CN107157579A - A kind of pedicle screw is implanted into paths planning method - Google Patents
A kind of pedicle screw is implanted into paths planning method Download PDFInfo
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- CN107157579A CN107157579A CN201710492167.8A CN201710492167A CN107157579A CN 107157579 A CN107157579 A CN 107157579A CN 201710492167 A CN201710492167 A CN 201710492167A CN 107157579 A CN107157579 A CN 107157579A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/101—Computer-aided simulation of surgical operations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/101—Computer-aided simulation of surgical operations
- A61B2034/102—Modelling of surgical devices, implants or prosthesis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/107—Visualisation of planned trajectories or target regions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B2090/364—Correlation of different images or relation of image positions in respect to the body
- A61B2090/367—Correlation of different images or relation of image positions in respect to the body creating a 3D dataset from 2D images using position information
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
- A61B2090/3762—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy using computed tomography systems [CT]
Abstract
The present invention relates to medical domain, more particularly to a kind of pedicle screw implantation paths planning method.This method comprises the following steps：S1, preoperative planning：Pre-operative patients CT image datas are entered to pre-process, is implanted into according to the anatomical features of vertebral arch pedicle of vertebral column in pedicle screw in 3D planning systems and carries out the optimal implantation path of operation pathway planning determination；S2, the adjustment backbone 3D poses in pedicle screw implantation 3D planning systems, interception left and right pedicle screw simulation axle position figure；S3, art Plays axle position figure are obtained：2D navigation system is implanted into using pedicle screw, by adjusting C-arm, the X Ray axle position figures of backbone in art are obtained；Pedicle screw implantation path confirms in S4, art：It is in pedicle screw implantation 2D navigation system, pedicle screw simulation axle position figure derived from 3D planning systems is registering with X Ray axle positions figure progress in art, determine that pedicle screw is implanted into point.This method can reduce human factor influence with the position of fast and accurate determination pedicle screw implantation point.
Description
Technical field
The present invention relates to medical domain, more particularly to a kind of pedicle screw implantation paths planning method.
Background technology
Pedicle screw instrumentation due to its post of backbone three fix biomethanics in terms of superiority so that it is outside backbone
It is widely used in section's operation.But conventional open pedicle of vertebral arch, which fixes fusion, needs that paraspinal muscle is carried out widely to peel off and long
The drawing of time, so often leads to the denervation and atrophy of paravertebral muscles, causes the generation of spinal fusion disease.In recent years, with
The progress of modern medical science technology, people explore fortune again while making every effort to the safety of pedicle screw implantation and be accurate
Pedicle screw is percutaneously implantable with minimally invasive means, so as to effectively reduce artificial damage.Due to percutaneous cervical arc root screw technology
Appearance avoid the big otch of conventional spinal fracture or dislocation implant surgery, muscle peel off it is many, postoperative rehabilitation slowly grade shortcoming,
It has been increasingly becoming one of basic fundamental means of Minimally invasive procedure at present.
Because pedicle of vertebral arch is narrow, screw once passes the side wall of pedicle of vertebral arch, and operation fails.Pedicle internal fixation operation
The key of success or failure is that can screw reach centrum by pedicle exactly.Therefore pedicle of vertebral arch mark is correctly found from the way of escape, entered
It is particularly important with the access point and inserting needle direction that determine screw.In actual operation more than doctor by virtue of experience, with reference to the backbone of x-ray image
Anatomic points carry out free-hand implantation, and current operative failure rate is up to 30%.
Optimal operation pathway, is to use pedicle of vertebral arch standard axle positioning principle, exactly allows the axis and C-arm of pedicle of vertebral arch
The transmitting axis of X-ray machine is as overlapping as possible, it is ensured that operation implantation path and pedicle of vertebral arch diameter parallel, the oval cat of selection pedicle of vertebral arch
The center of eye, it is possible to obtain the optimal path of pedicle of vertebral arch implantation.Patent CN104224306A utilizes three there is provided one kind
The method that the optimal access point of pedicle screw is found in dimension modeling, can aid in doctor to complete operation pathway planning in the preoperative.But it is real
In the operation of border, the determination of pedicle screw implantation point typically all by virtue of experience carries out artificial selection, it is impossible to ensure actual hand
Art path is consistent with path planning.
Due to the influence of subjective factor, the position that user selects in actual operation is all different.And select the accurate of position
Property badly influence the implantation effect of pedicle screw, it is improper to select, or even screw can be caused to pass pedicle of vertebral arch side wall, causes hand
Art fails.How science, rationally, accurately find the position of screw placement point, will during pedicle screw implant surgery
It is particularly important.
