CN102772244A - Intraoperative navigation system used for implanting pedicle screw - Google Patents
Intraoperative navigation system used for implanting pedicle screw Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1703—Guides or aligning means for drills, mills, pins or wires using imaging means, e.g. by X-rays
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Abstract
The invention discloses an intraoperative navigation system used for implanting a pedicle screw. The intraoperative navigation system comprises a multifunctional drill bit, a near-infrared parameter collecting device, an electromagnetic positioning device and a computer, wherein the electromagnetic positioning device comprises a magnetic field generator and an electromagnetic position indicator which are connected through a cable, and the electromagnetic position indicator is also connected with the computer; the multifunctional drill bit comprises a threaded sleeve, a receiving fiber, a launching fiber, an electromagnetic positioning coil, an inner stainless steel pipe, an outer stainless steel pipe and a handle, and the receiving fiber, the launching fiber and the electromagnetic positioning coil are parallelly and are closely arranged in the inner stainless steel pipe; the electromagnetic positioning coil is connected with the electromagnetic position indicator, and the receiving fiber and the launching fiber are respectively connected with a light source output interface and a light source input interface of the near-infrared parameter collecting device; and the near-infrared parameter collecting device is connected with the computer. The intraoperative navigation system provided by the invention has the advantages that the operation is simple, the navigation system is effective in real time, the implanting position, direction and depth of the pedicle screw can be monitored in real time, and early warning can be achieved when the screw is implanted in a deflection manner or reaches a boundary.
Description
Technical field
The invention belongs to medical instruments field, relate to navigation system in the art that a kind of bone surgery pedicle screw implants, be specifically related to a kind of near-infrared, electromagnetic location and CT image association art navigation system and method for work thereof that pedicle screw is implanted that be used for.
Background technology
With pedicle screw (Pedicle Screw; PS) internal fixation of spine that is implanted as the basis is performed the operation; Be to stablize spinal structure with the club formula internal fixation method that the pedicle screw constitutes; To promote lesion segment to merge rehabilitation, have advantages such as effective, cycle weak point, instant effect, be widely used in treating deformity of spine, spinal trauma, spondylolysis and various intervertebral disk retrogression disease clinically.Operation need be confirmed ideal implantation point, implant direction and implantation depth on vertebral body; Not good the implantation with mistake of screw implantation position has been to hinder the main cause that the pedicle screw fixation technology further develops, and the deviation of screw implantation passage is to cause the not good principal element of planting with mistake of implantation position.
In order to improve the accuracy rate that pedicle screw is implanted; The various countries scholar has launched deep research to monitoring method and airmanship that screw is implanted; Obtained development faster, its main monitoring means comprises: bring out current potential, computer assisted navigation, tissue conductivities, near-infrared location navigation etc. in x-ray imaging, the art.X ray just can done, photograph is thrown in side position or other positions, but can not do cross-section imaging, and anatomical structure exists and blocks before and after the pedicle of vertebral arch simultaneously.Bring out potentiometry in the art, change if monitored electromyogram, nerve injury possibly take place, and this technology also can't be carried out continuous monitoring in the art, can't understand direction and the position of PS simultaneously intuitively.And the spinal surgery navigation system costs an arm and a leg, complicated operation, and Accreditation System requires the location accurately, in case the back, location just can not be moved, inserts accuracy otherwise will have a strong impact on pedicle nail.Application of ct scan needs images acquired before art and matees in the art, can't obtain real-time completely.Tissue conductivities can only obtain to be about to wear out the information at place, can not judge the spatial relationship of screw and vertebral body and pedicle of vertebral arch, and the electrical conductivity difference of puncture path epipyramis tissue is less simultaneously.The near-infrared location navigation can obtain the optical parametric on the vertebral tissue needle track in real time, but can't obtain the information such as locus, direction, implantation depth of screw.
Through above analysis, do not have a kind of effective monitoring system that pedicle screw is implanted that is used at present, remain further perfect.
Summary of the invention
The object of the invention; Be to provide a kind of art navigation system that pedicle screw is implanted that is used for; It is simple to operate, effective in real time, can in art, monitor position, direction and the degree of depth that pedicle screw is implanted in real time, and before screw is planted partially or arrived the border, carry out early warning.
