CN107260306B - Planning method for three-dimensional simulation operation nail placement and surgical operation simulator - Google Patents
Planning method for three-dimensional simulation operation nail placement and surgical operation simulator Download PDFInfo
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- CN107260306B CN107260306B CN201710507671.0A CN201710507671A CN107260306B CN 107260306 B CN107260306 B CN 107260306B CN 201710507671 A CN201710507671 A CN 201710507671A CN 107260306 B CN107260306 B CN 107260306B
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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
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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
- A61B2034/101—Computer-aided simulation of surgical operations
- A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
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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
- A61B2034/107—Visualisation of planned trajectories or target regions
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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
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
Abstract
The invention is applicable to the field of medical instruments, and provides a planning method for three-dimensional simulation operation nail placement and a surgical operation simulator. The method comprises the following steps: performing three-dimensional modeling according to the received CT image of the spine to generate a three-dimensional model; generating three section maps according to the three-dimensional model; displaying the three-dimensional model and three sectional views of the three-dimensional model; adjusting the position and the sectioning direction of the sectioning surface so as to visually observe the section condition of the spine; determining a screw channel of the screw through the intersection line of the cutting surfaces in two directions; adding screws on the determined nail paths; and moving the screw in the direction of the screw channel to enable the screw to be in the position of the actual operation, and finishing the planning of the screw. The invention has simple and convenient planning, can more accurately plan the nail path and ensures that the nail placement is safer and more reliable.
Description
Technical Field
The invention belongs to the field of medical instruments, and particularly relates to a planning method for three-dimensional simulation operation nail placement and a surgical operation simulator.
Background
The spine is the central axis of the human body and mainly plays the roles of supporting, protecting, balancing and moving. The spine consists of vertebrae, intervertebral discs, spinal cord, spinal nerves, and the autonomic nervous system. The spinal column is internally provided with a vertebral canal for accommodating and protecting the spinal cord. And 31 pairs of spinal nerves connected to the spinal cord exit the spinal canal through the intervertebral foramen and are protected by the spinal column. Meanwhile, main arteriovenous vessels and neck arteriovenous vessels of the human body are distributed around the spine.
Because the pedicle of a vertebral arch is adjacent to more blood vessels and nerve structures, once the screw is improperly placed through the vertebral plate, the mistaken screw can cause serious neurovascular injury. Therefore, in spinal stapling, it is necessary to perform surgical planning with precision and to perform surgical procedures with accuracy.
The spine of a normal person has 32-34 spinal bones: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral vertebrae and 3-5 caudal vertebrae. There are 23 intervertebral discs and 134 joints. The side surface of the spine is S-shaped, and the front surface of the spine is a straight line.
Due to different anatomical forms of the vertebral bodies and individual differences and deformities, the screw insertion point, the screw placement direction and the screw placement depth of the screw need to be planned. During planning, it is ensured that the screws cannot penetrate the outer wall of the pedicle, otherwise the adjacent nerves and blood vessels are damaged. The angle of the nail feeding is changed along with the change of the angle of the vertebral arch, so as to avoid penetrating the cortical bone in front of the vertebral body. Meanwhile, in order to ensure the pull-out resistance of the screw, the size and length of the screw should be selected appropriately. The nail feeding point is not a point but an area, and is matched with the nail feeding angle. The selection of the screw feeding point ensures that the screw is reliably fed and is not easy to slide. The screw is advanced in a direction that allows the screw to pass through the narrowest portion of the pedicle without breaking through the outer wall. The depth of the screw is set so that the screw can not penetrate out of the vertebral body.
The existing planning method of three-dimensional simulation surgery is to add an instrument in a three-dimensional model and then move the instrument to a proper position in a three-dimensional view.
A domestic BOHOLO surgical operation simulator firstly introduces a CT image, then carries out three-dimensional modeling and then carries out three-dimensional planning. When three-dimensional planning is carried out, an instrument to be added is found in an instrument library, then the instrument is added to the lower right corner of the three-dimensional model, and then the instrument is moved to a proper position.