The content of the invention
(1) technical problem to be solved
Paths planning method is implanted into it is an object of the invention to provide a kind of pedicle screw, this method can be fast
Speed, the screw placement point accurately found in vertebral arch pedicle of vertebral column standard axle bitmap.
(2) technical scheme
To reach above-mentioned purpose, the present invention provides a kind of pedicle screw implantation paths planning method, such as Fig. 1 institutes
Show, comprise the following steps：S1, preoperative planning：Dividing processing and three-dimensional reconstruction are entered to pre-operative patients CT image datas, according to backbone
The anatomical features of pedicle of vertebral arch carries out operation pathway planning in pedicle screw implantation 3D planning systems and determines optimal implantation
Path；S2, pedicle screw be implanted into 3D planning systems, adjust backbone 3D poses, interception left and right pedicle screw simulation
Axle position figure；S3, art Plays axle position figure are obtained：2D navigation system is implanted into using pedicle screw, by adjusting C-arm,
Obtain the X-Ray axle position figures of backbone in art；Pedicle screw implantation path confirms in S4, art：In pedicle screw implantation
It is in 2D navigation system, pedicle screw simulation axle position figure derived from 3D planning systems is registering with X-Ray axle positions figure progress in art,
Determine that pedicle screw is implanted into point.
According to the present invention, vertebral arch pedicle of vertebral column axle position figure refers on projection images, and the edge of pedicle of vertebral arch axle front and rear surfaces is thrown
Projected image when two annulus that shadow is formed are overlapped.
According to the present invention, in step sl, pre-operative patients CT image datas are pre-processed, including：Preoperative CT is schemed
As being split and three-dimensional reconstruction, the CT data importeding into pedicle screw implantation 3D planning systems include DICOM numbers
According to the STL data split.
According to the present invention, in step sl, the anatomical features of described vertebral arch pedicle of vertebral column：
1) include, the left and right terminal of left and right key point and the pedicle screw implantation of backbone；
2) selection of left and right key point and left and right terminal is flat by X, Y, Z (being respectively red, green, blue, as shown in Figure 2) three
Face joining is determined；
3) key point is in pedicle of vertebral arch center, and red line is located at left nut center (Fig. 4 lower rights cross-sectional view), blueness
Line is located at pedicle of vertebral arch center (upper right side side bitmap), and blue line is located at panda eye center (the positive bitmap in Fig. 4 lower lefts)；
4) terminal is located at the 1/3 of centrum, right part of flg as shown in Figure 5.
According to the present invention, in step s 2, pedicle screw implantation 3D planning systems can be according to the left side planned
The standard axle bitmap (as shown in Figure 9) of right pedicle screw implantation coordinates measurement simulation, and preserved.
According to the present invention, in step s3, pedicle screw implantation 2D navigation system can be according to the X- photographed
The characteristic of ray images and backbone, calculates the adjustment amount of C arms, makes after adjustment C arms, can obtain the X-ray axle positions of standard
Scheme (as shown in Figure 10).
According to the present invention, in step s 4, pedicle screw implantation 2D navigation system can import X-ray images and
The derived simulation axle position figure of 3D softwares, navigation system can be translated to left and right standard axle bitmap, rotate, scale, and realize axle
Bitmap is registering with X-ray figure superpositions.
According to the present invention, in step s 4, after axle position figure is registering with X-ray figure superpositions, nail in chosen axis bitmap
Center is used as screw placement point (as shown in figure 12).
(3) beneficial effect
The pedicle screw implantation paths planning method of the present invention, scientific and rational can cook up pedicle of vertebral arch screw
Nail implantation path, during reduction pedicle screw implantation, the positioning heavy dependence doctors experience of path point, subjectivity are strong, easily go out
The problems such as existing deviation, the security of operation is improved, and then, the radiation number of times to patient is reduced, harm is reduced, shortens operation
Time, reduce medical treatment cost.
Brief description of the drawings
Fig. 1 is the flow chart of the implementation of pedicle screw implantation paths planning method
Fig. 2 is pedicle screw implantation 3D planning system software diagrams
Fig. 3 is planning spinal column segment selection
Fig. 4 is the left key point of planning
Fig. 5 is the left terminal of planning
Fig. 6 is left side pedicle screw path planning design sketch
Fig. 7 is left side pedicle screw path planning 3D diagrams under different angles
Fig. 8 is right side pedicle screw path planning design sketch
Fig. 9 is the simulation axle position figure obtained in 3D softwares (A is that right side, B are left side)
Figure 10 is the X-ray axle position figures shot in art
Figure 11 is simulation axle position figure and X-ray axle position figure registration results
Figure 12 is screw position implantation point in art
Embodiment
Below in conjunction with accompanying drawing, the present invention is described in further detail.
