計(jì)算機(jī)輔助導(dǎo)航技術(shù)在骨科中應(yīng)用

1、計(jì)算機(jī)輔助導(dǎo)航技術(shù)在骨科應(yīng)用計(jì)算機(jī)輔助導(dǎo)航技術(shù)在骨科應(yīng)用既往骨科手術(shù)：術(shù)前看片、計(jì)劃、手術(shù)既往骨科手術(shù)：術(shù)前看片、計(jì)劃、手術(shù)現(xiàn)在骨科手術(shù)：術(shù)前讀片+手術(shù)設(shè)計(jì)+精確=精準(zhǔn)醫(yī)療未來(lái)手術(shù)？如何讓機(jī)器輔助手術(shù)呢？人人機(jī)器人機(jī)器人機(jī)械機(jī)械融合融合廣義導(dǎo)航廣義導(dǎo)航基本概念基本概念即即利用各種影象設(shè)備如利用各種影象設(shè)備如CT、MRI、PET、DSA、US等結(jié)合等結(jié)合導(dǎo)航系統(tǒng)，對(duì)人體骨骼解剖結(jié)構(gòu)及手術(shù)器械進(jìn)行顯示和定導(dǎo)航系統(tǒng)，對(duì)人體骨骼解剖結(jié)構(gòu)及手術(shù)器械進(jìn)行顯示和定位，通過(guò)計(jì)算機(jī)制訂手術(shù)計(jì)劃，在術(shù)中進(jìn)行操作干預(yù)的一位，通過(guò)計(jì)算機(jī)制訂手術(shù)計(jì)劃，在術(shù)中進(jìn)行操作干預(yù)的一項(xiàng)技術(shù)。最早應(yīng)用于神經(jīng)外科領(lǐng)域的立體定位，腫瘤

2、切除項(xiàng)技術(shù)。最早應(yīng)用于神經(jīng)外科領(lǐng)域的立體定位，腫瘤切除化療等。其最大的優(yōu)勢(shì)是：簡(jiǎn)化了手術(shù)操作，縮短了手術(shù)化療等。其最大的優(yōu)勢(shì)是：簡(jiǎn)化了手術(shù)操作，縮短了手術(shù)時(shí)間，減少了手術(shù)創(chuàng)傷，減弱了術(shù)中放射線的照射，使骨時(shí)間，減少了手術(shù)創(chuàng)傷，減弱了術(shù)中放射線的照射，使骨科手術(shù)變的更安全、更準(zhǔn)確、更微創(chuàng)。科手術(shù)變的更安全、更準(zhǔn)確、更微創(chuàng)。骨科計(jì)算機(jī)輔助導(dǎo)航技術(shù)簡(jiǎn)史骨科計(jì)算機(jī)輔助導(dǎo)航技術(shù)簡(jiǎn)史199119921995日本的Wanatabe和美國(guó)的Pell相繼發(fā)明了遙控機(jī)械臂定位系統(tǒng)，可以不受瞄準(zhǔn)線約束。但因其體積過(guò)大，使醫(yī)生的操作受限. 1992年，使用紅外線跟蹤技術(shù)的影像導(dǎo)航系統(tǒng)在美國(guó)開(kāi)始應(yīng)用于臨床。這是世界上首

3、臺(tái)光學(xué)手術(shù)導(dǎo)航系統(tǒng)，由于其精度較高，所以成為目前市場(chǎng)上的主流產(chǎn)品1995年，Gunkel推出了電磁感應(yīng)型導(dǎo)航系統(tǒng)，但由于手術(shù)室各種金屬器械及儀器都會(huì)影響電磁場(chǎng)，從而影響其精度，所以未能很好推廣1999年首臺(tái)完全針對(duì)骨科的手術(shù)導(dǎo)航系統(tǒng)進(jìn)入市場(chǎng)。X線透視和紅外線跟蹤技術(shù)、計(jì)算機(jī)定點(diǎn)手術(shù)技術(shù)的結(jié)合提供了一種新穎的術(shù)中影像導(dǎo)航的方法19991986計(jì)算機(jī)輔助導(dǎo)航系統(tǒng)組成及工作原理計(jì)算機(jī)輔助導(dǎo)航系統(tǒng)組成及工作原理ImageImageActionActionNavigationNavigation基本設(shè)備基本設(shè)備 不同的導(dǎo)航系統(tǒng)有不同的設(shè)備，但其中最基本的設(shè)備是一致的。大概有以下三種分類：（1）SO（su