This approach is directed to general surgery and does not optimize the characteristics of spinal surgery stapling. The problems of poor planning precision and difficult instrument movement exist. Since there are six degrees of freedom (5 degrees of freedom for the screw) in space for one instrument, and only two-dimensional movement and one-angle rotation can be performed when moving the instrument in the PC interface, it is necessary to change the angle of the three-dimensional model continuously while moving the instrument to move the instrument to a proper position. Due to the complex movement, the planning precision is poor and can only be used as a reference.
The MAZOR corporation of israel has made certain optimizations for spinal stapling surgical planning. And (4) after the CT image is introduced for three-dimensional modeling, cutting the spine into single spines according to the structure of the spine of the human body. The three-dimensional model of the single spine is then fitted with three directional visual maps. The spinal screw is then added and the screw orientation is adjusted in each of the three views. However, this method only divides a three-dimensional view into three-dimensional views in three directions, which is convenient for adjusting instruments compared with the BOHOLO surgical simulator, but still cannot clearly know the condition of the staple path section in planning, so that the planning precision is still not high.
Disclosure of Invention
The invention aims to provide a planning method for three-dimensional simulation operation nail placement and a surgical operation simulator, and aims to solve the problem that planning precision is still low because only one three-dimensional view is divided into three-dimensional views in three directions.
In a first aspect, the present invention provides a method for planning surgical nail placement in three dimensions, the method comprising:
performing three-dimensional modeling according to the received CT image of the spine to generate a three-dimensional model;
generating three section maps according to the three-dimensional model;
displaying the three-dimensional model and three sectional views of the three-dimensional model;
adjusting the position and the sectioning direction of the sectioning surface so as to visually observe the section condition of the spine;
determining a screw channel of the screw through the intersection line of the cutting surfaces in two directions;
adding screws on the determined nail paths;
and moving the screw in the direction of the screw channel to enable the screw to be in the position of the actual operation, and finishing the planning of the screw.
In a second aspect, the present invention provides a computer-readable storage medium, in which a computer program is stored, which, when being executed by a processor, implements the steps of the planning method for three-dimensional simulated surgical staple placement as described above.
In a third aspect, the present invention provides a surgical simulator comprising:
one or more processors;
a memory; and
one or more computer programs, wherein the one or more computer programs are stored in the memory and configured to be executed by the one or more processors, which when executed perform the steps of a method of planning a three-dimensional simulated surgical staple placement as described above.
In the invention, three section views are generated according to the three-dimensional model, the position and the section direction of each section are adjusted to visually observe the section condition of the spine, the nail path of the screw is determined by the intersection line of the section views in two directions, the planning is simple and convenient, the nail path can be planned more accurately, and the nail placement is safer and more reliable.
Drawings
Fig. 1 is a flowchart of a planning method for three-dimensional simulated surgical nail placement according to an embodiment of the present invention.
Fig. 2 is a schematic view of a sagittal plane, a coronal plane and a horizontal plane of a three-dimensional model and a three-dimensional model in a planning method for three-dimensional simulation surgical nail placement according to an embodiment of the present invention.
Fig. 3 is an initial sectional relationship view.
FIG. 4 is a cross-sectional view with adjustments made.
Fig. 5 is a schematic view of the addition of screws on a defined trajectory.
Fig. 6 is a schematic view of the screw in place.
Fig. 7 is a schematic view of a surgical simulator provided in the third embodiment of the present invention.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more clearly apparent, the present invention is described in further detail below with reference to the accompanying drawings and embodiments. It should be understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the invention.
In order to explain the technical means of the present invention, the following description will be given by way of specific examples.
The parameters of the spinal screw placement include screw placement point, screw placement direction and screw placement depth. The key to accurate nail placement is to ensure that the pedicle nail cannot break through the pedicle bone wall when passing through the isthmus. The selection of the appropriate tack and the precise tack direction are the key points of the planning.