In order to reach above-mentioned purpose, solution of the present invention is:
A kind of art navigation system that is used for the pedicle screw implantation; Comprise multi-functional drill bit, near-infrared parameter acquisition device, electromagnetic location device and computer; Wherein, The electromagnetic location device comprises magnetic field generator and electromagnetic location appearance, and the two connects through cable, and said electromagnetic location appearance also connects computer through cable; Said multi-functional drill bit comprises threaded sleeve, receives optical fiber, launching fiber, electromagnetic location coil, inner stainless steel tube, outside stainless steel tube and handle; Wherein, Outside stainless steel tube is a hollow structure, and the one of which end closely is connected with threaded sleeve, the other end handle that is threaded; Said outside stainless steel tube is linked in the outside of inner stainless steel tube; The center of said inner stainless steel tube is a manhole, receives optical fiber, launching fiber is parallel with the electromagnetic location coil closely is located in the said through hole, and said electromagnetic location coil connects the electromagnetic location appearance in the electromagnetic location device through serial cable; Said near-infrared parameter acquisition device comprises the machine box and is located at machine box inner power supply, light source, spectrogrph; The outside of said machine box is respectively equipped with on and off switch, light source switch, light source output interface, light source input interface and USB interface; Wherein, Power supply is inner each module for power supply, and by its keying of on and off switch control; Light source connects launching fiber via the light source output interface, and this light source is by its keying of light source switch control; Spectrogrph connects reception optical fiber via the light source input interface; USB interface connects computer through the usb data line, in order to swap data.
Above-mentioned multi-functional drill bit also comprises the fiber optic cables output port; Said fiber optic cables output port is located at an inner stainless steel tube end relative with threaded sleeve, and said reception optical fiber, launching fiber and electromagnetic location coil are connected with external equipment after all passing this fiber optic cables output port again.
After adopting such scheme, the present invention combines near-infrared, electromagnetic location and CT image technology three, reaches real-time navigation and the purpose of monitoring pedicle screw implantation process and early warning in the art.Adopting near-infrared spectrum technique to obtain vertebra in real time is associated and organizes parameter; Adopt the electromagnetic location method to obtain multi-functional drill bit locus, angle information in real time; The CT image data converts the near-infrared parameter into before utilizing transformation model with art; Thereby real-time parameter in the art and the parameter before the art are united, reach the purpose of real-time navigation, accomplished the early warning of navigation procedure simultaneously.The present invention implements simply, and flexible operation need not large-scale surgical apparatus during operation, be convenient to clinical practice.
Description of drawings
Fig. 1 is an overall structure sketch map of the present invention;
Fig. 2 is the structural representation of multi-functional drill bit among the present invention;
Fig. 3 is implementing procedure figure of the present invention;
Fig. 4 is the threedimensional model after the present invention rebuilds vertebrae;
Fig. 5 is the present invention's registration sketch map of performing the operation;
Fig. 6 is a vertebra of the present invention border sketch map;
Fig. 7 (a) is that the present invention plants CT value curve chart on the nail path;
Fig. 7 (b) is that the present invention plants near-infrared optical parametric plot on the nail path;
Fig. 8 is the present invention plants nail and early warning on pedicle of vertebral arch a sketch map.
The specific embodiment
At first; The present invention provides a kind of art navigation system that pedicle screw is implanted that is used for; It combines near-infrared, electromagnetic location with CT image three, its operation principle is: utilize the good penetration of near-infrared to tissue, measure the last osseous tissue diffuse reflection spectrum of certain forward sight distance; Thereby calculate the light intensity of specific wavelength, the parameters such as spectrum integral area of particular range of wavelengths, be referred to as the near-infrared parameter.The near infrared light that near-infrared light source sends is through after the tissue attenuation of heterogeneity; The near infrared light electric transducer receives and organizes diffuse reflection spectrum is different; The near-infrared parameter that solves is also just different, just can distinguish the variation of pedicle screw puncture path and the last bone structure of certain forward sight distance according to the variation of near-infrared parameter.Newest research results shows; There is confidential relation in the intensity of near-infrared parameter and CT image; The near-infrared parameter has same reliability to the reflection of biological tissue's information and the result of CT; The anatomic information of distribution of near-infrared parameter tissue morphology and CT image is corresponding basically, and the real-time of near-infrared measuring parameter can remedy the limitation of monitoring in real time in the pedicle screw implant surgery with " observability ".
Below will combine accompanying drawing, technical scheme of the present invention will be elaborated.
