Severe Acetabular Defects: Image-Guided Reconstruction

严重髋臼缺损：图像引导重建

• 批准号: 6802222
• 负责人: DOUGLAS D ROBERTSON
• 金额: $ 18.07万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-20 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6802222
• 关键词: bioimaging /biomedical imaging; bone imaging /visualization /scanning; computed axial tomography; hip surgery; human tissue; image guided surgery /therapy; orthopedics; pelvis; postmortem; technology /technique development

DESCRIPTION (provided by applicant): Acetabular revision of total hip replacements (THR) is one of the most challenging problems in orthopedic surgery today. Despite great advances in imaging, preoperative visualization and assessment of even the most difficult cases is still performed just like the first revision over forty years ago, using subjective examination of anteroposterior (AP) radiographs. This presents an opportunity for improving clinical out-come, especially given the widely-held orthopaedic surgery tenet that clinical success is directly related to the thoroughness and accuracy of preoperative planning. Ideally, revision surgical planning should determine defect type, describe amount and location of remaining bone (to select the best mechanically-sound reconstruction option), and confirm whether reconstruction should be performed. Lack of a validated, quantitative assessment that provides structural information limits the usefulness of current systems and leads to worse clinical outcomes, added cost, and wide intra- and inter-surgeon variability in selecting reconstruction options. Therefore, the next step for biomedical imaging is to move beyond outdated radiograph-based evaluations and onto mechanically and clinically relevant structural imaging. Our goal is to replace conventional radiograph-based planning with structural imaging in order to guide surgical reconstruction and improve the clinical outcomes of individuals with deficient acetabular bone. Our broad hypothesis is that advanced CT techniques increase the predictive power of preoperative assessments, link defect type with mechanical effects, and improve clinical outcomes. We seek to develop image-guided techniques that are mechanically-relevant and based on existing imaging technologies. This R21 proposal's specific aim is: Aim 1: Develop and validate objective CT-based structural-imaging techniques to guide surgery by describing host bone and its mechanical environment. Hypothesis: CT-based structural-imaging accurately (+ 2mm linear measurements, + 3% volume measurements, <15 % bone density errors) and reliably (inter-observer, kappa >0.80) define 3D structure and mechanical consequence. Future research aims include clinical implementation, outcome and cost benefit analyses, and development of minimally invasive surgery. Completion of this project will create an accurate CT-based technique to guide surgery by structurally assessing the morphology, density, and mechanics of the deficient acetabulae. This is the first and important step toward improving surgical planning, execution, and clinical outcomes of these difficult cases.

描述（由申请人提供）： 总髋关节置换（THR）的髋臼修订是当今骨科手术中最具挑战性的问题之一。尽管在成像方面取得了长足的进步，术前可视化和对最困难的情况的评估仍然像四十年前的第一次修订一样，使用前后X线射线照片（AP）X光片的首次修订。这为改善临床外部的机会提供了机会，尤其是考虑到广泛控制的骨科手术宗旨是临床成功与术前计划的彻底性和准确性直接相关。理想情况下，修订手术计划应确定缺陷类型，描述剩余骨骼的数量和位置（选择最佳机械响起的重建选项），并确认是否应进行重建。缺乏经过验证的定量评估，提供结构信息限制了当前系统的有用性，并导致临床结果较差，增加成本以及较大的外床间和间层间可变性，从而选择重建选项。因此，生物医学成像的下一步是超越基于过时的X光片评估，并在机械和临床相关的结构成像上移动。我们的目标是用结构成像替换传统的基于X光片的计划，以指导手术重建并改善髋臼骨不足的个体的临床结果。我们广泛的假设是，先进的CT技术增加了术前评估的预测能力，将缺陷类型与机械效应联系起来，并改善了临床结果。我们试图开发与现有成像技术相关的图像引导技术。该R21提案的具体目的是：目标1：通过描述宿主骨骼及其机械环境来开发和验证基于目标CT的结构成像技术来指导手术。假设：基于CT的结构成像准确（ + 2mm线性测量， + 3％的体积测量值，<15％的骨密度误差）和可靠（观察者间，Kappa> 0.80）定义了3D结构和机械后果。未来的研究目的包括临床实施，结果和成本收益分析以及最低侵入性手术的发展。该项目的完成将创建一种基于CT的精确技术，通过结构评估缺乏乙酰词的形态，密度和力学来指导手术。这是改善这些困难病例的手术计划，执行和临床结果的第一步。