计算机辅助骨科手术的应用和进展

Application and progress in computer assisted orthopaedic surgery

计算机辅助手术(CAS)是近年来在外科手术领域发展最为迅速的一个领域。CAS在骨科手术中的具体应用被称为计算机辅助骨科手术(CAOS)。CAOS的含义是利用当今医学领域的先进成像设备如计算机断层扫描(CT)、磁共振成像(MRI)、正电子发射断层扫描(PET)、数字血管减影(DAS)、超声成像(US)以及医用机器人(MR)所得到的多模图像数据,在计算机的帮助下,对医学图像信息进行处理并结合立体定位系统,对人体骨骼的解剖结构进行显示和定位,并由计算机规划手术路径,制定合理、定量的手术方案,进行术前手术模拟,在适当的图像监视和立体定位系统下,利用一定的导引系统,在骨科手术中使用计算机和医用机器人进行手术干预,为骨科医生提供强有力的工具和方法。CAOS在提高病灶定位精度,减少手术损伤,执行复杂外科操作,提高手术成功率方面有卓越的表现,配准和定位是CAOS的核心技术。CAOS已应用在脊柱外科、人工关节置换术、创伤骨科、骨肿瘤治疗中。

Computer assisted orthopaedic surgery (CAOS) is a fast develop ing area nowadays. Its primary goal is to provide a direct link between preopera tive planning and intraoperative surgical action through advanced image-interac tive surgical navigation. CAOS integrates computer science, biomedical engineeri ng, mechanism, mathematics, and surgery. CAOS can help surgeons use multimodal d ata, such as CT, MRI, DSA, and PET. Planning and performing medical intervention in a rational and quantitative way,it has great advantages in precise determina tion of the focus, planning optimal surgical project and assuring success of ope ration. Stereotactic localization method and registration are two cruxes in CAOS . This paper covers basic concepts, planning, simulation, and execution of surge ry in different anatomical areas, including spine, hip, and knee. Different surg ical techniques such as joint reconstruction, joint replacement, trauma fixation , and minimally invasive approaches are also discussed with examples of specific applications in clinic practice. Finally, some future developments in CAOS are predicted.