CN116564149A - Operation training method for lumbar intervertebral foramen puncture - Google Patents
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Abstract
An operation training method for lumbar intervertebral foramen puncture comprises the following five steps: 1. preparing hardware; 2. pre-scanning a determined area; 3. scanning and three-dimensional reconstruction; 4. target point calibration; 5. preoperative planning. The excellent technical effects include: (1) The space position display and planning of the puncture training path are improved; (2) The skin projection of the needle insertion point and the puncture point model is determined, so that the puncture training efficiency and accuracy are improved; (3) no X-ray radiation related damage.
Description
Technical Field
The invention relates to the field of medical appliances and medicine, in particular to an operation training method for lumbar intervertebral foramen puncture.
Background
Lumbar disc herniation (Lumbar Disc Herniation, LDH) is one of the most common degenerative diseases of the spine, often causes uncomfortable symptoms such as lumbago, lower limb radioactive pain and the like, and has high morbidity, high disability rate and high disability rate which bring heavy social and economic burden to the country. The LDH treatment modes mainly comprise three modes of surgical open operation, lumbar minimally invasive operation and conservative treatment. With the rapid development of minimally invasive surgical techniques of the spine in recent years, percutaneous intervertebral Kong Jingyao discectomy (Percutaneous Endoscopic Lumbar Discectomy, PELD) has become the surgical treatment of choice for most LDHs due to its features of low trauma, low complications, rapid recovery, etc.
The lumbar intervertebral foramen puncture in the PELD operation is the key for establishing a working channel, however, the puncture difficulty is high, even a doctor with abundant experience needs to accurately plan before operation, and enough training experience is accumulated to ensure the accuracy and safety of puncture. The X-ray is the imaging positioning training method which is the first choice in the current lumbar intervertebral foramen puncture operation planning clinic, and can accurately position the puncture part. The preoperative planning training using X-rays is performed as follows: the Kirschner wire is placed on the body surface, the position of the Kirschner wire is adjusted so that the projection of the Kirschner wire at the positive position of X-ray passes through the puncture part (figure 1 a), a straight line where the Kirschner wire is positioned is drawn on the body surface, and the distance from the center line of the spine on the straight line is selected as a needle insertion point according to the height, the weight and the lumbar vertebra segment of puncture according to the experience of a user (figure 1 b). The puncture training method has the following defects: (1) radiation of X-rays poses a potential health hazard; (2) Planning of lumbar intervertebral foramen puncture can only determine a two-dimensional puncture plane, and cannot determine a puncture path in a three-dimensional space; (3) The determination of the needle insertion point on the body surface is roughly determined by the experience of a trainer and is not accurate.
In addition, the puncture training process needs to be skillfully mastered on anatomy structures of intervertebral foramen and surrounding human tissues, has the capability of three-dimensionally positioning targets and puncture paths in a three-dimensional space, can be completed only by long-term training and accumulation of a large number of cases, and has a longer learning curve. Lack of training methods to approximate the actual operation of the procedure makes physicians grow slowly.
Disclosure of Invention
Ultrasound is a non-radiative imaging examination method that can be dynamically monitored in real time. Traditional two-dimensional ultrasound has been applied to minimally invasive treatment of some lumbar diseases, such as: ultrasonic guided facet joint injections, selective nerve root blockade, and the like. However, the two-dimensional ultrasonic image lacks intuitiveness, an operator is required to be familiar with the lumbar ultrasonic image, the learning period is long, and the popularization is difficult. Three-dimensional ultrasonic imaging is an emerging technology with great potential in modern medical imaging, has the advantages of visual image, strong stereoscopic impression and the like, and can provide spatial information of the shape and structure of the whole lesion. Three-dimensional ultrasound imaging is divided into two main categories, real-time three-dimensional ultrasound and three-dimensional ultrasound reconstruction. The former has limited imaging range, and has high requirements on instruments and equipment, and relies on matrix probe imaging. The imaging range of the latter is wide, and the imaging method is suitable for stationary orthopedic operation imaging, and the image reconstruction requires space positioning technology, including mechanical positioning, acoustic positioning, optical positioning, magnetic positioning and the like. The magnetic positioning three-dimensional ultrasonic reconstruction system is characterized in that an electromagnetic sensor is embedded into a traditional ultrasonic probe, the position of the probe is tracked, and then the two-dimensional image information and the position information of the probe are combined to reconstruct a three-dimensional image of a scanned area. The magnetic positioning three-dimensional ultrasonic reconstruction system can be used for lumbar vertebrae structures. Therefore, the operation training method for the lumbar intervertebral foramen puncture is established based on the three-dimensional ultrasonic reconstruction system, and the accuracy, safety and effectiveness of the puncture training are improved.