Shown in reference picture 1, embodiment of the invention includes S1~S4 steps altogether.Embodiment is as follows：
The preoperative planning of step S1：
Step S1.1：Using MIMICS or other Medical Image Processing softwares, the preoperative CT data to patient are split
Processing, obtains patient spine bone surface, and carry out three-dimensional reconstruction export STL models.
Step S1.2：It is implanted into pedicle screw and the DICOM data of patient is imported in 3D planning system softwares and are divided
The STL data cut.
As shown in Fig. 2 upper left side is 3D diagrams, upper right side is side bitmap (sagittal plane), and lower left is that positive bitmap is (coronal
Face), lower right be (cross section)；Ridge is adjusted by adjusting X, Y, the position of Z plane (being respectively indicated as red, green, blue) and corner
Position, corner and size of the post in three-view diagram.
Step S1.3：As shown in figure 3, adjustment backbone three-view diagram, corrects spine image, regulation plotted line position, which is located at, works as
On preceding joint of vertebral column.
Step S1.4：Planning left side pedicle screw implantation path.
Step S1.4.1：Left key point is planned, regulation red line is located at left nut center (such as Fig. 4 lower rights cross section
Figure), blue line be located at pedicle of vertebral arch center (such as Fig. 4 upper right side side bitmap), blue line is located at panda eye center, and (such as Fig. 4 is left
The positive bitmap in lower section), the intersection point of three planes is left key point；
Step S1.4.2：Plan (right part of flg as shown in Figure 5), three at left terminal, regulation green planning line to the 1/3 of centrum
The intersection point of plane is left terminal.
As shown in fig. 6, completing after left key point and the planning of left terminal, path planning effect.
As shown in fig. 7, the operation pathway planning effect under different angles in 3D diagrams.
Step S1.5：With reference to step S1.4.1 and step S1.4.2 planning right side pedicle screw implantation path, planning
Effect is as shown in Figure 8.
Step S2：The pose of backbone is adjusted, is projected respectively along the vertebral arch pedicle of vertebral column of planning or so side path, obtains a left side
Right pedicle screw standard axle bitmap (as shown in Figure 9), and preserve.
Step S3：Obtain X-Ray axle position figures in art：According to the characteristic point of backbone in art, C arms are calculated by 2D navigation system
Adjusting parameter, adjusts C arm poses, the right standard axle position figure until getting backbone.On X-Ray images, before pedicle of vertebral arch axle
Two annulus that the edge projection on surface is formed afterwards overlap (as shown in Figure 10).
Step S4：Determine that pedicle screw is implanted into point：
Step S4.1：Mock standard right axle bitmap shown in Fig. 6 A is entered to pedicle screw and is implanted into 2D navigation system
In；
Step S4.2：By translating, rotating to mock standard right axle bitmap, scale, carried out with X-ray standard right axle positions figure
Superposition registration so that backbone contour convergence (as shown in figure 11)；
Step S4.3：The place-centric of screw in mock standard right axle bitmap is chosen, the screw placement on the right side of backbone is used as
Point (as shown in figure 12)；
Step S4.4：According to the screw placement point on the right side of the backbone shown in Figure 12, implantation backbone is indicated according to navigation system
Right side pedicle screw.
Step S4.5：Repeat step S3, S4.1-S4.4, is implanted into left of spine pedicle screw.
Claims (7)
1. a kind of pedicle screw is implanted into paths planning method, it is characterised in that comprise the following steps：
S1, preoperative planning, are pre-processed to pre-operative patients CT image datas, according to the anatomical features of vertebral arch pedicle of vertebral column point in ridge
Operation pathway planning is carried out in post pedicle screw implantation 3D planning systems and determines optimal implantation path；
S2, the adjustment backbone 3D poses in pedicle screw implantation 3D planning systems, interception left and right pedicle screw simulation
Axle position figure；
S3, art Plays axle position figure are obtained, and 2D navigation system is implanted into using pedicle screw, by adjusting C-arm, are obtained
The X-Ray axle position figures of backbone in art；
Pedicle screw implantation path confirms in S4, art, and in pedicle screw implantation 2D navigation system, 3D is planned into system
The derived pedicle screw simulation axle position figure of system is registering with X-Ray axle positions figure progress in art, determines that pedicle screw is implanted into
Point.
2. according to claim 1, a kind of pedicle screw is implanted into paths planning method, it is characterised in that described in step S4
Art in pedicle screw implantation path confirmation method, comprise the following steps：
S4.1 by preoperative 3D planning systems simulation axle position figure by being translated, being rotated, scaled, with the X-Ray axle position figures in art
Carry out registration so that preoperative simulation axle position figure is overlapping with the X-Ray axle position figure backbone profiles in art；
S4.2 regard the center that simulation nail in axle position figure is simulated after registration as pedicle screw implantation point in art.