4、rgical object）:手術(shù)操作實(shí)體，在骨科領(lǐng)域，主要是骨骼及相關(guān)聯(lián)的組織結(jié)構(gòu)。（2）VO（virtual object）成像設(shè)備?，F(xiàn)在常用的CT，X線，MRI ，PET，DSA 等影象設(shè)備，可以實(shí)時(shí)準(zhǔn)確地提供圖象及數(shù)據(jù)。（3）NAV（navigator）：導(dǎo)航儀。即在SO 和VO 之間的連接裝置。獲取操作器械在人體的定位和方向。Tool Set SpineTool Set Spine 4 chisels 4 chisels Pelvis Pelvis Fragment Fragment Calibration Calibration Pointer Pointer VK VK同時(shí)可跟隨

5、同時(shí)可跟隨9 9件器械件器械Tool Set PelvisTool Set PelvisTool Set Hip ProstheticsTool Set Hip Prostheticseasy setup, mobile, only 80 x 80 cm eacheasy setup, mobile, only 80 x 80 cm eachShieldShieldInfraredInfraredCameraCameraLEDLED High precision High precision long and compact tools long and compact tools Many

6、objects tracked Many objects tracked multiple tools and bonesmultiple tools and bones Large Field of View (FOV) Large Field of View (FOV) needed for C-Arm and other applications needed for C-Arm and other applications三個(gè)條件三個(gè)條件 1校準(zhǔn)（calibration）：對(duì)于描述骨骼的幾何形狀校準(zhǔn)是必需的。即在操作器械上安裝跟蹤器，是提高圖象配準(zhǔn)精度及定位精度的第一步。 2配準(zhǔn)(re

7、gistration)：其目的是在VO和術(shù)前圖象的基礎(chǔ)上對(duì)手術(shù)器械定位，提供相對(duì)應(yīng)的定位顯象。 3參照(reference)：動(dòng)態(tài)參照系統(tǒng)（dynamic reference bases,DRB）可以彌補(bǔ)由于導(dǎo)航儀和骨骼位置的移動(dòng)帶來(lái)的誤差。Automatic compensation of Automatic compensation of patient and camera motion.patient and camera motion.Reference coordinate Reference coordinate system is attached system is atta

8、ched anywhere on patient.anywhere on patient.ReferencingReferencingDefine Landmark in Define Landmark in ImageImageFind Landmark on Find Landmark on PatientPatientThe transformation between the patient world The transformation between the patient world and the CT image world is foundand the CT image

9、 world is foundMethods:Methods: Paired-Point Paired-Point MatchingMatching Surface Matching Surface MatchingDigitization of pointsDigitization of pointsImageImagePatientPatient工作模式工作模式 醫(yī)生通過(guò)術(shù)前或術(shù)中醫(yī)生通過(guò)術(shù)前或術(shù)中x線線CTMRI對(duì)對(duì)人體手術(shù)部位進(jìn)行顯示，定位，然后規(guī)劃人體手術(shù)部位進(jìn)行顯示，定位，然后規(guī)劃模擬，術(shù)中手持裝有跟蹤器的操作器械對(duì)模擬，術(shù)中手持裝有跟蹤器的操作器械對(duì)患者實(shí)施操作，手術(shù)工具的空間立

10、體定位患者實(shí)施操作，手術(shù)工具的空間立體定位及瞄準(zhǔn)過(guò)程均在跟蹤器的實(shí)時(shí)控制之下，及瞄準(zhǔn)過(guò)程均在跟蹤器的實(shí)時(shí)控制之下，跟蹤器能夠精確地給出術(shù)中解剖部位與多跟蹤器能夠精確地給出術(shù)中解剖部位與多模圖像之間的位置關(guān)系，經(jīng)過(guò)相應(yīng)坐標(biāo)轉(zhuǎn)模圖像之間的位置關(guān)系，經(jīng)過(guò)相應(yīng)坐標(biāo)轉(zhuǎn)換換(平移、旋轉(zhuǎn)等平移、旋轉(zhuǎn)等)的配準(zhǔn)過(guò)程控制手術(shù)器的配準(zhǔn)過(guò)程控制手術(shù)器械到達(dá)要求的部位，從而實(shí)施相應(yīng)的手術(shù)械到達(dá)要求的部位，從而實(shí)施相應(yīng)的手術(shù)操作。操作。Reference coordinate system Reference coordinate system is attached anywhere on is attached a

