CN111374740B - Interatrial septum puncture art is with supplementary puncture system of augmented reality - Google Patents

Interatrial septum puncture art is with supplementary puncture system of augmented reality Download PDF

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Publication number
CN111374740B
CN111374740B CN202010323763.5A CN202010323763A CN111374740B CN 111374740 B CN111374740 B CN 111374740B CN 202010323763 A CN202010323763 A CN 202010323763A CN 111374740 B CN111374740 B CN 111374740B
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puncture
computer
mechanical arm
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freedom mechanical
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CN111374740A (en
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徐翼
其他发明人请求不公开姓名
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Chongqing Xider Medical Instrument Co ltd
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Jiangjin Central Hospital of Chongqing
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34Trocars; Puncturing needles
    • A61B17/3403Needle locating or guiding means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101Computer-aided simulation of surgical operations
    • A61B2034/105Modelling of the patient, e.g. for ligaments or bones
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107Visualisation of planned trajectories or target regions
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108Computer aided selection or customisation of medical implants or cutting guides

Abstract

The invention relates to an augmented reality auxiliary puncture system for interatrial septum puncture, wherein a section scanning device is arranged on the side surface of a bed body and is vertical to the bed body, a three-coordinate adjusting device is arranged above the bed body, and a camera is fixed on the three-coordinate adjusting device; the six-degree-of-freedom mechanical arm is arranged on the side face of the bed body, the section scanning device and the three-coordinate adjusting device are connected with the camera and the six-degree-of-freedom mechanical arm respectively, and the computer is connected with the display; the cross-section scanning device performs cross-section scanning on the heart of the patient, sends the scanned two-dimensional image to the computer, and the computer converts the two-dimensional image into a three-dimensional image. The invention has the advantages of three-dimensional visualization, auxiliary positioning, positioning precision improvement, operation error reduction, success rate improvement and patient injury reduction.

Description

Interatrial septum puncture art is with supplementary puncture system of augmented reality
Technical Field
The invention relates to the field of medical operation equipment, in particular to an augmented reality auxiliary puncture system for atrial septal puncture, which can perform three-dimensional visualization, auxiliary positioning, positioning accuracy improvement, operation error reduction, success rate improvement and patient injury reduction.
Background
In interventional cardiology, interatrial puncture is a must-pass approach for the treatment of many diseases, such as: mitral valvuloplasty, left atrioventricular radiofrequency ablation, and the like. How to quickly and quickly puncture the interatrial septum is the first step in the success of the procedure. Among the procedures commonly used in radiofrequency ablation for atrial septal puncture are: left-side bypass transseptal pathway ablation; atrial fibrillation ablation; left atrial tachycardia ablation; left atrial flutter ablation; the left ventricle involves an alternative approach and necessary supplementation to arrhythmia ablation. Puncture route and application of the device: the instrument is mainly used for a right femoral vein, and is mainly composed of a Mullins sheath or a Swartz sheath (R0 or L1), a 145cm long guide wire of 0.032inch/0.035inch, an interatrial puncture needle and a contrast medium.
Attention is paid to the following matters: 1. when the contrast medium is successfully penetrated into the left atrium, the contrast medium is sprayed out like a line, and the contrast medium is sprayed towards the direction of the spine under the perspective of the left anterior oblique position, and pressure is reduced (less use). 2. Repositioning the puncture point after the needle puncture fails: the puncture needle is withdrawn into the sheath, the sheath is rotated properly under the premise that the front section is straightened through the perspective of the right oblique position 450, the puncture point position is properly adjusted and the puncture is performed again, and the sheath still lost needs to be sent to the superior vena cava to be positioned again according to the original method. 3. When the electrophysiology catheter is withdrawn from the sheath, the speed is not suitable to be too high so as to avoid negative pressure air intake. 4. When the catheter is fed into the electrophysiology catheter through the sheath tube, the left atrium is required to be penetrated as early as possible so as to avoid puncturing the left atrium, and the force is easy to be transmitted to the head end when the catheter is fed through the sheath tube, and is easy to penetrate out particularly when the catheter enters the left auricle.
