Image-Guided Workstation and Tools for Bone Defects

用于骨缺损的图像引导工作站和工具

• 批准号: 10176482
• 负责人: MEHRAN ARMAND
• 金额: $ 48.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176482
• 关键词: Address; Age; Animals; Area; Asians; Avascular Necrosis of Femur Head; Biomechanics; Blood Circulation; Bone Diseases; Bone Substitutes; Bone Transplantation; Bone necrosis; Cadaver; Cartilage; Cessation of life; Computer software; Country; Debridement; Defect; Development; Devices; Disease; Excision; Fracture; Goals; Head; Hemorrhage; Hip region structure; Hybrids; Image; Incidence; Intraoperative Monitoring; Lesion; Magnetic Resonance Imaging; Neck; Necrosis; Operative Surgical Procedures; Orthopedic Surgery; Orthopedics; Osteoporosis; Osteotomy; Outcome; Patient imaging; Patients; Pelvis; Performance; Phase; Positioning Attribute; Procedures; Research; Robot; Robotics; Series; Shapes; Site; Stimulus; Structure; Surface; Surgeon; System; Techniques; Technology; Testing; Time; Underweight; United States; Update; Vascular blood supply; Weight-Bearing state; Work; acetabulum; advanced disease; base; bone; calcium phosphate; design; dexterity; flexibility; follow-up; foot; hip replacement arthroplasty; image guided; improved; instrument; minimally invasive; next generation; novel; novel therapeutic intervention; operation; pain relief; pelvis fracture; prevent; procedure safety; prototype; real time monitoring; reconstruction; repaired; restoration; robot assistance; sensor; substantia spongiosa; success; tool

Summary Our long range goal is to develop an image-guided workstation that uses a novel Continuum Dexterous Manipulator (CDM) and tools to enable next generation of minimally- and less-invasive procedures allowing access to regions not currently accessible with conventional surgical tools in orthopaedic surgery. The system and devices will enable treatment of bone defects such as femoroacetabular impingement, metastatic bone disease, severe osteoporosis in areas including the pelvis/acetabulum, femoral neck, peri- and sub- trochanteric regions, as well as the shin and foot, and finally traumatic fracture repair. The near-term focus of this application is the core decompression for the treatment of Avascular Necrosis (AVN) of the femoral head and reduction of pelvis fracture. We propose the development of an image-guided prototype robot-assisted surgical system for planning, real-time intraoperative monitoring, navigation, and updating of the plans. In the United States, avascular necrosis (AVN, also known as osteonecrosis) of the femoral head occurs in 10000-20000 of patients per year between the ages of 20-50 years old. The incidence of the AVN is even higher in Middle Eastern and Asian countries. AVN occurs due to the loss of blood supply to the bone, leading to the spontaneous death of the trabecular bone, which in turn may cause microfractures in the trabecular bone. Depending on the amount of femoral head involved, collapse of the articular surface will occur as the disease advances. Once collapse of the femoral head occurs in these patients, the disease course rarely regresses. Total Hip Arthroplasty (THA) will be the primary surgery of choice and will provide pain relief to those AVN patients. However, because of the young age of the AVN patients, THA is not the most desirable choice. Core decompression is a conventional techniques used for the treatment of the AVN prior to the collapse of the femoral head. Typically in core decompression the lesion area (death bone) is removed by drilling and debriding. After debriding the bone graft will be inserted and/or bioresorbable material such as calcium phosphates will be injected into the core to fill the void and provide stability. The long-term success of core decompression is dependent on many parameters that may be out of the control of surgeons given the existing tools and techniques. Some of the issues that the current conventional techniques for core decompression does not answer are: 1) complete debriding of the death bone requires significant increase in dexterity of the debriding tools, currently not available to the surgeons; 2) While it is ideal to completely remove the death bone, the extent of the bone removal may be limited by the stability requirements of the femoral head to prevent its collapse underweight bearing conditions. Biomechanical analysis of the stability of the structure, therefore, must be important part of the planning. Further, the successful implementation of the plan will require robot-assisted, image-guided navigation technology that, to our knowledge, is currently not available to the surgeons. To our knowledge, tools for biomechanical planning to maintain the stability of the hip after the surgery and robotic platforms for minimally-invasive treatment of osteonecrosis are not developed. In particular, the design of the manipulators for the full debriding of the AVN poses unique challenges because of the opposing requirements for structural strength and flexibility. We propose to develop and test a prototype robot-assisted surgical workstation for minimally-invasive treatment of the AVN. The workstation, during the planning phase, will highlight the site of the lesion in MRI images of the patient and create an optimized surgical plan. During the procedure, the surgeon will use a Continuum dexterous manipulator (CDM) in conjunction with a positioning robot and various tools to remove the death bone and perform structural augmentation. Our goal is to demonstrate that the proposed system can significantly improve the treatment of the AVN and the stability of the hip, therefore, reducing the need for multiple follow-up surgeries and/or THA surgeries at early ages.