11、nywhere on patient.patient.Step 1: Placement of the Reference BaseStep 1: Placement of the Reference BaseStep 2: Shoot imagesStep 2: Shoot imagesImage stored in the computerImage stored in the computerActionActionImageImageStep 3: NavigateStep 3: Navigate基本類型基本類型CT依賴的導(dǎo)航系統(tǒng)依賴的導(dǎo)航系統(tǒng) 基于基于X線透視圖像導(dǎo)航系統(tǒng)線透視圖像導(dǎo)

12、航系統(tǒng) 三維三維X線透視導(dǎo)航系統(tǒng)（線透視導(dǎo)航系統(tǒng)（Iso-C） 非圖像依賴導(dǎo)航系統(tǒng)非圖像依賴導(dǎo)航系統(tǒng) 41231、CT依賴的導(dǎo)航系統(tǒng)依賴的導(dǎo)航系統(tǒng) 最早應(yīng)用于神經(jīng)外科，目前在骨科應(yīng)用比較廣泛，最早應(yīng)用于脊柱椎弓根螺釘固定系統(tǒng)。目前典型的系統(tǒng)有DiGioia等開(kāi)發(fā)的Hipnav系統(tǒng)，Langlotz等開(kāi)發(fā)的脊柱導(dǎo)航系統(tǒng)。術(shù)前將獲得CT掃描圖像，并將患者的模擬仿真數(shù)據(jù)導(dǎo)人計(jì)算機(jī)中；術(shù)中，通過(guò)定位跟蹤器獲得手術(shù)工具與解剖結(jié)構(gòu)之間的空間位置關(guān)系，并與術(shù)前的CT圖像進(jìn)行配準(zhǔn)，在計(jì)算機(jī)中實(shí)時(shí)顯示手術(shù)工具在仿真模型中的位置關(guān)系，以指導(dǎo)醫(yī)生實(shí)施手術(shù)操作。配準(zhǔn)是其最關(guān)鍵的技術(shù)，有過(guò)去的點(diǎn)匹配和現(xiàn)在的面匹配。該導(dǎo)

13、航最大的優(yōu)點(diǎn)是可以獲得良好的三維圖象，有利于術(shù)前計(jì)劃和模擬。其缺點(diǎn)是，需要嚴(yán)格的配準(zhǔn)和參照才能獲得更好的圖象，而且無(wú)法實(shí)時(shí)顯象，圖象無(wú)法更新。，現(xiàn)在已經(jīng)廣泛應(yīng)用于全髖置換和全膝置換，DHS，鎖式髓針，十字韌帶重建等。2、基于基于X線透視圖像導(dǎo)航系統(tǒng)線透視圖像導(dǎo)航系統(tǒng) C臂現(xiàn)在已經(jīng)成為骨科手術(shù)的基本設(shè)備。其最大的特點(diǎn)是實(shí)時(shí)迅速的顯象，無(wú)須術(shù)前模擬。在手術(shù)器械上和傳感器上安裝兩套光發(fā)射二級(jí)管（LEDS）通過(guò)顯示屏來(lái)配準(zhǔn)。其配準(zhǔn)過(guò)程包括X線的建模和補(bǔ)償由于C臂轉(zhuǎn)動(dòng)帶來(lái)的圖象變形。示蹤器安放在C臂上，可以計(jì)算控制功能參數(shù)，最先被ofsteterr使用。通過(guò)C臂的轉(zhuǎn)動(dòng)獲得圖象，是一對(duì)多的圖象，相當(dāng)于使用

