JP2005287813A - Optimal shape search system for artificial medical material - Google Patents
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- 238000003745 diagnosis Methods 0.000 description 1
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Abstract
Description
本発明は、人工関節等の人工医用材料を患者体内に埋め込む際に、該人工医用材料の形状と該医用材料が接合する部分の患者組織の形状を適合させ、最適な人工医用材料を検索するシステムに関する。 When an artificial medical material such as an artificial joint is implanted in a patient body, the present invention matches the shape of the artificial medical material with the shape of a patient tissue where the medical material joins, and searches for an optimal artificial medical material. About the system.
大腿骨頭の骨頭壊死や、外傷あるいは腫瘍手術による組織欠損に対する人工関節手術では、患者の長管骨、寛骨などの骨組織のサイズ、形状に応じたデバイスを用意、選択し、手術を施行する必要がある。現在、一般の医療機関では、手術前の検討に際し、骨組織などの臓器のサイズ、形状はX線写真あるいはCT画像を用いて簡易的な距離計測をおこなったのち、デバイスを選択しているが、その装着部位の組織サイズや形状を直接計測しているわけではないため、何種類かのデバイスを用意し、手術中に選択する必要がしばしば生じている。また、装着時の組織とデバイスの位置関係、装着部位の決定なども手術中の術者の判断により調整、変更される部分も多く、体組織の構築に細部を合わせた極めて精度の高い複雑なデバイスの製造、使用は困難な状況にある。 In artificial joint surgery for femoral head necrosis of the femoral head or tissue loss due to trauma or tumor surgery, prepare and select a device according to the size and shape of the bone tissue such as the long bone and hipbone of the patient, and perform surgery There is a need. Currently, in general medical institutions, when examining before surgery, the size and shape of organs such as bone tissue are measured using X-ray photographs or CT images, and then a device is selected. Since the tissue size and shape of the attachment site are not directly measured, it is often necessary to prepare several types of devices and select them during surgery. In addition, the positional relationship between the tissue and the device at the time of wearing, the determination of the wearing site, etc. are also adjusted and changed by the judgment of the operator during the operation, and there are many parts that are highly accurate and complicated with details tailored to the construction of the body tissue The device is difficult to manufacture and use.
従来、人工膝関節の手術に当たって、人工関節の設置位置を決める方法についての報告はあったが（特許文献１参照）、患者の疾患部に適合するような人口医用材料を検索する方法はなかった。 Conventionally, there has been a report on a method for determining the position of the prosthetic joint in the operation of the knee prosthesis (see Patent Document 1), but there has been no method for searching for a medical material suitable for the diseased part of the patient. .
人工関節などのデバイスを体内に装着する際に、数種類のサイズや形状のデバイスを用意し、実際に使用するもののみを選択するばあい、デバイスの準備、保存、保管に関するコスト増が見込まれる。また術前のデバイスと体組織の適合評価が精密にできない場合には、精巧な形状のデバイスは用いにくいため、誤差を想定したデバイスを用いて、誤差分は放置されるか、セメントなどの補間物質で装填するなど姑息的な調整方法をとらざるをえない場合が存在する。また、逆に、体組織の形状にあわせた特別な形状のものを指定して製造した場合にそのデバイスが実際の手術で適合しないリスクも存在する。 When a device such as an artificial joint is attached to the body, if a device of several sizes and shapes is prepared and only a device to be actually used is selected, the cost related to the preparation, storage and storage of the device is expected to increase. In addition, when the pre-operative device and body tissue cannot be accurately evaluated, it is difficult to use elaborately shaped devices. There are cases where compulsory adjustment methods, such as loading with substances, must be taken. On the other hand, there is a risk that the device may not be suitable for actual surgery when it is manufactured by specifying a special shape that matches the shape of the body tissue.