The puncture of interatrial puncture art is mainly doctor's experience, cooperates the X-ray development of two-dimensional plane, and is high to doctor's ability requirement, and the operation is difficult, appears the puncture mistake easily, and the beating heart that leaks is looked flat to doctor life in the art only relies on two-dimensional development, and difficult accurate positioning often needs puncture many times, causes unnecessary damage to the patient, leads to the fact serious consequence even.
AR is (Augmented Reality). Virtual information is applied to the real world through a computer technology, and a real environment and a virtual object are superposed on the same picture or space in real time and exist at the same time. In germany, engineers and technicians, when performing machine installation, maintenance and tuning, can completely present the internal structure of the machine, which could not be presented originally, and its related information and data through the helmet display. And can work according to the suggestion of computer, solve the technical problem. The work of the user is very convenient, fast and accurate. The method and the phenomenon that a large amount of heavy data are required to be carried around and be searched while working are abandoned, and once a difficult problem and an emergency situation occur, the method and the phenomenon are abandoned.
"reconstruction of heart three-dimensional model based on Chinese digital human data", article number 1673-. The two-dimensional image is obtained by adopting the technical means of section dissection, cardiac ultrasound, CT, MRI and the like.
The technologies of augmented reality, three-dimensional imaging technology, cross-sectional anatomy, cardiac ultrasound, CT, MRI and the like provide further support for medical equipment. Aiming at the defects that the puncture is difficult and the heart of a patient is easily damaged in the existing interatrial septum puncture, an augmented reality auxiliary puncture system for the interatrial septum puncture, which has the advantages of three-dimensional visualization, auxiliary positioning, positioning precision improvement, operation error reduction, success rate improvement and patient damage reduction, is needed.
Disclosure of Invention
The invention aims to provide an augmented reality auxiliary puncture system for atrial septal puncture, which has the advantages of three-dimensional visualization, auxiliary positioning, positioning precision improvement, operation error reduction, success rate improvement and patient injury reduction.
An augmented reality assisted puncture system for interatrial septum puncture comprising:
the section scanning device is arranged on the side face of the bed body and is vertical to the bed body, a three-coordinate adjusting device is arranged above the bed body, and a camera is fixed on the three-coordinate adjusting device;
the six-degree-of-freedom mechanical arm is arranged on the side face of the bed body, the section scanning device, the three-coordinate adjusting device, the camera and the six-degree-of-freedom mechanical arm are respectively connected with a computer, and the computer is connected with a display;
the section scanning device performs section scanning on the heart of a patient, the scanned two-dimensional image is sent to a computer, the computer converts the two-dimensional image into a three-dimensional image, the camera sends the photographed heart real-time image of the patient to the computer, the computer controls the six-degree-of-freedom mechanical arm to calibrate the heart of the patient, the real-time image of the camera, the three-dimensional image and the calibration value of the six-degree-of-freedom mechanical arm modify the three-dimensional image into a three-dimensional model together, and the computer sends the three-dimensional model to a model image frame of a display for display;
the three-dimensional model rotates by rotating the menu frame, is decomposed into sub-models by decomposing the menu frame, is subjected to section by section-cutting the menu frame, and is subjected to puncture simulation by simulating the menu frame.
The section scanning device is one or more of section anatomy, cardiac ultrasound, CT and MRI.
The bed body is provided with a sliding device which is driven by a motor to push the bed body to reciprocate along the longitudinal direction.
The three-coordinate adjusting device is fixed on the support, the horizontal moving device and the horizontal driving device are horizontally arranged on the three-coordinate adjusting device, the longitudinal moving device and the longitudinal driving device are arranged on the horizontal moving device, the vertical moving device and the vertical driving device are arranged on the longitudinal moving device, and the camera is fixed on the vertical moving device.
The six-degree-of-freedom mechanical arm is a six-axis mechanical arm and realizes linear motion and rotary motion in X, Y and Z directions respectively.