14、了多個(gè)C臂，這是2維顯象的一個(gè)優(yōu)勢(shì)。另一個(gè)優(yōu)勢(shì)是圖象可以更新，隨時(shí)可以獲得最新的圖象，有利于復(fù)雜骨折的復(fù)位?，F(xiàn)在2維依賴的導(dǎo)航已經(jīng)廣泛應(yīng)用于關(guān)節(jié)置換、鎖式髓針，DHS，十字韌帶重建中。3、三維三維X線依賴的導(dǎo)航線依賴的導(dǎo)航 1999年，3維依賴的導(dǎo)航開(kāi)始應(yīng)用于臨床 （德國(guó)西門子公司）。其配置了特殊的發(fā)動(dòng)機(jī)和旋轉(zhuǎn)程序來(lái)實(shí)現(xiàn)高清晰的圍繞骨骼旋轉(zhuǎn)軌跡的圖象。大約可以旋轉(zhuǎn)190度?？梢赃_(dá)到CT一樣的顯象效果。每一次旋轉(zhuǎn)可以獲得50200套2維圖象。把骨骼放在C臂中心，通過(guò)圖象數(shù)據(jù)綜合，來(lái)獲得高分解的3維圖象數(shù)據(jù)，其中容量掃描的準(zhǔn)確性是成功的關(guān)鍵。3維X線依賴的導(dǎo)航還可以實(shí)時(shí)顯象，所以前景非常廣闊，是計(jì)

15、算機(jī)導(dǎo)航的發(fā)展方向。非圖像依賴導(dǎo)航系統(tǒng)非圖像依賴導(dǎo)航系統(tǒng) 這種導(dǎo)航?jīng)]有具體的圖象，而是通過(guò)示蹤系統(tǒng)作用于不同的骨性結(jié)構(gòu)和參照標(biāo)記建立起來(lái)的。最早應(yīng)用于前交叉韌帶的重建。其最大的特色是旋轉(zhuǎn)程序，嚴(yán)格的人體機(jī)械定位和數(shù)據(jù)優(yōu)化來(lái)計(jì)算運(yùn)動(dòng)參數(shù)，決定特殊關(guān)節(jié)的運(yùn)動(dòng)特征。最大的優(yōu)點(diǎn)是骨骼變形技術(shù)。必須建立骨骼解剖模型數(shù)據(jù)庫(kù)，需要大量的高分解的容積圖象、數(shù)據(jù)參數(shù)和表面形態(tài)，以及尸體模型。在術(shù)中通過(guò)個(gè)解剖區(qū)的點(diǎn)數(shù)據(jù)對(duì)應(yīng)來(lái)達(dá)到導(dǎo)航作用。要作到微創(chuàng)很難，必須借助2維和3維圖象來(lái)獲得所有必要的解剖標(biāo)記。因此適合于那些解剖結(jié)構(gòu)暴露比較充分的手術(shù)，典型的如ACL重建，全膝關(guān)節(jié)置換，全髖關(guān)節(jié)置換等。Dessenne等于1

16、995年最早應(yīng)用于交叉韌帶重建。 臨床應(yīng)用臨床應(yīng)用臨床臨床應(yīng)用應(yīng)用腫瘤腫瘤關(guān)節(jié)關(guān)節(jié)脊柱脊柱創(chuàng)傷創(chuàng)傷脊柱手術(shù)脊柱手術(shù)最早在實(shí)驗(yàn)室應(yīng)用于椎弓根螺釘系統(tǒng)，由于設(shè)備技術(shù)的限制，以前僅最早在實(shí)驗(yàn)室應(yīng)用于椎弓根螺釘系統(tǒng)，由于設(shè)備技術(shù)的限制，以前僅限于腰椎的應(yīng)用，現(xiàn)已拓展到頸椎和胸椎。最常用的導(dǎo)航是依賴限于腰椎的應(yīng)用，現(xiàn)已拓展到頸椎和胸椎。最常用的導(dǎo)航是依賴CT的導(dǎo)航。如椎弓根螺釘?shù)闹萌?，術(shù)前通過(guò)的導(dǎo)航。如椎弓根螺釘?shù)闹萌?，術(shù)前通過(guò)CT對(duì)手術(shù)部位脊柱進(jìn)行三對(duì)手術(shù)部位脊柱進(jìn)行三維重建，制定手術(shù)方案，然后在脊柱上確定維重建，制定手術(shù)方案，然后在脊柱上確定36個(gè)術(shù)中可分辨的標(biāo)記個(gè)術(shù)中可分辨的標(biāo)記點(diǎn)。術(shù)中通過(guò)帶有動(dòng)