The first embodiment is as follows:
referring to fig. 1, a planning method for three-dimensional simulated surgical nail placement according to an embodiment of the present invention includes the following steps:
s101, performing three-dimensional modeling according to the received CT (Computed Tomography) image of the spine to generate a three-dimensional model.
The CT image is a technology for acquiring the model section information of an object by performing ray projection measurement on the object at different angles, and a set of slice two-dimensional medical images in DICOM format are obtained.
In the first embodiment of the present invention, S101 may specifically include the following steps:
converting the DICOM image of the CT into a BMP bitmap file;
smoothing the image of the BMP bitmap file to filter noise;
sharpening and enhancing the image after the noise is filtered out so as to enhance the image of the bone part;
segmenting the enhanced image, and separating the gray value of the section of the object and the gray value belonging to the back shadow by using a threshold value;
extracting a vector outline of the segmented image;
and performing surface rendering or volume rendering to generate a three-dimensional model.
And S102, generating three section maps according to the three-dimensional model.
In one embodiment of the present invention, the three cross-sectional views include a sagittal plane, a coronal plane, and a horizontal plane.
S103, displaying the three-dimensional model and three section views of the three-dimensional model (shown in figure 2).
In the first embodiment of the present invention, the sagittal plane, the coronal plane, and the horizontal plane all pass through the center of the original image, as shown in FIG. 3.
And S104, adjusting the position and the cutting direction of the section to visually observe the section condition of the spine.
In the first embodiment of the present invention, each of the three cutting planes has two cutting lines of the other cutting plane. The cutting plane may be translated and rotated.
S104 may specifically be:
when the mouse selects a cutting line in the image range of the cutting plane and then moves up and down or left and right, the cutting plane of the three-dimensional model is translated;
when the mouse selects the cutting line outside the image range of the cutting line and then moves up and down or left and right, the intersection point position of the cutting line is unchanged, and the coordinate of the selected point of the cutting line moves along with the movement of the mouse, so that the cutting line rotates around the intersection point;
when the cutting line of one cutting plane is changed, the other two cutting planes are correspondingly changed.
And S105, determining the screw path of the screw through the intersection line of the cutting planes in the two directions.
When a screw is added, the screw path of the screw is the intersection line of the transverse section (initially horizontal plane) and the front and back sections (initially sagittal plane). Therefore, the detailed condition of the nail path can be observed by adjusting the cutting plane, so that the planning of the nail placing is more accurate.
The nail path can be planned more accurately by adjusting the cutting plane, so that the nail placement is safer and more reliable. The adjusted cross-sectional view is shown in FIG. 4.
And S106, adding screws on the determined nail paths.
The cutting plane is adjusted, and the screw inserting point and the screw inserting direction of the screw are planned. The nail inserting point is the intersection point when the screw just contacts the bone tissue when the screw is inserted into the bone tissue of the three-dimensional model from the outside along the nail path, and the nail inserting direction is the direction from the nail inserting point along the nail path. In this way, screws can be added directly.
After the specification (diameter and length) of the screw is selected, the screw can be added. The addition of screws is shown in figure 5.
And S107, moving the screw in the direction of the screw channel to enable the screw to be positioned at the position of the actual operation, and finishing the planning of the screw.
In the first embodiment of the present invention, S107 specifically is: and moving the screw in the direction of the screw channel to move the screw rod root of the screw to the position of the screw-in point, so that the screw is positioned at the position of the actual operation, and finishing the planning of the screw, as shown in fig. 6.
Since a plurality of screws are placed in one operation, the next screw needs to be planned after one screw is completed. Therefore, in the first embodiment of the present invention, after S107, the following steps may be further included:
and the planned screws are overlapped with the three-dimensional model to participate in the planning of the next screw as an integral three-dimensional model. Therefore, each screw can be better planned, and mutual interference is avoided.
In the first embodiment of the present invention, after S107, the following steps may be further included:
when a certain screw needs to be re-planned, the process returns to S104 after the screw is deleted.