The end part of the six-degree-of-freedom mechanical arm is provided with a calibration rod, the end part of the calibration rod, which is close to the six-degree-of-freedom mechanical arm, is provided with a force sensor, when the calibration rod touches an object to be calibrated, the force sensor sends a detection signal to a computer, and the position of the six-degree-of-freedom mechanical arm is controlled by the computer in a matching manner to calibrate.
The end part of the six-degree-of-freedom mechanical arm is provided with a sheath body fixing seat which is used for fixing the puncture sheath body and is provided with a hollow hole, and the hollow hole is attached to the outer surface of the puncture sheath body and is in an inverted frustum shape; the puncture needle fixing device is characterized in that a puncture needle fixing head is arranged above the sheath body fixing seat, the puncture needle fixing head is a clip with a groove, the clip is fixed at a working rod of the linear driving motor, and the linear driving motor is connected with a computer.
The display is provided with a real-time image frame, the real-time image frame displays a real-time image sent by the camera, the model image frame is provided with calibration scales, the three-dimensional model in the model image frame rotates in the three-dimensional coordinate through the rotating menu frame, and the three-dimensional model in the model image frame selects a viewing surface and a sectional direction through the sectional menu frame.
The decomposition menu frame decomposes the three-dimensional model into a plurality of submodels, wherein the submodels are one or more of superior vena cava, pulmonary vein, right atrium, right ventricle, inferior vena cava, aorta, pulmonary artery, left ventricle and left atrium.
And the simulation menu frame selects a model of the puncture sheath, adjusts the angle and the depth of the puncture sheath entering the three-dimensional model, and simulates puncture.
The section scanning device is arranged on the side surface of the bed body and is vertical to the bed body, the three-coordinate adjusting device is arranged above the bed body, and the camera is fixed on the three-coordinate adjusting device; the six-degree-of-freedom mechanical arm is arranged on the side face of the bed body, the section scanning device and the three-coordinate adjusting device are connected with the camera and the six-degree-of-freedom mechanical arm respectively, and the computer is connected with the display; the section scanning device carries out section scanning on the heart of a patient, a scanned two-dimensional image is sent to a computer, the computer converts the two-dimensional image into a three-dimensional image, a camera sends a shot heart real-time image of the patient to the computer, the computer controls a six-degree-of-freedom mechanical arm to calibrate the heart of the patient, the real-time image of the camera, the three-dimensional image and a calibration value of the six-degree-of-freedom mechanical arm modify the three-dimensional image into a three-dimensional model together, and the computer sends the three-dimensional model to a model image frame of a display for display; the three-dimensional model rotates through the rotating menu frame, is decomposed into the sub-models through the decomposition menu frame, is subjected to section through the section-cutting menu frame, and is subjected to puncture simulation through the simulation menu frame. The patient lies on the bed body, and the bed body is under controller control, sends into the inside scanning that scans of section scanning device with the patient, and section scanning device adopts the formula of advancing in layers to scan patient's target position under controller control. The three-coordinate adjusting device comprises a transverse driving device, a longitudinal driving device and a vertical driving device, wherein the transverse driving device, the longitudinal driving device and the vertical driving device are motors, transverse moving devices and longitudinal moving devices, and the vertical moving devices are gear racks. The six-degree-of-freedom mechanical arm is six-axis, and the six-axis is respectively controlled to realize the adjustment of angles in different directions, so that the determination of the position in a three-dimensional coordinate is realized. The computer has image processing function and can process the image sent by the camera. The display is a liquid crystal display, has a touch function, and can also realize an interaction function by matching with a computer through external equipment of a mouse and a keyboard. The invention has the advantages of three-dimensional visualization, auxiliary positioning, positioning precision improvement, operation error reduction, success rate improvement and patient injury reduction.