従って、術前に体組織の医用画像および手術用インプラントのデータを統合して、３次元的に体組織のサイズ、形状、手術による切除、再建部位の情報を表現できるシミュレーションシステムを構築し、さらにそれを専門医療機関同士やデバイスの製造メーカー等と交換できるようになれば、高度な手術に関する安全性と精度の向上、手術に必要なサイズ形状のデバイスの適切な選択、術者自身による装着前後の手術部位の形状評価と認識、術後の機能の予測などあらたな利点がみこまれ、またデバイスのコスト低下や提供時間の短縮も見込むことができる。 Therefore, by integrating the medical image of the body tissue and the data of the surgical implant before operation, a simulation system capable of expressing the size, shape, surgical resection and reconstruction information of the body tissue in three dimensions is constructed. If it can be exchanged with specialized medical institutions and device manufacturers, etc., it will improve the safety and accuracy of advanced surgery, appropriately select the size and shape of the device necessary for surgery, and before and after wearing by the surgeon himself New advantages such as shape evaluation and recognition of the surgical site and prediction of post-operative function can be realized, and cost reduction of the device and shortening of the provision time can be expected.
骨・関節などの体内組織や皮下に種々の人工物を埋め込む外科治療は整形外科領域を中心に盛んに行われているが、手術前には再建に最適なデバイスあるいは人工材料の形状ならびにサイズの決定、装着時の機能予測評価が極めて重要である。従来これらは画像診断の資料などをもとに臨床医や技術者の予測により行われてきたが、ときには適切な材料の選択作成において精度が不十分、製作に時間がかかる、費用が高い、実際の装着のイメージがとらえにくい、などの点が問題になっていた。 Surgical treatments for implanting various artificial materials in body tissues such as bones and joints and subcutaneously are performed mainly in the orthopedic field, but before surgery, the shape and size of the device or artificial material that is optimal for reconstruction The function prediction evaluation at the time of determination and wearing is extremely important. Conventionally, these have been performed based on predictions from clinicians and engineers based on diagnostic imaging materials, but sometimes the accuracy of the selection and creation of appropriate materials is insufficient, production takes time, and costs are high. The problem was that it was difficult to capture the image of the installation.
具体的な例として、人工関節を体内に埋め込む場合、患者の骨サイズと人工関節のサイズが完全に一致しないため、数種類のサイズを予め準備し、手術中に準備した人工関節で最も適合するサイズを選択し置換する。しかし、骨頭部分が適合しても大腿骨の埋め込み部分のサイズが適合しないなどの問題が発生し、接合部分にセメントを詰めるなどして合致させているが、術後時間が経過するに従って不具合が生じ再手術が必要となる場合があり、患者に負担が掛かっている。このため、患者の生体に出来るだけ近い人工関節を選択する方法が必要となっている。 As a specific example, when an artificial joint is implanted in the body, the bone size of the patient and the size of the artificial joint do not completely match.Therefore, several sizes are prepared in advance, and the size most suitable for the artificial joint prepared during the operation. Select and replace. However, even if the head part fits, there is a problem that the size of the femoral implant does not fit, and it is matched by filling the joint part with cement etc. Occasionally, re-operation may be necessary, placing a burden on the patient. For this reason, a method for selecting an artificial joint as close as possible to the living body of the patient is required.
本発明者等は、上記課題を解決すべく、以下の人工医用材料の最適形状検索システムを完成させた。 In order to solve the above-mentioned problems, the present inventors have completed the following optimal shape search system for artificial medical materials.
X線CTまたはMR1撮像された患者の高解像度連続断層画像を取得し、この元データを専門の画像診断医が臨床医からの治療方針に関する情報とともに確認の上、３次元解析システムに投入する。 A high-resolution continuous tomographic image of a patient who has been imaged by X-ray CT or MR1 is acquired, and this original data is checked by a specialized diagnostician with information on a treatment policy from a clinician and input to a three-dimensional analysis system.
