混合现实技术对脊柱经皮后突成形术的探索与应用

Application and exploration of mixed reality technology in accurate operation of percutaneous vertebroplasty of spine

目的·探讨混合现实技术在脊柱经皮后突成形术中的应用与临床意义。方法·选择上海交通大学附属第一人民医院骨科1例多发骨质疏松性压缩骨折患者(女性,79岁),术前行腰椎64排CT扫描并获得医学数字成像和通信(digital imaging and communicationsin medicine,DICOM)原始数据,导入Visual Volume重建软件,构建脊柱压缩骨折模型,对脊柱骨骼模型可视化边缘检测、分割、提取和测算,生成三维网络模型。运用全息影像眼镜将脊柱压缩影像精确映射于真实世界,协助术者完成术前模拟及术中引导。结果·此患者术中在混合现实协助下穿刺准确,骨水泥在椎体内分布良好、无渗漏,术后患者腰背部疼痛缓解。混合现实技术有助于缩短手术时间,减少副损伤。基于脊柱骨骼结构的CT原始数据的重建,混合现实技术术中可视化清晰显示压缩骨折部位与周围解剖结构,手术路径清晰,可准确定位压缩骨折成型部位。结论·混合现实技术与脊柱经皮后突成形术的有机结合是新的有效的临床诊疗模式,协助精准穿刺,在脊柱微创个性化治疗中具有发展潜力。

Objective·To explore the application and clinical significance of mixed reality technology in percutaneous vertebroplasty of spine.Methods·A 79-year-old female patient with multiple osteoporotic compression fractures was selected in Department of Orthopedics,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine.Lumbar 64-row CT scan was performed to obtain digital imaging and communications in medicine (DICOM) data.Three-dimensional reconstruction software was imported to construct the model of spinal compression fracture.Visual edge detection,segmentation,extraction and calculation of spinal skeleton were performed to generate a three-dimensional network.Collateral model,by mixed reality smartglasses,three-dimensional image of the compression spine image was compared to the real world.Mixed reality technology could assist the surgeon to complete the preoperative simulation,communicate effectively with the patient,and guide percutaneous vertebroplasty of lumber.Results·With mixed reality,the puncture was accurate.The distribution of bone cement was good.The pain of patients was relieved obviously after operation.By mixed reality,the operation time was shortened and the side-effects were reduced.Based on reconstruction of mixed reality technology from original CT imaging data,the compression fracture and anatomical structure were visualized clearly during operation.The operation path was clear and the compression fracture forming site was accurately located.Conclusion ·Mixed reality technology is helpful for accurate puncture in percutaneous vertebroplasty of spine,and has potential for development in minimally invasive treatment of spine.