Drawings
FIG. 1 is a schematic structural view of the present invention;
FIG. 2 is a schematic interface diagram of a display according to the present invention;
FIG. 3 is a schematic structural diagram of an end of a six-DOF robot arm according to the present invention;
in the figure: 1. section scanning device, 2, the bed body, 3, three-coordinate adjusting device, 4, the camera, 5, six degree of freedom arms, 6, the computer, 7, the display, 51, mark pole, 52, sheath body fixing base, 53, pjncture needle fixed head, 54, linear drive motor, 71, real-time image frame, 72, model image frame, 73, rotatory menu frame, 74, decompose the menu frame, 75, cross-section menu frame, 76, simulation menu frame.
Detailed Description
The invention is further described below with reference to the following figures and specific examples.
An augmented reality assisted puncture system for interatrial septum puncture comprising: the device comprises a section scanning device 1, a three-coordinate adjusting device 3 and a camera 4, wherein the section scanning device 1 is arranged on the side surface of a bed body 2 and is vertical to the bed body 2, the three-coordinate adjusting device 3 is arranged above the bed body 2, and the camera 4 is fixed on the three-coordinate adjusting device 3; the six-degree-of-freedom mechanical arm 5 is arranged on the side face of the bed body 2, the section scanning device 1, the three-coordinate adjusting device 3, the camera 4 and the six-degree-of-freedom mechanical arm 5 are respectively connected with the computer 6, and the computer 6 is connected with the display 7; the section scanning device 1 carries out section scanning on the heart of a patient, a scanned two-dimensional image is sent to the computer 6, the computer 6 converts the two-dimensional image into a three-dimensional image, the camera 4 sends a shot real-time image of the heart of the patient to the computer 6, the computer 6 controls the six-freedom-degree mechanical arm 5 to calibrate the heart of the patient, the real-time image of the camera 4, the three-dimensional image and the calibration value of the six-freedom-degree mechanical arm 5 modify the three-dimensional image into a three-dimensional model together, and the computer 6 sends the three-dimensional model to the model image frame 72 of the display 7 for display; the three-dimensional model is rotated by rotating the menu frame 73, decomposed into sub-models by decomposing the menu frame 74, sectioned by sectioning the menu frame 75, and subjected to puncture simulation by simulating the menu frame 76.
The section scanning device 1 is one or more of section anatomy, cardiac ultrasound, CT and MRI. The bed body 2 is provided with a sliding device which is driven by a motor to push the bed body 2 to reciprocate along the longitudinal direction. The three-coordinate adjusting device 3 is fixed on the support, a transverse moving device and a transverse driving device are horizontally arranged on the three-coordinate adjusting device, a longitudinal moving device and a longitudinal driving device are arranged on the transverse moving device, a vertical moving device and a vertical driving device are arranged on the longitudinal moving device, and a camera 4 is fixed on the vertical moving device. The six-degree-of-freedom mechanical arm 5 is a six-axis mechanical arm and realizes linear motion and rotary motion in the X direction, the Y direction and the Z direction respectively.
The end part of the six-degree-of-freedom mechanical arm 5 is provided with a calibration rod 51, the end part of the calibration rod 51 close to the six-degree-of-freedom mechanical arm 5 is provided with a force sensor, and when the calibration rod 51 touches an object to be calibrated, the force sensor sends a detection signal to the computer 6 and coordinates with the position of the six-degree-of-freedom mechanical arm 5 under the control of the computer 6 to calibrate. The end part of the six-degree-of-freedom mechanical arm 5 is provided with a sheath body fixing seat 52, the sheath body fixing seat 52 is used for fixing the puncture sheath body and is provided with a hollow hole, and the hollow hole is attached to the outer surface of the puncture sheath body and is in an inverted frustum shape; a puncture needle fixing head 53 is arranged above the sheath body fixing seat 52, the puncture needle fixing head 53 is a clip with a groove, the clip is fixed at the working rod of the linear driving motor 54, and the linear driving motor 54 is connected with the computer 6.
