School of Mechanical Engineering, Fuzhou University, Fuzhou, 350108, Fujian, China.
Department of Orthopedic Surgery, Fujian Provincial Hospital, Fuzhou, 350013, Fujian, China.
Int J Comput Assist Radiol Surg. 2023 Dec;18(12):2155-2166. doi: 10.1007/s11548-023-02861-x. Epub 2023 Mar 9.
Minimally invasive total hip arthroplasty (MITHA) is a treatment for hip arthritis, and it causes less tissue trauma, blood loss, and recovery time. However, the limited incision makes it difficult for surgeons to perceive the instruments' location and orientation. Computer-assisted navigation systems can help improve the medical outcome of MITHA. Directly applying existing navigation systems for MITHA, however, suffers from problems of bulky fiducial marker, severe feature-loss, multiple instruments tracking confusion, and radiation exposure. To tackle these problems, we propose an image-guided navigation system for MITHA using a novel position-sensing marker.
A position-sensing marker is proposed to serve as the fiducial marker with high-density and multi-fold ID tags. It results in less feature span and enables the use of ID for each feature, overcoming the problem of bulky fiducial markers and multiple instruments tracking confusion. And the marker can be recognized even when a large part of locating features is obscured. As for the elimination of intraoperative radiation exposure, we propose a point-based method to achieve patient-image registration based on anatomical landmarks.
Quantitative experiments are conducted to evaluate the feasibility of our system. The accuracy of instrument positioning is achieved at 0.33 ± 0.18 mm, and that of patient-image registration is achieved at 0.79 ± 0.15 mm. And qualitative experiments are also performed, verifying that our system can be used in compact surgical spatial volume and can address severe feature-loss and tracking confusion problems. In addition, our system does not require any intraoperative medical scans.
Experimental results indicate that our proposed system can assist surgeons without larger space occupations, radiation exposure, and extra incision, showing its potential application value in MITHA.
微创全髋关节置换术（MITHA）是一种治疗髋关节关节炎的方法，它造成的组织创伤、失血量和恢复时间都较少。然而，有限的切口使得外科医生难以感知器械的位置和方向。计算机辅助导航系统可以帮助提高 MITHA 的医疗效果。然而，直接应用现有的导航系统进行 MITHA 会遇到笨重的基准标记、严重的特征丢失、多器械跟踪混淆和辐射暴露等问题。为了解决这些问题，我们提出了一种使用新型位置感应标记的 MITHA 图像引导导航系统。
提出了一种位置感应标记作为基准标记，具有高密度和多倍 ID 标签。这导致特征跨度较小，并能够为每个特征使用 ID，从而解决了基准标记笨重和多器械跟踪混淆的问题。即使定位特征的大部分被遮挡，标记也可以被识别。为了消除术中辐射暴露，我们提出了一种基于解剖学标志点的基于点的方法来实现患者图像配准。
进行了定量实验来评估我们系统的可行性。仪器定位的精度达到 0.33 ± 0.18 毫米，患者图像配准的精度达到 0.79 ± 0.15 毫米。还进行了定性实验，验证了我们的系统可以在紧凑的手术空间体积中使用，并可以解决严重的特征丢失和跟踪混淆问题。此外，我们的系统不需要任何术中医疗扫描。
实验结果表明，我们提出的系统可以在不占用更大空间、不产生辐射暴露和不增加切口的情况下协助外科医生，显示出其在 MITHA 中的潜在应用价值。