The embodiment of the invention provides an operation training method for lumbar intervertebral foramen puncture by a magnetic positioning three-dimensional ultrasonic imaging system, which comprises the following steps:
1. and reconstructing lumbar vertebra images by using a magnetic positioning three-dimensional ultrasonic imaging system, and determining puncture training targets.
The magnetic positioning three-dimensional ultrasonic imaging system comprises: the portable two-dimensional ultrasonic scanner based on Bluetooth and WIFI and the wireless electromagnetic positioning device are respectively used for acquiring two-dimensional ultrasonic cross-section images and corresponding spatial position information. And after the two-dimensional imaging sequence and the corresponding space information are acquired, three-dimensional image reconstruction is carried out through a reconstruction algorithm of the steps of coordinate transformation, projection calculation, interpolation imaging and the like.
In the operation process, firstly, the lumbar vertebra main body of the model is rapidly pre-scanned, and the accurate spatial position of the magnetic field where the lumbar vertebra operation is positioned is determined; then, a portable ultrasonic instrument with an electromagnetic positioning sensor is used for scanning lumbar vertebra at a speed of 1cm/s to obtain a three-dimensional image; and finally, target point calibration is carried out according to the image information.
The target point calibration method comprises the following steps: entering the training interactive interface, the section images of the lumbar vertebra in three dimensions of the horizontal plane, the coronal plane and the sagittal plane (left one to left three in fig. 3) and the two-dimensional projection images of the sagittal plane and the coronal plane (right one and right two in fig. 3) can be displayed. As the two-dimensional projection images are points with the maximum pixel values, the two-dimensional projection images are firstly clicked on the target points, and then the frame numbers of the two section views with the maximum pixel values and the two-dimensional position information of the target points can be obtained. And then adjusting the third section view to obtain the three-dimensional position information of the target point. In the process of determining the target point, the accurate target point target, namely the red cross point in fig. 4, can be determined by scaling, adjusting image adjustment modes such as contrast, brightness and the like and combining the lesion part. After the training target point is determined, the locking target point can be clicked, and the consistency of the follow-up target point is ensured.
2. Preoperative planning for realizing puncture according to training target point and optimal needle insertion angle range of body surface
After the intervertebral foramen puncture training target point is determined, the projection of the space optimal puncture range on the surface of the model skin can be given by a program immediately, and the line can be drawn on the surface of the model skin according to the projection, so that the preoperative planning of puncture is realized. The whole implementation process can be divided into the following two steps: (1) obtaining a puncture angle boundary value; (2) And obtaining an optimal puncture range and projecting the optimal puncture range on the surface of the model skin.
(1) Obtaining the boundary value of the puncture angle
For convenience of description, a space rectangular coordinate system Oxyz of the human body model is first determined. The target point is taken as a coordinate origin O, the direction of the head is taken as the +z direction, the left hand direction is taken as the +x direction, and the back direction is taken as the +y direction.
By default, the navigation procedure uses a default angular size, i.e., 5 ° to 10 ° from the x-axis direction in the xy-plane, and 10 ° to 30 ° from the x-axis direction in the zx-plane. This direction is the range of penetration normally used in minimally invasive lumbar surgery, and the navigation procedure also supports manual entry of the required angle for adjustment, for the particular situation that may exist.
(2) Obtaining the optimal puncture range and projecting the optimal puncture range on the surface of the model skin
Generating an infinitely extended elliptical cone which takes the target point as a vertex according to the angle boundary value obtained in the step (1), wherein the elliptical cone is the optimal puncture range. When the three-dimensional ultrasonic sagittal plane projection image is obtained, the gray value of the model skin surface relative to air is large, so that the curve of the model skin surface is obtained.
