IEEE Trans Med Imaging. 2015 Feb;34(2):487-95. doi: 10.1109/TMI.2014.2361155. Epub 2014 Oct 2.
The interlocking of intramedullary nails is a technically demanding procedure which involves a considerable amount of X-ray acquisitions; one study lists as many as 48 to successfully complete the procedure and fix screws into 4-6 mm distal holes of the nail. We propose to design an augmented radiolucent drill to assist surgeons in completing the distal locking procedure without any additional X-ray acquisitions. Using an augmented reality fluoroscope that coregisters optical and X-ray images, we exploit solely the optical images to detect the augmented radiolucent drill and estimate its tip position in real-time. Consequently, the surgeons will be able to maintain the down the beam positioning required to drill the screws into the nail holes successfully. To evaluate the accuracy of the proposed augmented drill, we perform a preclinical study involving six surgeons and ask them to perform distal locking on dry bone phantoms. Surgeons completed distal locking 98.3% of the time using only a single X-ray image with an average navigation time of 1.4 ± 0.9 min per hole.
髓内钉的锁定是一项技术要求很高的操作，需要进行大量的 X 射线采集；有一项研究列出了多达 48 次 X 射线采集，以成功完成该操作并将螺钉固定在钉的 4-6 毫米远侧孔中。我们建议设计一种增强型半透明钻头，以帮助外科医生在不进行任何额外 X 射线采集的情况下完成远端锁定操作。我们使用增强现实透视仪来对光学和 X 射线图像进行配准，仅利用光学图像来检测增强型半透明钻头，并实时估计其尖端位置。因此，外科医生将能够保持成功钻入螺钉所需的沿光束定位。为了评估所提出的增强钻头的准确性，我们进行了一项涉及六名外科医生的临床前研究，并要求他们在干骨模型上进行远端锁定。外科医生仅使用单次 X 射线图像，平均每个孔的导航时间为 1.4±0.9 分钟，成功完成远端锁定的时间为 98.3%。