Example two:
the second embodiment of the present invention provides a computer-readable storage medium, where a computer program is stored, and when the computer program is executed by a processor, the steps of the planning method for three-dimensional simulation surgical nail placement provided in the first embodiment of the present invention are implemented.
Example three:
fig. 7 is a detailed block diagram of a surgical simulator provided in a third embodiment of the present invention, and the surgical simulator includes:
one or more processors 101;
a memory 102; and
one or more computer programs, wherein the one or more computer programs are stored in the memory and configured to be executed by the one or more processors, which when executed perform the steps of a method for planning three-dimensional simulated surgical staples as provided in an embodiment of the present invention.
The above description is only for the purpose of illustrating the preferred embodiments of the present invention and is not to be construed as limiting the invention, and any modifications, equivalents and improvements made within the spirit and principle of the present invention are intended to be included within the scope of the present invention.
Claims (16)
1. A computer-readable storage medium storing a computer program which, when executed by a processor, implements a method of planning surgical nail placement in three dimensions, the method comprising:
performing three-dimensional modeling according to the received CT image of the spine to generate a three-dimensional model;
generating three section maps according to the three-dimensional model;
displaying the three-dimensional model and three sectional views of the three-dimensional model;
adjusting the position and the sectioning direction of the sectioning surface so as to visually observe the section condition of the spine;
determining a screw channel of the screw through the intersection line of the cutting surfaces in two directions;
adding screws on the determined nail paths;
and moving the screw in the direction of the screw channel to enable the screw to be in the position of the actual operation, and finishing the planning of the screw.
2. The computer-readable storage medium of claim 1, wherein the three cut plane views include a sagittal plane, a coronal plane, and a horizontal plane.
3. The computer-readable storage medium of claim 2, wherein the sagittal plane, coronal plane, and horizontal plane all pass through a center position of the original image.
4. The computer-readable storage medium of claim 1, wherein each of the three cut planes has two additional cut planes, the cut planes being translatable and rotatable.
5. The computer-readable storage medium of claim 4, wherein the adjusting of the position and the direction of the cut plane is specifically:
when the mouse selects a cutting line in the image range of the cutting plane and then moves up and down or left and right, the cutting plane of the three-dimensional model is translated;
when the mouse selects the cutting line outside the image range of the cutting line and then moves up and down or left and right, the intersection point position of the cutting line is unchanged, and the coordinate of the selected point of the cutting line moves along with the movement of the mouse, so that the cutting line rotates around the intersection point;
when the cutting line of one cutting plane is changed, the other two cutting planes are correspondingly changed.
6. The computer-readable storage medium of claim 1, wherein moving the screw in the direction of the staple track to position the screw in the actual surgical site accomplishes the planning of the screw by:
and moving the screw in the direction of the screw channel, and moving the root of the screw rod of the screw to the position of a screw-in point to enable the screw to be positioned at the position of an actual operation, thereby finishing the planning of the screw.
7. The computer-readable storage medium of claim 1, wherein moving the screw in the direction of the staple track places the screw in an actual surgical position, the method further comprising, after planning the screw:
and the planned screws are overlapped with the three-dimensional model to participate in the planning of the next screw as an integral three-dimensional model.
8. The computer-readable storage medium of claim 1, wherein moving the screw in the direction of the staple track places the screw in an actual surgical position, the method further comprising, after planning the screw:
and when the screw needs to be re-planned, after the screw is deleted, returning to the step of adjusting the position and the cutting direction of the cutting surface.
9. A surgical simulator, comprising:
one or more processors;
a memory; and
one or more computer programs, wherein the one or more computer programs are stored in the memory and configured to be executed by the one or more processors, which when executed by the processor implement a method of planning three-dimensional simulated surgical staples, the method comprising:
performing three-dimensional modeling according to the received CT image of the spine to generate a three-dimensional model;
generating three section maps according to the three-dimensional model;
displaying the three-dimensional model and three sectional views of the three-dimensional model;
adjusting the position and the sectioning direction of the sectioning surface so as to visually observe the section condition of the spine;
determining a screw channel of the screw through the intersection line of the cutting surfaces in two directions;
adding screws on the determined nail paths;
and moving the screw in the direction of the screw channel to enable the screw to be in the position of the actual operation, and finishing the planning of the screw.