体内に装着するデバイスのサンプルデータは、人工医用材料製造元から提供された材質、種別、サイズ別に３次元的データを記録登録し、インプラントのデータベースとして保管する。 As the sample data of the device to be worn in the body, three-dimensional data is recorded and registered for each material, type and size provided by the artificial medical material manufacturer, and stored as an implant database.
３次元解析システムにより解析されたデータとインプラントのデータを「専用のプログラム」に投入する事により患者に最適な人工医用材料が選択され、手術用情報として提供される。 By inputting the data analyzed by the three-dimensional analysis system and the implant data into a “dedicated program”, an optimal artificial medical material for the patient is selected and provided as information for surgery.
すなわち、本発明は以下のとおりである。
[１] 人工医用材料への置換手術を行うときの、最適形状を有する人工医用材料を検索する方法であって、
(a) 人工医用材料の置換手術を必要とする患者の疾患部の断層画像を得る工程、
(b) 得られた断層画像データを３次元形状に再構成することにより、３次元形状データを作成する工程、
(c) 工程(b)で得られた３次元形状データをあらかじめ構築しておいた人工医用材料の３次元形状データを含むデータベース中の人工医用材料の３次元形状データと適合させる工程、
(d) 患者の疾患部の人工医用材料を接合すべき組織と形状が適合する人工医用材料を選択する工程、
とを含む最適形状を有する人工医用材料を検索する方法、
[２] 人工医用材料が人工関節である、[１]の最適形状を有する人工医用材料を検索する方法、
[３] 人工医用材料のデータベースがさらに、人工医用材料の材質に関するデータを含む[１]または[２]の最適形状を有する人工医用材料を検索する方法、
[４] 工程(b)において、患者の疾患部の断層画像データに基づいて、疾患部の３次元輪郭追跡を行い、ついで輪郭面の多項式近似を行い疾患部の輪郭面を決定し、３次元形状データが作成される[１]から[３]のいずれかの最適形状を有する人工医用材料を検索する方法、
[５] 工程(b)において、患者の疾患部を正常部分と切除すべき病変部である特異部分に分けて解析し、正常部の断層画像データについてはそのまま、特異部分の断層画像データについては濃淡分布解析を行い、その後正常部のデータおよび特異部分のデータに基づいて、それぞれ３次元輪郭追跡を行い、ついで輪郭面の多項式近似を行い輪郭面を決定し、特異部分の輪郭面についてのデータに基づいて特異部分の３次元形状データが提供され、正常部分の輪郭面についてのデータと特異部分の輪郭面についてのデータを合成することにより疾患部の３次元全体形状データが提供される、[１]から[４]のいずれかの最適形状を有する人工医用材料を検索する方法、
[６]人工医用材料への置換手術を行うときの、最適形状を有する人工医用材料を検索するシステムであって、
(a) 人工医用材料の置換手術を必要とする患者の疾患部の断層画像を入力する手段、
(b) 得られた断層画像データを３次元形状に再構成することにより、３次元形状データを作成する画像解析手段、
(c) (b)の画像解析手段により得られた３次元形状データをあらかじめ構築しておいた人工医用材料の３次元形状データを含むデータベース中の人工医用材料の３次元形状データと適合させ、患者の疾患部の人工医用材料を接合すべき組織と形状が適合する人工医用材料を選択するデータ処理手段、ならびに
(d) 選択した人工医用材料を出力する手段、
とを含む最適形状を有する人工医用材料を検索するシステム、
[７] 人工医用材料が人工関節である、[６]の最適形状を有する人工医用材料を検索するシステム、
[８] 人工医用材料のデータベースがさらに、人工医用材料の材質に関するデータを含む[６]または[７]の最適形状を有する人工医用材料を検索するシステム、
[９] (b)の画像解析手段において、患者の疾患部の断層画像データに基づいて、疾患部の３次元輪郭追跡を行い、ついで輪郭面の多項式近似を行い輪郭面を決定し、３次元形状データが作成される[６]から[８]のいずれかの最適形状を有する人工医用材料を検索するシステム、
[１０] (b)の画像解析手段において、患者の疾患部を正常部分と切除すべき病変部である特異部分に分けて解析し、正常部の断層画像データについてはそのまま、特異部分の断層画像データについては濃淡分布解析を行い、その後正常部のデータおよび特異部分のデータに基づいて、それぞれ３次元輪郭追跡を行い、ついで輪郭面の多項式近似を行い輪郭面を決定し、特異部分の輪郭面についてのデータに基づいて特異部分の３次元形状データが提供され、正常部分の輪郭面についてのデータと特異部分の輪郭面についてのデータを合成することにより疾患部の３次元全体形状データが提供される、[６]から[９]のいずれかの最適形状を有する人工医用材料を検索するシステム、ならびに
[１１] 医療機関から、人工医用材料の置換手術を受けようとする患者の疾患部についての断層画像を受け、該画像データに基づいて[１]から[５]のいずれかの方法により、最適形状を有する人工医用材料を検索し、選択された人工医用材料を前記医療機関に通知する、最適形状を有する人工医用材料を決定する方法。
That is, the present invention is as follows.
[1] A method for searching for an artificial medical material having an optimal shape when performing a replacement operation for the artificial medical material,
(a) obtaining a tomographic image of a diseased part of a patient in need of replacement surgery for an artificial medical material;
(b) a step of creating three-dimensional shape data by reconstructing the obtained tomographic image data into a three-dimensional shape;
(c) a step of matching the three-dimensional shape data obtained in step (b) with the three-dimensional shape data of the artificial medical material in the database including the three-dimensional shape data of the artificial medical material that has been constructed in advance;
(d) selecting an artificial medical material that matches the shape of the tissue to which the artificial medical material of the diseased part of the patient is to be joined;
A method for searching for an artificial medical material having an optimal shape including:
[2] A method for searching for an artificial medical material having the optimum shape of [1], wherein the artificial medical material is an artificial joint,
[3] A method for searching for an artificial medical material having an optimal shape according to [1] or [2], wherein the database of the artificial medical material further includes data on the material of the artificial medical material,
[4] In step (b), based on the tomographic image data of the diseased part of the patient, the three-dimensional contour tracking of the diseased part is performed, and then the contour surface of the diseased part is determined by performing polynomial approximation of the contoured surface. A method of searching for an artificial medical material having an optimal shape of any one of [1] to [3], in which shape data is created;
[5] In step (b), the diseased part of the patient is analyzed by dividing it into a normal part and a specific part which is a lesion part to be excised. Perform density distribution analysis, then perform 3D contour tracking based on the normal part data and singular part data, respectively, then perform contour approximation of the contour surface to determine the contour surface, data on the contour surface of the singular part 3D shape data of the singular part is provided based on the above, and the three-dimensional whole shape data of the diseased part is provided by combining the data on the contour surface of the normal part and the data on the contour surface of the singular part, [ 1) to a method for searching for an artificial medical material having an optimal shape according to any one of [4],
[6] A system for searching for an artificial medical material having an optimal shape when performing a replacement operation for the artificial medical material,
(a) means for inputting a tomographic image of a diseased part of a patient in need of replacement surgery for an artificial medical material;
(b) Image analysis means for creating three-dimensional shape data by reconstructing the obtained tomographic image data into a three-dimensional shape;
(c) matching the 3D shape data obtained by the image analysis means of (b) with the 3D shape data of the artificial medical material in the database including the 3D shape data of the artificial medical material that has been constructed in advance; A data processing means for selecting an artificial medical material whose shape is compatible with a tissue to which the artificial medical material of a diseased part of a patient is to be joined; and
(d) means for outputting the selected artificial medical material;
A system for searching for an artificial medical material having an optimal shape including:
[7] A system for searching for an artificial medical material having the optimum shape according to [6], wherein the artificial medical material is an artificial joint,
[8] A system for searching for an artificial medical material having an optimal shape according to [6] or [7], wherein the database of the artificial medical material further includes data on the material of the artificial medical material,
[9] In the image analysis means of (b), based on the tomographic image data of the diseased part of the patient, the three-dimensional contour tracking of the diseased part is performed, and then the contour surface is determined by performing polynomial approximation of the contour surface. A system for searching for an artificial medical material having an optimal shape of any one of [6] to [8] in which shape data is created;