As shown in Figure 1; A kind of art navigation system that is used for the pedicle screw implantation of the present invention; During operation the present invention is placed near the operating-table; Cooperate corresponding operating theater instruments to carry out the pedicle screw implant surgery, navigation system comprises multi-functional drill bit 12, near-infrared parameter acquisition device, electromagnetic location device and computer 1 in the said art, will introduce respectively below.
The electromagnetic location device comprises magnetic field generator 15 and electromagnetic location appearance 14, and the two connects through cable, and said electromagnetic location appearance 14 also connects computer 1 through serial cable 16, and said electromagnetic location appearance 14 also connects multi-functional drill bit 12 through cable 13.
Cooperate shown in Figure 2; Said multi-functional drill bit 12 comprises threaded sleeve 16, receives optical fiber 10, launching fiber 11, electromagnetic location coil 19, inner stainless steel tube 17, outside stainless steel tube 20 and handle 21, and wherein, outside stainless steel tube 20 is a hollow structure; The one of which end closely is connected with threaded sleeve 16; Said threaded sleeve 16 is a cross section U type structure, thereby with this end sealing of outside stainless steel tube 20, the other end of said outside stainless steel tube 20 handle 21 that is threaded; Said outside stainless steel tube 20 is linked in the outside of inner stainless steel tube 17; Thereby with the end sealing of inner stainless steel tube 17, the other end that defines inner stainless steel tube 17 is a free end, can be conveniently with outer, inner stainless steel tube 20,17 fit or fractionations through handle 21; The center of said inner stainless steel tube 17 is a manhole; Receive optical fiber 10, launching fiber 11 and electromagnetic location coil 19 parallel closely being located in the said through hole; Can in inner stainless steel tube 17, fill glue in the present embodiment in order to fixing, and the diameter of said reception optical fiber 10, launching fiber 11 and electromagnetic location coil 19 all is about 200um; In order to prevent that cable from twining, the free end of said inner stainless steel tube 17 also is provided with fiber optic cables output port 18, said reception optical fiber 10, launching fiber 11 and be connected with external equipment after electromagnetic location coil 19 all passes this fiber optic cables output port 18 again.
Said multi-functional drill bit 12 in use; The electromagnetic location appearance 14 that electromagnetic location coil 19 connects in the electromagnetic location device through serial cable 13; And receive optical fiber 10, launching fiber 11 connects near-infrared parameter acquisition device respectively; Electromagnetic location coil 19 is used for the magnetic field coordinate that recording magnetic field generator 15 produces, and receives 10 of optical fiber and gathers tissue scatter's near infrared light, calculates the near infrared light mathematic(al) parameter through sending into computer 1 after the near-infrared parameter acquisition apparatus processes.
Said near-infrared parameter acquisition device comprises machine box 2 and is located at power supply, light source, spectrogrph, the alarm module of machine box 2 inside; Said machine box 2 profiles are cuboid, and are provided with handle, are convenient to carry and carry; The outside of said machine box 2 is respectively equipped with on and off switch 3, light source switch 4, light source output interface 5, light source input interface 6 and USB interface 8; Wherein, power supply is inner each module for power supply, and by on and off switch 3 its keyings of control; Light source connects launching fiber 11 via light source output interface 5, and this light source is by light source switch 4 its keyings of control; The input of spectrogrph connects reception optical fiber 10 via light source input interface 6, and outfan then connects USB interface 8, and said USB interface 8 connects computers 1 through usb data line 9, in order to realize the exchanges data between spectrogrph and the computer 1; Said alarm module also connects computer 1, and when (what) data of spectrogrph transmission surpassed preset value, computer 1 control alarm module was reported to the police.
As shown in Figure 3, be the method for work of the present invention in application, comprise navigation and monitoring, explanation respectively below in the preceding plan of art, the art.
Plan comprises following steps before the described art:
Before the steps A, art patient's vertebra is carried out CT scan, obtain DICOM fault image data;
Step B, computer read in the image data that steps A obtains, and according to patient's operative site, pick out appropriate C T image, these CT images are done cut apart and interpolation, obtain new image sequence;
Step C, the image sequence that step B is obtained carries out the body three-dimensional reconstruction, obtains the three-dimensional reconstruction volume data;
Step D; On the three-dimensional reconstruction volume data that step C obtains, delineating the best plants the nail path and extracts the half-tone information RCT on the path; According to the mathematics transformation model of near infrared light mathematic(al) parameter and CT image data, convert half-tone information RCT into near-infrared information R that the best is planted the nail path
NIRS
Wherein, the acquisition methods of the mathematics transformation model of near infrared light mathematic(al) parameter and CT image data is: at first vertebra is carried out CT scan, use the present invention that a plurality of near-infrared parameters of planting the nail path of vertebra are tested then, obtain the CT data on each path; CT data and the normalization of near-infrared parameter are handled, sought the dependency between the two, set up the mathematics transformation model.
