Wang Jichuan, Zhao Zhiqing, Liang Haijie, Zhang Ranxin, Liu Xingyu, Zhang Jing, Singh Swapnil, Guo Wei, Yan Taiqiang, Hoang Bang H, Geller David S, Tang Xiaodong, Yang Rui
Musculoskleletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China.
Department of Orthopedics, Peking University First Hospital, Beijing, China.
Front Bioeng Biotechnol. 2024 Jul 29;12:1404937. doi: 10.3389/fbioe.2024.1404937. eCollection 2024.
The percutaneous screw reconstruction technique, known as the "Tripod Technique," has demonstrated favorable clinical outcomes in the management of metastatic periacetabular lesions, as evidenced by our prior investigations and corroborated by independent studies. Nevertheless, there is a steep learning curve in handling this technique, with possible complications such as intraarticular screw placement.
Preoperative pelvic CT scans were acquired before surgery and utilized for the guiding frame design. A convolutional neural network model was trained with annotated data to identify the starting point and trajectory of each potential screw. A model boundary intersection detection technology was used to determine the optimal diameter and length of each screw. A non-rigid registration technology was matched with a prefabricated model of the body surface to design personalized anchoring skin pads. Finally, a polylactic acid-based guiding frame for intraoperative was custom-made with a 3D printer.
12 patients underwent a guiding frame-assisted Tripod procedure for treatment of periacetabular metastatic lesions. An intraoperative CT scan was performed in all cases to confirm screw trajectories. Among 36 screws that were implanted, 26 screws were implanted as designed. The remaining ten screws drifted, but all remained within the intra-osseous conduit without any complications. The mean surgical time was 1.22 h with the guiding frame compared with 2.3 h without the guiding frame. Following the surgical procedure, a noteworthy enhancement in pain management, as evidenced by a reduction in scores on the visual analog scale ( < 0.01), and an improvement in functional status, as assessed through the Eastern Cooperative Oncology Group score ( < 0.01), were observed when compared to the patient's pre-operative condition.
This proof-of-concept investigation demonstrates that the amalgamation of AI-assisted surgical planning and additive manufacturing can improve surgical accuracy and shorten surgical duration. While access to this technology is currently constrained during its early stages of development, it is anticipated that these limitations will diminish as the potential of AI and additive manufacturing in facilitating complex orthopedic procedures becomes more evident, leading to a surge in interest and adoption of this approach.
经皮螺钉重建技术，即“三脚架技术”，在转移性髋臼周围病变的治疗中已显示出良好的临床效果，我们之前的研究已证明这一点，独立研究也予以了证实。然而，掌握这项技术存在陡峭的学习曲线，可能会出现诸如关节内螺钉置入等并发症。
术前进行骨盆CT扫描，并用于指导框架设计。使用带注释的数据训练卷积神经网络模型，以识别每个潜在螺钉的起点和轨迹。采用模型边界相交检测技术确定每个螺钉的最佳直径和长度。将非刚性配准技术与体表预制模型相匹配，以设计个性化的锚固皮肤垫。最后，用3D打印机定制术中使用的基于聚乳酸的导向框架。
12例患者接受了导向框架辅助的三脚架手术治疗髋臼周围转移性病变。所有病例均进行了术中CT扫描以确认螺钉轨迹。在植入的36枚螺钉中，26枚按设计植入。其余10枚螺钉发生偏移，但均留在骨内管道内，未出现任何并发症。使用导向框架时的平均手术时间为1.22小时，而不使用导向框架时为2.3小时。与患者术前状况相比，手术后疼痛管理有显著改善，视觉模拟量表评分降低（<0.01），功能状态有所改善，通过东部肿瘤协作组评分评估（<0.01）。
这项概念验证研究表明，人工智能辅助手术规划与增材制造相结合可提高手术准确性并缩短手术时间。虽然目前在该技术发展的早期阶段，其应用受到限制，但预计随着人工智能和增材制造在促进复杂骨科手术方面的潜力变得更加明显，这些限制将会减少，从而导致对这种方法的兴趣和采用率激增。