10. The surgical simulator of claim 9, wherein said three cross-sectional views comprise a sagittal plane, a coronal plane, and a horizontal plane.
11. The surgical simulator of claim 10, wherein the sagittal plane, coronal plane and horizontal plane each pass through a central location of the original image.
12. The surgical simulator of claim 9, wherein each of the three cut planes has two other cut planes, the cut planes being translatable and rotatable.
13. The surgical simulator of claim 12, wherein the adjustment of the position and direction of the cut plane is embodied as:
when the mouse selects a cutting line in the image range of the cutting plane and then moves up and down or left and right, the cutting plane of the three-dimensional model is translated;
when the mouse selects the cutting line outside the image range of the cutting line and then moves up and down or left and right, the intersection point position of the cutting line is unchanged, and the coordinate of the selected point of the cutting line moves along with the movement of the mouse, so that the cutting line rotates around the intersection point;
when the cutting line of one cutting plane is changed, the other two cutting planes are correspondingly changed.
14. The surgical simulator of claim 9, wherein moving the screw in the direction of the staple track to position the screw in the actual surgical site accomplishes the planning of the screw by:
and moving the screw in the direction of the screw channel, and moving the root of the screw rod of the screw to the position of a screw-in point to enable the screw to be positioned at the position of an actual operation, thereby finishing the planning of the screw.
15. The surgical simulator of claim 9, wherein moving the screw in the direction of the staple track places the screw in an actual surgical position, the method further comprising, after planning the screw:
and the planned screws are overlapped with the three-dimensional model to participate in the planning of the next screw as an integral three-dimensional model.
16. The surgical simulator of claim 9, wherein moving the screw in the direction of the staple track places the screw in an actual surgical position, the method further comprising, after planning the screw:
and when the screw needs to be re-planned, after the screw is deleted, returning to the step of adjusting the position and the cutting direction of the cutting surface.
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| CN201710507671.0A CN107260306B (en) | 2017-06-28 | 2017-06-28 | Planning method for three-dimensional simulation operation nail placement and surgical operation simulator |
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| CN107260306B true CN107260306B (en) | 2020-04-14 |
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| CN110946652B (en) * | 2019-11-29 | 2021-11-12 | 北京工业大学 | Method and device for planning screw path of bone screw |
| CN116712168B (en) * | 2023-08-10 | 2023-11-21 | 鑫君特(苏州)医疗科技有限公司 | Vertebral plate grinding control method and surgical robot system |
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| US10123840B2 (en) * | 2015-02-13 | 2018-11-13 | Scapa Flow, Llc | System and method for medical device placement in bone |
| US10695099B2 (en) * | 2015-02-13 | 2020-06-30 | Nuvasive, Inc. | Systems and methods for planning, performing, and assessing spinal correction during surgery |
| US10390886B2 (en) * | 2015-10-26 | 2019-08-27 | Siemens Healthcare Gmbh | Image-based pedicle screw positioning |
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| CN104224306A (en) * | 2014-09-30 | 2014-12-24 | 华蓥市人民医院 | Method for utilizing three-dimensional modeling for looking for optimum inserting point for inserting pedicle screw |
| CN106308919A (en) * | 2015-07-01 | 2017-01-11 | 张宇鹏 | Method for producing navigation template for assisting imbedding of thoracic vertebra pedicle screw and navigation template |
| CN106408652A (en) * | 2016-09-05 | 2017-02-15 | 上海逸动医学科技有限公司 | Screw path positioning method and system of anterograde screw of anterior column of acetabulum |
| CN106420053A (en) * | 2016-09-05 | 2017-02-22 | 上海逸动医学科技有限公司 | Channel positioning method and system of sacroiliac joint placed in screw fixation S2 vertebral body |
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