The display 7 is provided with a real-time image frame 71, the real-time image frame 71 displays a real-time image sent by the camera 4, the model image frame 72 is provided with calibration scales, a three-dimensional model in the model image frame 72 rotates in three-dimensional coordinates through a rotating menu frame 73, and a section plane and a section direction are selected from the three-dimensional model in the model image frame 72 through a section menu frame 75. The decompose menu box 74 decomposes the three-dimensional model into sub-models, which are one or more of superior vena cava, pulmonary vein, right atrium, right ventricle, inferior vena cava, aorta, pulmonary artery, left ventricle, and left atrium. The simulation menu box 76 selects the model of the puncture sheath and adjusts the angle and depth at which the puncture sheath enters the three-dimensional model to simulate puncture.
The combination of section scanning device 1 and the bed body 2 is common among the existing equipment, and the patient lies on the bed body 2, and the bed body 2 is under controller control, sends into the patient that section scanning device 1 is inside scans, and section scanning device 1 adopts the formula of advancing in layers to scan patient's target position under controller control. The three-coordinate adjusting device 3 is provided with a transverse driving device, a longitudinal driving device and a vertical driving device which are motors, a transverse moving device and a longitudinal moving device, and the vertical moving device is a gear rack. The six-degree-of-freedom mechanical arm 5 is six-axis, and the six axes are respectively controlled to realize adjustment of angles in different directions, so that the position in a three-dimensional coordinate is determined. The computer 6 has an image processing function and can process the image sent by the camera 4. The display 7 is a liquid crystal display, has a touch function, and can also realize an interaction function by matching with the computer 6 through external equipment of a mouse and a keyboard.
After the calibration rod 51 of the six-degree-of-freedom mechanical arm 5 touches the heart of the patient or passes through other calibration objects, the computer 6 records the position of the six-degree-of-freedom mechanical arm 5 at that time, and the position of the vertex of the calibration rod 51 is obtained through conversion. The specific size of the patient's heart can be derived using the calibration rod 51 for multiple calibrations. In the calibration process, the image of the camera 4 is sent to the computer 6, the computer 6 identifies the position of the calibration point through the image and coordinates with the calibration of the calibration rod 51 to realize the conversion of the three-dimensional image into a three-dimensional model and the digitization of the three-dimensional image. The computer 6 divides the three-dimensional model to generate a plurality of sub-modules, and joints among the sub-modules are arranged as required to divide equally or belong to a certain sub-module.
The sheath body is fixed by the sheath body fixing seat 52, the puncture needle fixing head 53 fixes the puncture needle, and the puncture needle fixing head 53 is driven by the linear driving motor 54, so that the puncture depth and the puncture force of the puncture needle are controlled, the puncture needle is driven to a preset position by the six-degree-of-freedom mechanical arm 5 under the control of the computer 6, and the computer 6 controls the linear driving motor 54 to drive the puncture of the puncture needle to provide accurate control.
The live view frame 71 displays a live view image transmitted from the camera 4, and the model image frame 72 displays an image of the three-dimensional model. The rotating and section functions of the rotating menu frame 73 and the section menu frame 75 are common in the existing three-dimensional modeling software, and are not described again here. The exploded menu frame 74 can adjust the explosion type of the three-dimensional model, and cooperate with the rotary menu frame 73 and the sectional menu frame 75 to effectively observe the three-dimensional model, and display the internal structure in detail.
Under the simulation menu frame 76, sheath tubes and puncture needles of different types can be selected, the real state is simulated, the puncture depth and angle of the puncture needle can be set, the condition of a three-dimensional model under the puncture condition is displayed on the model image frame 72, and the rotating menu frame 73, the decomposing menu frame 74 and the section-cutting menu frame 75 are matched to rotate, decompose and section-cutting operations under the simulation state.
The foregoing illustrates and describes the principles, general features, and advantages of the present invention. It will be understood by those skilled in the art that the present invention is not limited to the embodiments described above, which are given by way of illustration of the principles of the present invention, and that various changes and modifications may be made without departing from the spirit and scope of the invention as defined by the appended claims. The scope of the invention is defined by the appended claims and equivalents thereof.

