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 Therefore, the next step for biomedical imaging is to move beyond outdated radiograph-based evaluations and onto mechanically and clinically relevant structural imaging.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）： 全髋关节置换术（THR）的髋臼翻修是当今骨科手术中最具挑战性的问题之一。尽管影像学取得了巨大进步，但即使是最困难的病例，术前可视化和评估仍然像四十多年前的第一次修订一样，使用前后位（AP）X线片的主观检查进行。这为改善临床结果提供了机会，特别是考虑到临床成功与术前计划的彻底性和准确性直接相关的广泛接受的骨科手术原则。理想情况下，翻修手术计划应确定缺损类型，描述剩余骨的数量和位置（以选择机械上最佳的重建方案），并确认是否应进行重建。缺乏提供结构信息的经过验证的定量评估限制了当前系统的实用性，并导致临床结果更差、成本增加以及选择重建方案时外科医生内部和外部的广泛差异。因此，生物医学成像的下一步是超越过时的基于射线照片的评估，转向机械和临床相关的结构成像。我们的目标是用结构成像取代传统的基于射线照相的计划，以指导手术重建并改善髋臼骨缺陷个体的临床结果。我们的广泛假设是，先进的 CT 技术可提高术前评估的预测能力，将缺陷类型与机械效应联系起来，并改善临床结果。我们寻求开发与机械相关且基于现有成像技术的图像引导技术。该 R21 提案的具体目标是： 目标 1：开发和验证客观的基于 CT 的结构成像技术，通过描述宿主骨及其机械环境来指导手术。假设：基于 CT 的结构成像准确（+ 2mm 线性测量，+ 3% 体积测量，<15% 骨密度误差）且可靠（观察者间，kappa > 0.80）定义 3D 结构和机械结果。未来的研究目标包括临床实施、结果和成本效益分析以及微创手术的开发。该项目的完成将创建一种精确的基于 CT 的技术，通过从结构上评估缺陷髋臼的形态、密度和力学来指导手术。这是改善这些疑难病例的手术计划、执行和临床结果的第一步，也是重要的一步。