17、態(tài)參考系統(tǒng)的操作器械進(jìn)行點(diǎn)對(duì)點(diǎn)匹配。當(dāng)二者點(diǎn)。術(shù)中通過(guò)帶有動(dòng)態(tài)參考系統(tǒng)的操作器械進(jìn)行點(diǎn)對(duì)點(diǎn)匹配。當(dāng)二者完全匹配時(shí)再鉆孔置入螺釘。由于完全匹配時(shí)再鉆孔置入螺釘。由于CT良好的三維圖象，最常用于頸良好的三維圖象，最常用于頸椎和胸椎上段。在計(jì)算機(jī)導(dǎo)航系統(tǒng)引導(dǎo)下的頸椎離體實(shí)驗(yàn)中，椎和胸椎上段。在計(jì)算機(jī)導(dǎo)航系統(tǒng)引導(dǎo)下的頸椎離體實(shí)驗(yàn)中，C1、2經(jīng)關(guān)節(jié)螺釘與經(jīng)椎弓螺釘?shù)氖褂枚际前踩慕?jīng)關(guān)節(jié)螺釘與經(jīng)椎弓螺釘?shù)氖褂枚际前踩?而且有很高的精確性以而且有很高的精確性以依賴依賴X 線的導(dǎo)航：術(shù)中通過(guò)線的導(dǎo)航：術(shù)中通過(guò)X線獲得圖象，然后通過(guò)計(jì)算機(jī)工作中心線獲得圖象，然后通過(guò)計(jì)算機(jī)工作中心設(shè)計(jì)引導(dǎo)下置入椎弓根螺釘。不需

18、要術(shù)前模擬，而且術(shù)中圖象可以更設(shè)計(jì)引導(dǎo)下置入椎弓根螺釘。不需要術(shù)前模擬，而且術(shù)中圖象可以更新，但是無(wú)法得到良好的三維圖象。所以更廣泛應(yīng)用于腰椎和下胸椎，新，但是無(wú)法得到良好的三維圖象。所以更廣泛應(yīng)用于腰椎和下胸椎，不過(guò)也有人開(kāi)始應(yīng)用于頸椎和上胸椎。目前的脊柱外科的研究熱點(diǎn)是不過(guò)也有人開(kāi)始應(yīng)用于頸椎和上胸椎。目前的脊柱外科的研究熱點(diǎn)是如何進(jìn)行經(jīng)皮螺釘植入和脊柱內(nèi)窺鏡技術(shù)。如何進(jìn)行經(jīng)皮螺釘植入和脊柱內(nèi)窺鏡技術(shù)。Advanced pre-op planningAdvanced pre-op planningCurrent Current positionpositionTarget position

19、Target positionGuidanceGuidanceFuture Future penetrationspenetrationsCurrent Current positionpositionRealtime TrajectoryRealtime TrajectoryRL1234Kotani等回顧性分析 32 例（416 根椎弓根螺釘）脊柱側(cè)彎患者 Rajasekaran 進(jìn)行了一項(xiàng) 31 例（242 顆螺釘）胸椎骨折患者的隨機(jī)臨床研究創(chuàng)傷骨科創(chuàng)傷骨科 隨著微創(chuàng)的要求變高和隨著微創(chuàng)的要求變高和X線的局限性，計(jì)算機(jī)導(dǎo)航在在創(chuàng)線的局限性，計(jì)算機(jī)導(dǎo)航在在創(chuàng)傷骨科的應(yīng)用將更加廣泛，主要集中在

20、骨盆骨折和長(zhǎng)骨骨傷骨科的應(yīng)用將更加廣泛，主要集中在骨盆骨折和長(zhǎng)骨骨折。骨盆骨折有些位置比較深而且移位比較小，折。骨盆骨折有些位置比較深而且移位比較小，X片不容片不容易發(fā)現(xiàn)，而且手術(shù)入路比較困難，很難達(dá)到堅(jiān)強(qiáng)固定。用易發(fā)現(xiàn)，而且手術(shù)入路比較困難，很難達(dá)到堅(jiān)強(qiáng)固定。用以以CT依賴的導(dǎo)航則變的簡(jiǎn)單方便，將參考架固定于病人依賴的導(dǎo)航則變的簡(jiǎn)單方便，將參考架固定于病人骨折肢體表面，術(shù)前進(jìn)行骨折肢體表面，術(shù)前進(jìn)行CT掃描，手術(shù)模擬入路位置術(shù)掃描，手術(shù)模擬入路位置術(shù)中導(dǎo)航儀幫助引導(dǎo)，配準(zhǔn)，經(jīng)皮即可到達(dá)理想部位，達(dá)到中導(dǎo)航儀幫助引導(dǎo)，配準(zhǔn)，經(jīng)皮即可到達(dá)理想部位，達(dá)到堅(jiān)強(qiáng)準(zhǔn)確固定骨折。鎖式髓釘?shù)膽?yīng)用。主要應(yīng)用與

