计算机辅助外科手术的基本概念

BASIC CONCEPT IN COMPUTER ASSISTED SURGERY

目的讨论医用数字影像系统与计算机技术在骨科手术中的应用。方法总结目前计算机技术在骨科临床开发应用的几个组成部分及其应用。结果计算机辅助外科可以:1对患者的数字资料进行采集记录,从术前的CT、MRI和X线片来提取,从术中的X线透视或B超影像获得,从术中手术器械和骨组织上通过三维定位装置得到的定位与定向资料中汲取;2将术前影像资料与术中从解剖标志或从骨表面探取的数据进行配准、整合,或直接利用术中从B超图像截取的骨轮廓影像资料进行手术导航;3帮助医生进行准确的决策过程,采用各种信息,术中针对器械与骨组织的相互位置,在术前或术中的数字影像资料上模拟显示预设导航方案,包括器械的方位、轴线、定向、长度和直径等;4通过被动、主动及半主动系统帮助医生术中监控具体操作,准确地达到术前计划好的方案。结论计算机辅助骨科手术系统可以为术者提供具有安全性与准确性的手术技术,是一种优化手术治疗的步骤。

Objective To investigate application of medical digital imaging systems and computer technologies in orthpedics. Methods The main computer-assisted surgery systems comprise the four following subcategories. Results （1）A collection and recording process for digital data on each patient, including preoperative images （CT scans, MRI, standard X-rays）, intraoperative visualization （fluoroscopy, ultrasound）, and intraoperative position and orientation of surgical instruments or bone sections （using 3D localisers）. Data merging based on the matching of preoperative imaging （CT scans, MRI, standard X-rays） and intraoperative visualization （anatomical landmarks, or bone surfaces digitized intraoperatively via 3D localiser; intraoperative ultrasound images processed for delineation of bone contours）. （2）In cases where only intraoperative images are used for computer-assisted surgical navigation, the calibration of the intraoperative imaging system replaces the merged data system, which is then no longer necessary. （3） A system that provides aid in decision-making, so that the surgical approach is planned on basis of multimodal information： the interactive positioning of surgical instruments or bone sections transmitted via preor intraoperative images, display of elements to guide surgical navigation （direction, axis, orientation, length and diameter of a surgical instrument, impingement, etc. ）. And （A） A system that monitors the surgical procedure, thereby ensuring that the optimal strategy defined at the preoperative stage is taken into account. Conclusion It is possible that computerassisted orthopedic surgery systems will enable surgeons to better assess the accuracy and reliability of the various operative techniques, an indispensable stage in the optimization of surgery.