In performing projection of the model skin surface, the program generates four vectors with target points as starting points according to default angle extremum or manually input angle of the operator(as shown in fig. 3), then the intersection A, B, C, D of the model skin surface with the four vectors is calculated. Comparing the lengths of the line segments AB and CD, determining that the CD is the major axis of the ellipse and the AB is the minor axis of the ellipse if the CD is considered to be longer according to a default value, and then calculating the coordinate of the intersection point of the straight line AB and the CD to be used as the center point of the ellipse, thereby obtaining the coordinate equation of the ellipse. The procedure then draws the position of the ellipse and displays it to the operator in a two-dimensional projection of the model skin surface, whereby the operator can draw an elliptic curve from the elliptic projection of the model skin surface to help the operator determine the optimal penetration point, the elliptic ACBD in fig. 5 being the elliptic projection of the model skin surface. In addition, the program can provide a vertical projection point of the target point on the surface of the model skin, when an operator determines the puncture needle insertion point, a straight line can be drawn on the surface of the model skin to connect the puncture needle insertion point and the target point projection point, and the straight line is the planning path of the puncture needle, so that the preoperative planning of the puncture path is realized, and the operator is assisted in performing operation training.
The excellent technical effects of the invention include:
(1) And the display and planning of the space position of the puncture training path are improved.
(2) And the skin projection of the needle insertion point and the puncture point model is determined, so that the puncture training efficiency and accuracy are improved.
(3) There is no X-ray radiation related damage.
Drawings
Fig. 1 shows the projection of the positive X-ray position through the puncture site (fig. 1 a) and the needle insertion site (fig. 1 b).
Fig. 2 is a schematic diagram of a three-dimensional ultrasound data scanning process.
Fig. 3 is a slice view (left one to left three) and a projection view (right one and right two) of three-dimensional data of lumbar vertebrae.
FIG. 4 is a schematic diagram of target calibration.
Fig. 5 is a schematic view of model skin surface projection generation.
Fig. 6 is a schematic flow chart of an operation training method for lumbar intervertebral foramen puncture according to an embodiment.
Fig. 7 is a schematic diagram of a hardware device system.
Detailed Description
In order to make the objects, technical solutions and advantages of the present invention more clear, the present invention will be further described in detail below with reference to specific embodiments and with reference to the accompanying drawings. Those skilled in the art will recognize that the present invention is not limited to the drawings and the following examples.
The embodiment of the invention provides an operation training method for lumbar intervertebral foramen puncture, which comprises the following five steps: 1. and (5) preparing hardware. 2. The defined area is pre-scanned. 3. Scanning and three-dimensional reconstruction. 4. Target point calibration. 5. Preoperative planning. The flow is shown in fig. 6.
1. Hardware preparation: the whole hardware device system can be divided into two parts: a positioning system and a hand-held ultrasound scanner (as shown in fig. 7). The positioning System uses a G4 Tracking System (Polhemus, G4 Tracking System, u.s.a.) to acquire position information at 120hz, and the G4 Tracking System includes an electromagnetic signal emitting Source (Source in the figure), a Hub (Hub in the figure), an RF/USB module (RF/USB in the figure), and a Sensor (Sensor in the figure). The electromagnetic signal transmitter can emit an electromagnetic field around, the hub is connected with the sensor in a wired mode to acquire and calculate the spatial position information and the angle information of the sensor under the electromagnetic field in real time, and the information is wirelessly transmitted to the computer through the RF/USB module so that the computer can acquire the tracking information of the sensor. A hand-held ultrasound scanner (Clarius, C3HD, canada) acquires two-dimensional ultrasound images at a frequency of 20Hz. In order to match real-time position and angle information with an ultrasonic image, a 3D printing technology is used for printing a bracket to fix both the sensor and the handheld ultrasonic scanner, and meanwhile, in order to prevent the handheld ultrasonic scanner from interfering with the positioning precision of the sensor, a certain safety distance is properly kept between the sensor and the handheld ultrasonic scanner, and the ultrasonic image is matched with the tracking information of the sensor by means of space coordinate transformation.
Because the electromagnetic positioning system is easier to receive the interference of electromagnetic signals, an operation space without strong magnetic interference is needed, and the distance between an electromagnetic emission source and an operation table is kept at about 50cm to 150 cm. The training process is to keep the training model free of movement, so that the three-dimensional reconstruction information is still consistent with the spine information of the training model in spatial positions. Therefore, the whole hardware comprises a two-dimensional ultrasonic scanner based on wireless transmission and a wireless electromagnetic positioning system, wherein the two-dimensional ultrasonic scanner is non-radiative, the electromagnetic positioning system does not affect the operation of an operator like an optical positioning system, and the whole equipment occupies small space and is convenient to carry and move.