[10] In the image analysis means of (b), the diseased part of the patient is analyzed by dividing it into a normal part and a specific part which is a lesion part to be excised, and the tomographic image data of the normal part remains as it is. The data is subjected to a light and shade distribution analysis, and then 3D contour tracking is performed based on the normal portion data and the singular portion data, respectively, and then the contour surface is determined by polynomial approximation of the contour portion. 3D shape data of the singular part is provided based on the data about the three-dimensional shape data of the diseased part by synthesizing the data about the contour surface of the normal part and the data about the contour surface of the singular part. A system for searching for an artificial medical material having an optimal shape according to any one of [6] to [9], and
[11] A tomographic image of a diseased part of a patient who is going to undergo a replacement operation for artificial medical material is received from a medical institution, and optimally performed by any of the methods [1] to [5] based on the image data A method of determining an artificial medical material having an optimum shape by searching for an artificial medical material having a shape and notifying the medical institution of the selected artificial medical material.
本発明の人工医用材料の最適形状検索システムを用いることにより、あらかじめ形状、サイズの異なる人工医用材料を準備しておく必要はなく、それぞれの患者に適合した人工医用材料を容易に選択することが可能である。 By using the optimal shape retrieval system for artificial medical materials according to the present invention, it is not necessary to prepare artificial medical materials having different shapes and sizes in advance, and it is possible to easily select artificial medical materials suitable for each patient. Is possible.
本発明の人工医用材料の最適形状の検索システムは、人体の骨、関節等の組織を人工医用材料に置換する場合に、人体の組織の部分に形状的に適合した人工医用材料を検索するシステムである。 The system for searching for the optimum shape of artificial medical material according to the present invention is a system for searching for an artificial medical material conforming in shape to a portion of a human tissue when a tissue such as a bone or a joint of a human body is replaced with the artificial medical material. It is.
人工医用材料は限定されず、人体に埋め込むときに人体の組織と形状を適合させる必要がある医用材料ならば本発明の検索システムを適用することが可能である。例えば、人工関節、人工骨、骨折部固定用インプラント等がある。人工関節としては、人工股関節、人工膝関節、人工肘関節、人工足関節等がある。 The artificial medical material is not limited, and the search system of the present invention can be applied to any medical material that needs to conform to the shape and structure of the human body when implanted in the human body. For example, there are artificial joints, artificial bones, fracture fixing implants, and the like. Examples of the artificial joint include an artificial hip joint, an artificial knee joint, an artificial elbow joint, and an artificial ankle joint.
例えば、関節炎等の疾患あるいは損傷により、関節や骨片を切除した場合、切除した関節や骨片に代わる人工医用材料を切除した部分にインプランとして埋め込むが、この際、埋め込んだインプラントが正常に機能するためには、インプラントと該インプラントが接合する部分の人体組織の形状が適合している必要がある。本発明の検索システムを用いれば、種々のサイズおよび形状を有する複数の既製品の候補インプラントの中から最適なインプラントを検索することが可能である。 For example, when a joint or bone fragment is excised due to a disease or injury such as arthritis, an artificial medical material that replaces the excised joint or bone fragment is implanted as an implant in the excised part. In order to function, it is necessary that the shape of the human tissue in the portion where the implant and the implant are joined is matched. By using the search system of the present invention, it is possible to search for an optimum implant from among a plurality of ready-made candidate implants having various sizes and shapes.