概括 我们的远距离目标是开发一个使用新颖的连续性灵巧的图像引导的工作站 操纵器（CDM）和工具，以实现下一代最小和侵入性的程序允许 目前使用骨科手术中的常规手术工具可以进入区域。系统 设备将能够治疗骨缺损，例如股tabular撞击，转移性骨骼 疾病，包括骨盆/髋臼，股骨颈，骨和亚的区域的严重骨质疏松症 车骨区域以及胫骨和脚，最后是创伤性的骨折修复。近期重点 该应用是治疗股头血管坏死（AVN）的核心减压 和减少骨盆骨折。我们提出了图像引导原型机器人辅助的开发 计划，实时术中监控，导航和更新计划的手术系统。 在美国，股骨头的无血管坏死（AVN，也称为骨坏死）发生在 每年10000-20000名20至50岁的患者。 AVN的发生率甚至是 中东和亚洲国家较高。 AVN发生是由于骨骼失去血液供应而导致的 小梁骨的自发死亡，这又可能导致小梁中的微裂缝 骨。根据所涉及的股骨头的数量，关节表面的崩溃将发生，因为 疾病进展。一旦股骨头崩溃，这些患者就会发生疾病病例很少 回归。总髋关节置换术（THA）将是首选的主要手术，并可以缓解疼痛 那些AVN患者。但是，由于AVN患者的年龄很小，THA并不是最可取的 选择。核心减压是一种常规技术，用于治疗AVN 股骨头的倒塌。通常，在核心减压中，病变区域（死亡骨）由 钻孔和清理。清理后，将插入骨移植物和/或可生物吸收的材料，例如 磷酸钙将被注入核心，以填充空隙并提供稳定性。 核心减压的长期成功取决于许多参数，这些参数可能超出 鉴于现有工具和技术的外科医生的控制。当前常规的一些问题 核心减压的技术没有回答：1）死亡骨的完整清理需要 目前外科医生目前无法使用的清理工具的灵巧性大幅增加； 2）虽然是理想的 要完全清除死亡骨，骨骼清除的程度可能受到稳定性的限制 股骨头的要求防止其体重不足的轴承条件。生物力学 因此，对结构的稳定性分析必须是计划的重要组成部分。此外， 该计划的成功实施将需要机器人辅助，图像引导的导航技术 我们的知识目前无法提供外科医生。 据我们所知，生物力学计划的工具，以维持手术后髋关节的稳定性 没有开发用于最小侵入性治疗骨坏死的机器人平台。特别是设计 AVN的全部清理器的操纵器的作品构成了独特的挑战 结构强度和灵活性的要求。我们建议开发和测试由机器人辅助的原型 用于对AVN的最小侵入性治疗的手术工作站。工作站，在计划阶段， 将在患者的MRI图像中突出显示病变的部位，并创建优化的手术计划。期间 该过程，外科医生将使用连续的灵巧操纵器（CDM）与 定位机器人和各种工具以去除死亡骨头并进行结构增强。我们的目标是 为了证明所提出的系统可以显着改善AVN的处理和稳定性 因此，髋关节减少了早年对多次随访手术和/或THA手术的需求。