2. The pre-scan determines the reconstruction space: after the preparation is finished, firstly, performing quick pre-scanning on a spine of a training model which needs to be operated, wherein the pre-scanning process is not limited in speed, and is only used for acquiring initial and ending space positions, and the initial and ending space positions are subtracted to obtain depth; and simultaneously, the length and the width are obtained according to the size of each frame of ultrasonic image, and further the space coordinates of the cuboid-shaped operation training area and the space coordinates of the starting point under the electromagnetic sensing source coordinate system are calculated, so that the space position of the electromagnetic sensing source coordinate system of each point in the operation area can be obtained.
3. Scanning and three-dimensional reconstruction: after the pre-scanning is completed, slowly moving the ultrasonic probe bound with the electromagnetic positioning equipment at a moving speed of not more than 1cm/s to complete data acquisition. And after the acquisition is completed, the data information is stored and three-dimensional reconstruction is carried out. The data acquisition of this step includes ultrasound information and positional information, and the cuboid spatial position under the electromagnetic sensing source coordinate system that will be acquired later using this scan. Each two-dimensional image information can be regarded as a slice of a three-dimensional real object, a sufficient number of slices are obtained through a high scanning frame number, and a digitized accurate three-dimensional ultrasonic image is obtained through reconstruction according to a Fast Dot-project (FDP) algorithm. After the scanning is finished, the transformation relation of each frame of image relative to the electromagnetic emission source coordinate system can be calculated, and the space coordinate of each pixel point in the three-dimensional image based on the coordinate system can be obtained through coordinate change, so that the follow-up navigation is convenient to use. The software program displays the reconstructed three-dimensional data in five parts of a cross section tangent plane, a sagittal plane tangent plane, a coronal plane projection and a sagittal plane projection graph, and helps an operator to further know and understand the three-dimensional space display of the lumbar vertebra.
4. Target point calibration: and after the three-dimensional reconstruction is finished, automatically popping up a projection view of the three-section view of the training model spine and the coronal and sagittal planes. The operator from his own experience, starting from the projection view, relies on the image processing tools of zoom, contrast, brightness etc. to determine the target location, which will be identified in all views using a red cross.
5. Preoperative planning: after the target point position is determined, clicking a program button of 'preoperative path planning', calculating an elliptic cone by using a default or an angle input by an operator by a program, projecting the surface of model skin, observing the projection of the optimal puncture range on the model skin by the operator in a projection view, drawing a line on the model skin to determine the optimal puncture position according to the projection, and realizing preoperative planning; meanwhile, the straight line path, namely the shortest path, of the cutting point and the target point is displayed after the cutting position of the puncture needle is determined, so that an operator can be helped to quickly and accurately determine the cutting position of the puncture needle and find the lesion target point.
Claims (6)
1. An operation training method for lumbar intervertebral foramen puncture, which is characterized by comprising the following five steps: (1), preparing hardware; (2) pre-scanning the determined area; (3) scanning and three-dimensional reconstruction; (4) target point calibration; (5) preoperative planning.
2. The method for the operation training of lumbar intervertebral foramen puncture according to claim 1, wherein 1, hardware preparation, comprising: the whole hardware equipment system comprises two parts: a positioning system and a handheld ultrasound scanner; the positioning system uses a G4 tracking system to acquire position information, the frequency is 120Hz, and the G4 tracking system comprises an electromagnetic signal emission Source, a Hub, an RF/USB module and a Sensor; the system comprises a hub, a sensor, an RF/USB module, an electromagnetic signal transmitter, a computer, a wireless communication module and a wireless communication module, wherein the electromagnetic signal transmitter can emit an electromagnetic field around the hub, the hub is connected with the sensor in a wired manner to acquire and calculate the spatial position information and the angle information of the sensor under the electromagnetic field in real time, and the spatial position information and the angle information of the sensor are wirelessly transmitted to the computer through the RF/USB module, so that the computer acquires the tracking information of the sensor; a handheld ultrasonic scanner acquires a two-dimensional ultrasonic image, and the frequency of the two-dimensional ultrasonic image is 20Hz; in order to match real-time position and angle information with an ultrasonic image, a 3D printing technology is used for printing a bracket to fix the sensor and the handheld ultrasonic scanner, and meanwhile, in order to prevent the handheld ultrasonic scanner from interfering with the positioning precision of the sensor, a certain safety distance is properly kept between the sensor and the handheld ultrasonic scanner, and the ultrasonic image is matched with the tracking information of the sensor by means of space coordinate transformation;
because the electromagnetic positioning system is easier to receive the interference of electromagnetic signals, an operation space without strong magnetic interference is needed, and the distance between an electromagnetic emission source and an operation table is kept between 50cm and 150cm; the training process keeps the training model free of movement, and the information used for three-dimensional reconstruction is still consistent with the spine information of the training model in spatial positions.