図１に本発明の人工医用材料の最適形状の検索システムの構成を示す。本発明の検索システムにおいては、患者の人口医用材料を接合する組織の画像を断層撮影等により撮像し、該撮像データから３次元形状を再構成し、該３次元形状データを、あらかじめ取得しておいた人工医用材料の３次元形状データと演算処理により適合させ、患者の組織と形状、サイズが適合した人工医用材料を検索し出力する。 FIG. 1 shows the configuration of a search system for an optimal shape of an artificial medical material according to the present invention. In the search system of the present invention, an image of a tissue that joins a patient's medical material is captured by tomography or the like, a three-dimensional shape is reconstructed from the imaging data, and the three-dimensional shape data is acquired in advance. The artificial medical material is matched with the three-dimensional shape data of the placed artificial medical material by arithmetic processing, and the artificial medical material that matches the patient's tissue, shape, and size is retrieved and output.
本発明の検索システムは具体的には、以下のように運用される。以下、人工関節を埋め込む場合を例にとって説明する。 Specifically, the search system of the present invention is operated as follows. Hereinafter, a case where an artificial joint is embedded will be described as an example.
（１）人工関節の埋め込み手術を受ける患者の、人工関節を接合する患者の骨頭部分の２次元断層画像を撮像する。この際、CT/MRI等を用いればよい。CT/MRIとしては、市販のものを用いればよい。CT/MRI等による撮像により、人工医用材料を埋め込む患者の組織の解剖学的形態が、３次元の座標系によって再生されるデータを得ることができる。すなわち、人工関節を接合させる部分について、互いに平行な断層撮像によって、層状の情報が得られる。この際、断層撮像の情報は、以降の工程でデジタル情報として処理されるため、デジタル情報として得るか、あるいは処理する必要がある。データの入力は、断層画像を画像解析手段に入力する手段であり、得られた電子データを適当なデータ移送手段を用いて入力すればよい。例えば、撮像によられた電子データをコンピュータ回線等により解析手段に入力してもよいし、適当な媒体を用いて解析手段に入力してもよい。 (1) A two-dimensional tomographic image of a patient's bone head portion to be joined to the artificial joint of a patient undergoing an artificial joint implantation operation is taken. At this time, CT / MRI or the like may be used. A commercially available CT / MRI may be used. By imaging with CT / MRI or the like, it is possible to obtain data in which an anatomical form of a patient's tissue in which an artificial medical material is implanted is reproduced by a three-dimensional coordinate system. In other words, layered information can be obtained for the portions to which the artificial joint is to be joined by tomographic imaging parallel to each other. At this time, since the tomographic information is processed as digital information in the subsequent steps, it needs to be obtained or processed as digital information. Data input is a means for inputting a tomographic image to the image analysis means, and the obtained electronic data may be input using an appropriate data transfer means. For example, electronic data obtained by imaging may be input to the analysis unit via a computer line or the like, or may be input to the analysis unit using an appropriate medium.
（２）撮像した２次元CT画像から３次元画像処理装置を用いて３次元形状を再構成する。この工程を図２に示す。前記の断層撮像により得られた医用材料を接合させる部分の層状データをデータ処理装置を用いて、３次元形状を構成する。３次元処理装置は、２次元画像入力装置、３次元再構成（画像）処理装置から構成されている。この際、２次元画像を３次元再構成コンピュータに入力し、専門医が「疾患部の抽出」において正常部分と特異部分の判断（診断）を行い、該判断に基づいて人工関節（インプラント）との置換部位の３次元画像を作成する。得られた断層画像の厚さは１ｍｍ前後で、疾患部の断層画像の枚数は１００枚から２００枚程度となる。それぞれの断層画像上から骨部分のみを抽出し、重ね合わせることにより疾患部の３次元形状データを作成する事が出来る。 (2) A 3D shape is reconstructed from the captured 2D CT image using a 3D image processing apparatus. This process is shown in FIG. The layered data of the portion where the medical material obtained by the tomographic imaging is joined is formed into a three-dimensional shape using a data processing device. The three-dimensional processing device includes a two-dimensional image input device and a three-dimensional reconstruction (image) processing device. At this time, a two-dimensional image is input to a three-dimensional reconstruction computer, and a specialist performs determination (diagnosis) of a normal part and a specific part in “extraction of diseased part”, and based on the determination, an artificial joint (implant) is determined. A three-dimensional image of the replacement site is created. The thickness of the obtained tomographic image is around 1 mm, and the number of tomographic images of the diseased part is about 100 to 200. By extracting only the bone part from each tomographic image and overlaying it, the three-dimensional shape data of the diseased part can be created.