3. according to claim 1, a kind of pedicle screw is implanted into paths planning method, it is characterised in that described axle position
Figure refers on projection images, perspective view when two annulus that the edge projections of pedicle of vertebral arch axle front and rear surfaces is formed are overlapped
Picture.
4. according to claim 1, a kind of pedicle screw is implanted into paths planning method, it is characterised in that described in step S1
Vertebral arch pedicle of vertebral column anatomical features including backbone left and right key point and the left and right terminal of pedicle screw implantation：
Described key point is in pedicle of vertebral arch center；
Described terminal is located at the 1/3 of centrum.
5. according to claim 1, a kind of pedicle screw is implanted into paths planning method, it is characterised in that described in step S1
Pre-operative patients CT image datas are pre-processed, including：Preoperative CT images are split and three-dimensional reconstruction.
6. according to claim 1, a kind of pedicle screw is implanted into paths planning method, it is characterised in that described step
The CT data that S1 is imported into pedicle screw implantation 3D planning systems include DICOM data and the STL data split.
7. according to claim 1, a kind of pedicle screw is implanted into paths planning method, it is characterised in that step 3 is step
C-arm must be adjusted by 2D navigation system first in 4 precondition, art, get the X-Ray axle position figures of backbone in art.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710492167.8A CN107157579A (en) | 2017-06-26 | 2017-06-26 | A kind of pedicle screw is implanted into paths planning method |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201710492167.8A CN107157579A (en) | 2017-06-26 | 2017-06-26 | A kind of pedicle screw is implanted into paths planning method |
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| CN107157579A true CN107157579A (en) | 2017-09-15 |
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| CN201710492167.8A Pending CN107157579A (en) | 2017-06-26 | 2017-06-26 | A kind of pedicle screw is implanted into paths planning method |
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Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109925054A (en) * | 2019-03-04 | 2019-06-25 | 杭州三坛医疗科技有限公司 | Determine the householder method, device and system, readable storage medium storing program for executing in target spot path |
| CN110738681A (en) * | 2019-10-11 | 2020-01-31 | 北京航空航天大学 | automatic pedicle screw operation path planning method based on deep learning network |
| CN113781496A (en) * | 2021-08-06 | 2021-12-10 | 北京天智航医疗科技股份有限公司 | Vertebral pedicle screw channel automatic planning system and method based on CBCT vertebral image |
| CN113940752A (en) * | 2021-11-11 | 2022-01-18 | 首都医科大学 | Multi-angle projection-based optimal path planning method for pedicle screws |
| CN114288018A (en) * | 2022-01-04 | 2022-04-08 | 青岛大学附属医院 | Robot-assisted under-mirror fusion technical method |
| US11576727B2 (en) | 2016-03-02 | 2023-02-14 | Nuvasive, Inc. | Systems and methods for spinal correction surgical planning |
-
2017
- 2017-06-26 CN CN201710492167.8A patent/CN107157579A/en active Pending
Cited By (9)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US11576727B2 (en) | 2016-03-02 | 2023-02-14 | Nuvasive, Inc. | Systems and methods for spinal correction surgical planning |
| US11903655B2 (en) | 2016-03-02 | 2024-02-20 | Nuvasive Inc. | Systems and methods for spinal correction surgical planning |
| CN109925054A (en) * | 2019-03-04 | 2019-06-25 | 杭州三坛医疗科技有限公司 | Determine the householder method, device and system, readable storage medium storing program for executing in target spot path |
| CN110738681A (en) * | 2019-10-11 | 2020-01-31 | 北京航空航天大学 | automatic pedicle screw operation path planning method based on deep learning network |
| WO2021068933A1 (en) * | 2019-10-11 | 2021-04-15 | 北京航空航天大学 | Method for automatically planning surgical path of pedicle screw on basis of deep learning network |
| CN113781496A (en) * | 2021-08-06 | 2021-12-10 | 北京天智航医疗科技股份有限公司 | Vertebral pedicle screw channel automatic planning system and method based on CBCT vertebral image |
| CN113781496B (en) * | 2021-08-06 | 2024-02-27 | 北京天智航医疗科技股份有限公司 | Automatic planning system and method for pedicle screw channel based on CBCT (computed tomography) spine image |
| CN113940752A (en) * | 2021-11-11 | 2022-01-18 | 首都医科大学 | Multi-angle projection-based optimal path planning method for pedicle screws |
| CN114288018A (en) * | 2022-01-04 | 2022-04-08 | 青岛大学附属医院 | Robot-assisted under-mirror fusion technical method |
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