Claims (1)

1. The utility model provides an interatrial puncture art is with supplementary puncture system of augmented reality which characterized in that includes:
the device comprises a section scanning device (1), wherein the section scanning device (1) is arranged on the side face of a bed body (2) and is vertical to the bed body (2), a three-coordinate adjusting device (3) is arranged above the bed body (2), and a camera (4) is fixed on the three-coordinate adjusting device (3);
the bed comprises a six-degree-of-freedom mechanical arm (5), the six-degree-of-freedom mechanical arm (5) is arranged on the side face of a bed body (2), the section scanning device (1), a three-coordinate adjusting device (3), a camera (4) and the six-degree-of-freedom mechanical arm (5) are respectively connected with a computer (6), and the computer (6) is connected with a display (7);
the section scanning device (1) performs section scanning on the heart of a patient, the scanned two-dimensional image is sent to the computer (6), the computer (6) converts the two-dimensional image into a three-dimensional image, the camera (4) sends the photographed real-time image of the heart of the patient to the computer (6), the computer (6) controls the six-degree-of-freedom mechanical arm (5) to calibrate the heart of the patient, the real-time image of the camera (4), the three-dimensional image and the calibration value of the six-degree-of-freedom mechanical arm (5) modify the three-dimensional image into a three-dimensional model together, and the computer (6) sends the three-dimensional model to a model image frame (72) of the display (7) for display;
the three-dimensional model rotates through a rotating menu frame (73), is decomposed into sub-models through a decomposing menu frame (74), is subjected to section through a section-cutting menu frame (75), and is subjected to puncture simulation through a simulating menu frame (76);
the section scanning device (1) is one or more of section dissection, cardiac ultrasound, CT and MRI;
the bed body (2) is provided with a sliding device, and the sliding device is driven by a motor to push the bed body (2) to reciprocate along the longitudinal direction;
the three-coordinate adjusting device (3) is fixed on the support, a transverse moving device and a transverse driving device are horizontally arranged on the three-coordinate adjusting device, a longitudinal moving device and a longitudinal driving device are arranged on the transverse moving device, a vertical moving device and a vertical driving device are arranged on the longitudinal moving device, and a camera (4) is fixed on the vertical moving device;
the six-degree-of-freedom mechanical arm (5) is a six-axis mechanical arm and realizes linear motion and rotary motion in the X direction, the Y direction and the Z direction respectively;
a calibration rod (51) is arranged at the end part of the six-degree-of-freedom mechanical arm (5), a force sensor is arranged at the end part of the calibration rod (51) close to the six-degree-of-freedom mechanical arm (5), when the calibration rod (51) touches an object to be calibrated, the force sensor sends a detection signal to the computer (6), and the position of the six-degree-of-freedom mechanical arm (5) is controlled by the computer (6) to be calibrated;
the end part of the six-degree-of-freedom mechanical arm (5) is provided with a sheath body fixing seat (52), the sheath body fixing seat (52) is used for fixing a puncture sheath body and is provided with a hollow hole, and the hollow hole is attached to the outer surface of the puncture sheath body and is in an inverted frustum shape; a puncture needle fixing head (53) is arranged above the sheath body fixing seat (52), the puncture needle fixing head (53) is a clip with a groove, the clip is fixed at a working rod of a linear driving motor (54), and the linear driving motor (54) is connected with a computer (6);
the display (7) is provided with a real-time image frame (71), the real-time image frame (71) displays a real-time image sent by the camera (4), the model image frame (72) is provided with calibration scales, a three-dimensional model in the model image frame (72) rotates in a three-dimensional coordinate through a rotating menu frame (73), and a section plane and a section direction are selected from a three-dimensional model in the model image frame (72) through a section menu frame (75);
the decomposition menu frame (74) decomposes the three-dimensional model into a plurality of submodels, wherein the submodels are one or more of superior vena cava, pulmonary vein, right atrium, right ventricle, inferior vena cava, aorta, pulmonary artery, left ventricle and left atrium;
the simulation menu frame (76) selects a model of the puncture sheath, adjusts the angle and the depth of the puncture sheath entering the three-dimensional model, and simulates puncture.
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