Step e is carried out the circular cone processing to the described nail path of planting of step D, obtains N cone, adopts the Tri linear interpolation algorithm to extract the half-tone information of the taper seat of each cone respectively, sets up and plants nail path half-tone information data base ACT;
Wherein, the method for said circular coneization is: planting the nail path with the best is perpendicular bisector, is the summit of cone to plant nail point, and the circular cone drift angle changes the draw circles cone continuously according to 1～N degree and obtains N conical area to be spaced apart 1 degree, and wherein N is the natural number less than 30;
Step F, according to the mathematics transformation model of near infrared light mathematic(al) parameter and CT image data, with the described half-tone information data base of step e convert into plant the nail path near-infrared optical parameter database A
NIRS, and set up border Early-warning Model W
NIRS
Wherein, the method for building up of border Early-warning Model is: the border when planting nail comprises pedicle of vertebral arch both sides, anterior margin of vertebral body and both sides, intervertebral foramina side, lamina of vertebral arch side etc., is planting nail path near-infrared information database A
NIRSIn find the near infrared light mathematic(al) parameter situation of change on each border, set and prevent the safe distance T that wears out
Safe, and with border T
SafeThe near-infrared parameter value at place is set at threshold value of warning.
Navigation comprises following steps in the described art:
Step G uses operating theater instruments to push vertebra front end skin and fascia thoracolumbalis aside, exposes vertebra;
Step H; Open the electromagnetic location device; Patient's operative site is placed in the positioner effective magnetic field scope, use multi-functional drill bit that the coordinate of point of significance such as the spinous process on the vertebra, transverse process is registered, and correspondingly in three-dimensional CT images, delineate out the image coordinate of this group registration point;
Step I adopts quick ICP algorithm that two groups of coordinate points are carried out registration, obtains the transition matrix of operative space and Computerized three-dimensional image space, in 3-D view, shows position, the direction of the multi-functional drill bit of operation in real time, realizes the location;
Step J, information such as the locus of the multi-functional probe of electromagnetic location device calculating acquisition, angle;
Step K is chosen suitable planting the nail point and plant the nail angle according to step J, uses multi-functional drill bit to begin to plant nail, and near-infrared parameter acquisition device calculates the near-infrared parameter D of biological tissue that obtains multi-functional probe position simultaneously
NIRS
Step L works as D
NIRSPlant nail path R with the best
NIRSBetween matching error less than the scope of setting, it is correct then to plant nail;
Step M plants nail path D when step L is described
NIRSPlant nail path R with the best
NIRSBetween matching error greater than the range of error of setting, the real-time spatial positional information that combines the electromagnetic location device to provide simultaneously then adopts based on the curvilinear trend matching algorithm of Hausdorff distance and curvature described the planting of step M is followed closely path D
NIRSWith plant the nail path near-infrared information database A
NIRSMate, judge the position of pedicle screw, and utilize border Early-warning Model W
NIRSBefore screw arrives the border, start alarm device and carry out early warning.
As shown in Figure 3, at first before art, the patient is carried out CT scan, obtain patient's vertebra CT image data.According to each tissue of human body different to the absorption of X ray and transmitance, in the CT image, show as different gray values, because skeleton has high-absorbility for X ray, so in image, show as Bai Ying.During concrete operations, the CT sequence image is imported to system support software, utilize thresholding method that the bone segmentation in the CT image is extracted, reconstruct the threedimensional model of vertebra again.The doctor selects suitable planting the nail point and plant the nail angle according to threedimensional model.The vertebral surface reconstructed image that is after vertebra of the present invention is rebuild shown in Figure 4.The sketch map of registering for performing the operation shown in Figure 5.The operation registration is the process that electronic 3-D model is associated with the actual patient brain.Arrange that in multi-functional drill bit electromagnetism passes coil.In threedimensional model, delineate out earlier a plurality of gauge points 22 such as spinous process on the vertebrae, transverse process; Utilize multi-functional drill bit to press close to the physical location of these gauge points on patient's vertebra again; Obtain the space coordinates of these points, obtain the transition matrix between these two coordinate systems through the registration transformation algorithm.After operation is succeeded in registration, utilize electromagnetic location device 13 to record locus, the angle information of multi-functional drill bit 11 and transfer to computer 1, computer 1 is presented in the electronic 3-D model according to the registering result conversion data and with it, and the guiding doctor accomplishes operation.