21、遠(yuǎn)端鎖堅(jiān)強(qiáng)準(zhǔn)確固定骨折。鎖式髓釘?shù)膽?yīng)用。主要應(yīng)用與遠(yuǎn)端鎖釘?shù)墓潭?，關(guān)鍵有兩步：首先準(zhǔn)確的控制鎖釘入孔，在髓釘?shù)墓潭?，關(guān)鍵有兩步：首先準(zhǔn)確的控制鎖釘入孔，在髓針進(jìn)入髓腔以后，遠(yuǎn)端的鎖釘必須準(zhǔn)確。其次術(shù)中鉆孔需針進(jìn)入髓腔以后，遠(yuǎn)端的鎖釘必須準(zhǔn)確。其次術(shù)中鉆孔需要跟蹤實(shí)時(shí)顯象要跟蹤實(shí)時(shí)顯象DHS的應(yīng)用。首先復(fù)位用克氏針臨時(shí)固定，的應(yīng)用。首先復(fù)位用克氏針臨時(shí)固定，然后將動(dòng)態(tài)參考系統(tǒng)固定在斯氏針上插入股骨近端。然后將動(dòng)態(tài)參考系統(tǒng)固定在斯氏針上插入股骨近端。C臂臂照射，將圖象傳到投射計(jì)算機(jī)工作站，通過(guò)設(shè)計(jì)軌跡和引照射，將圖象傳到投射計(jì)算機(jī)工作站，通過(guò)設(shè)計(jì)軌跡和引導(dǎo)進(jìn)行螺釘置入。導(dǎo)進(jìn)行螺釘置入。 Inser

22、tion of IM Nails Insertion of IM Nails Fragment Reduction Fragment Reduction K-Wire Placement K-Wire Placement Near Joint Surgery Near Joint Surgery Distal Locking of IM Nails Distal Locking of IM NailsApplicationsApplicationsTraumaTraumaRealtime modeRealtime mode6 622223 3Fragment motionFragment mo

23、tion關(guān)節(jié)外科關(guān)節(jié)外科 包括髖關(guān)節(jié)置換（包括髖關(guān)節(jié)置換（TKA）和膝關(guān)節(jié)置換）和膝關(guān)節(jié)置換(THA)。髖關(guān)節(jié)置。髖關(guān)節(jié)置換的應(yīng)用比較早。最主要的問(wèn)題是確定假體的位置和軸線。換的應(yīng)用比較早。最主要的問(wèn)題是確定假體的位置和軸線。計(jì)算機(jī)輔助骨科技術(shù)系統(tǒng)可以在術(shù)前用計(jì)算機(jī)輔助骨科技術(shù)系統(tǒng)可以在術(shù)前用CT或或X線對(duì)關(guān)節(jié)進(jìn)線對(duì)關(guān)節(jié)進(jìn)行掃描及三維重建，設(shè)計(jì)假體的位置、大小，通過(guò)計(jì)算機(jī)行掃描及三維重建，設(shè)計(jì)假體的位置、大小，通過(guò)計(jì)算機(jī)計(jì)算出力學(xué)軸線和截骨平面，模擬匹配，模擬關(guān)節(jié)活動(dòng)。計(jì)算出力學(xué)軸線和截骨平面，模擬匹配，模擬關(guān)節(jié)活動(dòng)。術(shù)中通過(guò)導(dǎo)航系統(tǒng)指導(dǎo)醫(yī)生在合適的位置安放假體。術(shù)中通過(guò)導(dǎo)航系統(tǒng)指導(dǎo)醫(yī)生在合適

