navigation function needed by the surgeon for the ear surgery, and help the doctor to protect the important tissue structure during the operation. To improve the safety of the operation. The image in the text: the operation of the picture
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：TP277

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