3. The operational training method for lumbar inter-foraminal puncture of claim 2, wherein the 2, pre-scan determination of the reconstruction space comprises: after the preparation of the step 1 is finished, firstly, performing quick pre-scanning on a training model spine to be operated, wherein the pre-scanning process is not limited in speed, and is only used for acquiring initial and ending space positions, and the initial and ending space positions are subtracted to obtain depth; and simultaneously, the length and the width are obtained according to the size of each frame of ultrasonic image, and further the space coordinates of the cuboid-shaped operation training area and the space coordinates of the starting point under the electromagnetic sensing source coordinate system are calculated, so that the space position of the electromagnetic sensing source coordinate system of each point in the operation area can be obtained.
4. The operational training method for lumbar intervertebral foramen puncture of claim 3, wherein 3, scanning and three-dimensional reconstruction comprises: after the pre-scanning in the step 2 is completed, slowly moving the ultrasonic probe bound with the electromagnetic positioning equipment at a moving speed of not more than 1cm/s to complete data acquisition; after the acquisition is completed, data information is stored and three-dimensional reconstruction is carried out; the data acquisition of the step comprises ultrasonic information and position information, and the cuboid space position under the electromagnetic sensing source coordinate system acquired by the scanning is used subsequently; each two-dimensional image information can be regarded as a slice of a three-dimensional real object, a sufficient number of slices is obtained through a high scanning frame number, and a digitized accurate three-dimensional ultrasonic image is obtained through reconstruction according to a rapid point projection algorithm; after the scanning is finished, the transformation relation of each frame of image relative to the electromagnetic emission source coordinate system is calculated, and the space coordinate of each pixel point in the three-dimensional image based on the coordinate system is obtained through coordinate change, so that the follow-up navigation is convenient to use; the software program displays the reconstructed three-dimensional data in five parts of a cross section tangent plane, a sagittal plane tangent plane, a coronal plane projection and a sagittal plane projection graph, and helps an operator to further know and understand the three-dimensional space display of the lumbar vertebra.
5. The method for performing training of lumbar intervertebral foramen puncture of claim 4, wherein 4, target targeting comprises: after the three-dimensional reconstruction is finished, automatically popping up a projection view of a three-section view of a training model spine and a projection view of a coronal plane and a sagittal plane; the operator from his own experience, starting from the projection view, relies on the image processing tools of zoom, contrast, brightness etc. to determine the target location, which will be identified in all views using a red cross.
6. The method of claim 5, wherein 5, the preoperative planning comprises: after the target position is determined, calculating an elliptic cone by using a default or an angle input by an operator, projecting the surface of the model skin, observing the projection of the optimal puncture range on the model skin in a projection view by the operator, and drawing a line on the model skin to determine the optimal puncture position according to the projection, so as to realize preoperative planning; and meanwhile, the puncture position is determined, and then the straight-line path, namely the shortest path, of the puncture point and the target point is displayed, so that an operator is helped to quickly and accurately determine the position of the puncture needle and find the lesion target point.
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| CN202310348302.7A CN116564149A (en) | 2023-04-03 | 2023-04-03 | Operation training method for lumbar intervertebral foramen puncture |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN116725673A (en) * | 2023-08-10 | 2023-09-12 | 卡本(深圳)医疗器械有限公司 | Ultrasonic puncture navigation system based on three-dimensional reconstruction and multi-modal medical image registration |
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN116725673A (en) * | 2023-08-10 | 2023-09-12 | 卡本(深圳)医疗器械有限公司 | Ultrasonic puncture navigation system based on three-dimensional reconstruction and multi-modal medical image registration |
| CN116725673B (en) * | 2023-08-10 | 2023-10-31 | 卡本(深圳)医疗器械有限公司 | Ultrasonic puncture navigation system based on three-dimensional reconstruction and multi-modal medical image registration |
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