Wong Kwok Chuen, Sun Edgar Yan, Wong Irene Oi Ling, Kumta Shekhar Madhukar
Orthopaedic Oncology, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.
Independent Contractor, Hong Kong SAR, People's Republic of China.
Orthop Res Rev. 2023 Jul 31;15:139-149. doi: 10.2147/ORR.S421077. eCollection 2023.
INTRODUCTION: In orthopedic oncology, computer navigation and 3D-printed guides facilitate precise osteotomies only after surgical exposure. Before surgeries start, it is challenging to mentally process and superimpose the virtual medical images onto patients' anatomy for preoperative surgical planning. Mixed Reality (MR) is an immersive technology merging real and virtual worlds, and users can interact with digital objects in real time. Through Head-Mounted Displays, surgeons directly visualize holographic models that overlaid on tumor patients. The technology may facilitate surgical planning before skin incisions. METHODS: Nine bone tumor patients were included (July 2021 - Dec 2022). There were six primary bone sarcomas, two benign bone tumors, and one revision pelvic prosthesis. MR applications were created using patients' preoperative medical images. The surgeon examined each patient clinically using the conventional method of viewing 2D images and MR via HMD, Hololens 2. A Likert-Scale (LS) questionnaire and The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score were used to evaluate and compare the effectiveness of surgical planning and the surgeon's clinical cognitive workload for the two methods. RESULTS: The qualitative survey of the LS questionnaire suggested that the MR group had superior spatial awareness of tumors and was considered more effective as a preoperative planning tool than the conventional group. For NASA-TLX scores, the overall cognitive workload was lower in MR 3D hologram group than in the 2D Group for preoperative clinical assessment. When using MR technology with HMDs, the surgeon reported no discomfort. CONCLUSION: MR technology may improve 3D visualization and spatial awareness of bone tumors in patients' anatomies and may facilitate surgical planning before skin incisions in orthopedic oncology surgery. With less cognitive load and better ergonomics, surgeons can focus on patients and surgical tasks with MR technology. Further studies must investigate whether MR technology improves clinical outcomes.
引言：在骨肿瘤学中，计算机导航和3D打印导板仅在手术暴露后才能辅助进行精确截骨。在手术开始前，要在脑海中将虚拟医学图像与患者的解剖结构进行处理和叠加以进行术前手术规划具有挑战性。混合现实（MR）是一种融合真实和虚拟世界的沉浸式技术，用户可以实时与数字对象进行交互。通过头戴式显示器，外科医生可以直接可视化叠加在肿瘤患者身上的全息模型。该技术可能有助于在皮肤切口前进行手术规划。 方法：纳入9例骨肿瘤患者（2021年7月至2022年12月）。其中有6例原发性骨肉瘤、2例良性骨肿瘤和1例翻修骨盆假体。使用患者的术前医学图像创建MR应用程序。外科医生通过传统的二维图像查看方法和通过HMD（Hololens 2）查看MR对每位患者进行临床检查。使用李克特量表（LS）问卷和美国国家航空航天局任务负荷指数（NASA-TLX）评分来评估和比较两种方法的手术规划效果和外科医生的临床认知工作量。 结果：LS问卷的定性调查表明，MR组对肿瘤的空间意识更强，并且被认为作为术前规划工具比传统组更有效。对于NASA-TLX评分，在术前临床评估中，MR 3D全息图组的总体认知工作量低于二维组。当使用带有HMD的MR技术时，外科医生报告没有不适。 结论：MR技术可能会改善骨肿瘤在患者解剖结构中的三维可视化和空间意识，并可能有助于骨肿瘤外科手术在皮肤切口前进行手术规划。由于认知负荷较低且人体工程学更好，外科医生可以借助MR技术专注于患者和手术任务。进一步的研究必须调查MR技术是否能改善临床结果。
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