Fig. 7 (a) and Fig. 7 (b) represent to plant nail path CT value curve and corresponding near-infrared parameter curve respectively.The CT value is the pairing material of each pixel expression big or small to X ray linear averaging attenuation in the CT influence; Because linear attenuation coefficient is relevant with the mass density and the chemical composition of material, thereby the mass density of CT value and this material and chemical composition are closely related.Caused anaclasis meeting does not cause scattering of light because the refractive index on the inner small border of biological tissue matches, and near-infrared is optimized the size that scattering coefficient is represented the attenuation that this scattering causes, and this coefficient is relevant with the size of particle density and scattering section.In conjunction with curve tendency and the influence factor of the two among two width of cloth figure, can see having certain mutual transforming relationship between the two, test a plurality of optical parametric and CT data of planting the nail path of vertebra respectively through experiment.CT data and the normalization of near infrared light mathematic(al) parameter are handled the back carrying out the pseudo-shadow elimination of optical parametric, seek the dependency between the two, set up the mathematical model M
NIRS=h (CT).
Shown in Figure 8 for to utilize the present invention to carry out the sketch map of pedicle screw implant surgery.At first use multi-functional drill bit to enjoy operation registration during operation, then choose to have chosen on the vertebra and suitable plant the nail point, puncture after planting the nail angle, gather the near-infrared parameter simultaneously according to navigation system.Light source output interface during puncture in the near-infrared parameter acquisition system to osseous tissue, receives inner the diffusing of osseous tissue through receiving optical fiber through the emission of the launching fiber on drill bit near infrared light again.Calculate the μ ' of puncture needle in-position osseous tissue according to the relation between diffuse-reflectance light intensity and the reduced scattering coefficient μ ' s
sValue is according to the mathematical model M that has set up
BoundaryAnd M
Warning, the position that the real-time judge drill bit is arrived, early warning before arriving the border simultaneously.
Above content is the detailed description of specific embodiments of the present invention; Can not assert that practical implementation of the present invention is only limited to these explanations; The deduction or replace that those skilled in the art do implementation step of the present invention and mentality of designing all should be encompassed in the claim scope of the present invention.
Claims (2)
1. one kind is used for the art navigation system that pedicle screw is implanted; It is characterized in that: comprise multi-functional drill bit, near-infrared parameter acquisition device, electromagnetic location device and computer; Wherein, The electromagnetic location device comprises magnetic field generator and electromagnetic location appearance, and the two connects through cable, and said electromagnetic location appearance also connects computer through cable; Said multi-functional drill bit comprises threaded sleeve, receives optical fiber, launching fiber, electromagnetic location coil, inner stainless steel tube, outside stainless steel tube and handle; Wherein, Outside stainless steel tube is a hollow structure, and the one of which end closely is connected with threaded sleeve, the other end handle that is threaded; Said outside stainless steel tube is linked in the outside of inner stainless steel tube; The center of said inner stainless steel tube is a manhole, receives optical fiber, launching fiber is parallel with the electromagnetic location coil closely is located in the said through hole, and said electromagnetic location coil connects the electromagnetic location appearance in the electromagnetic location device through serial cable; Said near-infrared parameter acquisition device comprises the machine box and is located at machine box inner power supply, light source, spectrogrph; The outside of said machine box is respectively equipped with on and off switch, light source switch, light source output interface, light source input interface and USB interface; Wherein, Power supply is inner each module for power supply, and by its keying of on and off switch control; Light source connects launching fiber via the light source output interface, and this light source is by its keying of light source switch control; The input of spectrogrph connects reception optical fiber via the light source input interface, and outfan connects USB interface, and said USB interface connects computer through the usb data line, in order to realize the exchanges data between spectrogrph and the computer.
2. a kind of art navigation system that pedicle screw is implanted that is used for as claimed in claim 1; It is characterized in that: said multi-functional drill bit also comprises the fiber optic cables output port; Said fiber optic cables output port is located at an inner stainless steel tube end relative with threaded sleeve, and said reception optical fiber, launching fiber and electromagnetic location coil are connected with external equipment after all passing this fiber optic cables output port again.
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