24、的位置安放假體。Leenders的一項(xiàng)臨床隨機(jī)研究表明的一項(xiàng)臨床隨機(jī)研究表明CAOS對(duì)于假體安放對(duì)于假體安放位置要優(yōu)于傳統(tǒng)手術(shù)。減少了全髖置換中由于位置不合適位置要優(yōu)于傳統(tǒng)手術(shù)。減少了全髖置換中由于位置不合適而造成的假體脫位。而造成的假體脫位。optimal implantoptimal implantoptimal placementoptimal placementCup PlanningCup PlanningExecution PhaseExecution PhaseExecution PhaseExecution Phase骨腫瘤骨腫瘤 如何能夠精確的切除靶區(qū)腫瘤組織，進(jìn)行化療和放療

25、，這是醫(yī)學(xué)界的一大難題。計(jì)算機(jī)導(dǎo)航在此方面優(yōu)勢(shì)明顯。CAOS通過(guò)CT定位系統(tǒng)能夠?qū)Ω叨炔灰?guī)則腫瘤制訂精確的三維立體顯象，提供腫瘤的實(shí)際形狀，能夠嚴(yán)格的區(qū)分腫瘤與周圍的正常組織。以達(dá)到準(zhǔn)確切除和最佳照射角度和放射野來(lái)避開(kāi)重要組織器官，并使放射計(jì)劃的劑量分布更為精確合理。它不僅對(duì)放射治療的計(jì)劃設(shè)計(jì)和照射質(zhì)量的提高有明顯作用，而且將顯著提高存某些腫瘤的控制率和病人生存率. 計(jì)算機(jī)輔助導(dǎo)航技術(shù)存在的問(wèn)題計(jì)算機(jī)輔助導(dǎo)航技術(shù)存在的問(wèn)題減少患者及醫(yī)務(wù)減少患者及醫(yī)務(wù)人員的輻射暴露人員的輻射暴露增加了手術(shù)的安全增加了手術(shù)的安全性減少手術(shù)的風(fēng)險(xiǎn)性減少手術(shù)的風(fēng)險(xiǎn)減少手術(shù)時(shí)間減少手術(shù)時(shí)間患者體位必須嚴(yán)患者體位必須嚴(yán)格

26、固定不能移動(dòng)格固定不能移動(dòng)術(shù)者需要術(shù)者需要 嚴(yán)格培嚴(yán)格培訓(xùn)，學(xué)習(xí)曲線長(zhǎng)訓(xùn)，學(xué)習(xí)曲線長(zhǎng)設(shè)備昂貴，增加設(shè)備昂貴，增加患者手術(shù)費(fèi)用患者手術(shù)費(fèi)用發(fā)展趨勢(shì)發(fā)展趨勢(shì)更簡(jiǎn)單的注冊(cè)更簡(jiǎn)單的注冊(cè)多種導(dǎo)航方法融合，圖像注冊(cè)更準(zhǔn)確與導(dǎo)航設(shè)備相配套的手術(shù)室建立，影像設(shè)備更加合理布局，更加便捷的圖像數(shù)據(jù)傳輸各種手術(shù)機(jī)器人結(jié)合導(dǎo)航設(shè)備引用于現(xiàn)代骨科手術(shù)極大的節(jié)約醫(yī)療衛(wèi)生成本，更加充分利用專家資源數(shù)字化手術(shù)室建數(shù)字化手術(shù)室建立立手術(shù)機(jī)器人應(yīng)用手術(shù)機(jī)器人應(yīng)用遠(yuǎn)程醫(yī)療發(fā)展遠(yuǎn)程醫(yī)療發(fā)展計(jì)算機(jī)輔助導(dǎo)航系統(tǒng)已經(jīng)使骨科手術(shù)迅速、安全、準(zhǔn)確。隨著計(jì)算機(jī)和電腦圖像處理系統(tǒng)的發(fā)展，該技術(shù)將會(huì)輔助醫(yī)生完成更多骨科疑難與復(fù)雜手術(shù)。 計(jì)算機(jī)輔助導(dǎo)

27、航技術(shù)的發(fā)展必將日益高科技化，應(yīng)用領(lǐng)域也將多樣化。Thank You! How do I incorporate my logo to a slide that will apply to all the other slides? On the View menu, point to Master, and then click Slide Master or Notes Master. Change images to the one you like, then it will apply to all the other slides. Image information in pro

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