CT/MRIで撮像された画像からの３次元形状データの作成は以下のようにして行う。
CT/MRIで得られた画像において疾患部を把握する。疾患部を大きく捉えると正常部分と疾患に侵されている特異部分が存在し、正常部分と特異部分に分けて解析を行う。これは、実際に人工医用材料の埋め込み手術を行う場合、疾患部のうち正常部分を残して特異部分を削除し、残った正常部分と形状、サイズが適合し、なおかつ削除した特異部分とも同等の形状、サイズを有する人工医用材料を用いる必要があるからである。
Creation of 3D shape data from an image captured by CT / MRI is performed as follows.
The diseased part is grasped in the image obtained by CT / MRI. When the diseased part is roughly grasped, there are a normal part and a specific part affected by the disease, and the analysis is performed by dividing into the normal part and the specific part. This is because when an artificial medical material implantation operation is actually performed, the normal part of the diseased part is left and the specific part is deleted, and the remaining normal part is matched in shape and size, and is equivalent to the deleted specific part. This is because it is necessary to use an artificial medical material having a shape and a size.
人工関節を疾患部位の特異部分と置換する場合は解剖学的な位置関係を正常にするため特異部分の形状と共に正常部分の構造を把握する必要がある。具体的な例として、例えば大腿骨の付け根（大腿骨頭：股関節を形成している部分）が骨折をした場合にはこの骨頭を受けている骨盤側（きゅう蓋部）の形状に関するデータが必要である。骨頭が複雑に折れて元の大きさを復元できない場合はきゅう蓋部に適合する形状およびサイズを有する人工関節を選べばよい。また、先天的に股関節脱臼がある場合は左右の大腿骨頭の位置が上下にずれているため、この場合は正常側のデータとも比較して人工関節を選ぶ。
いずれの場合も、最終的に特異部分を切り取り人工関節をはめ込むが、はめ込む部分の骨髄の範囲や骨の直径、骨の厚さなどを参考にして人工関節を選ぶ。
When replacing an artificial joint with a specific part of a diseased part, it is necessary to grasp the structure of the normal part together with the shape of the specific part in order to normalize the anatomical positional relationship. As a specific example, for example, when the base of the femur (femoral head: the part forming the hip joint) has a fracture, data on the shape of the pelvis side (clutch part) receiving this bone head is required. is there. When the head of the bone is complicated and the original size cannot be restored, an artificial joint having a shape and size that fits the cranium can be selected. Further, when there is a congenital dislocation of the hip joint, the positions of the left and right femoral heads are shifted up and down. In this case, the artificial joint is selected by comparing with the data on the normal side.
In either case, the specific part is finally cut out and the artificial joint is inserted, but the artificial joint is selected with reference to the bone marrow range, bone diameter, bone thickness, etc. of the part to be inserted.
まず、特異部分について濃淡分布解析を行う。特異部分も疾患部における病変の重篤度により画像上に濃淡が出現し、濃淡分布解析により、病変が重篤で切除し人工医用材料と置き換えるべき部分が明らかになる。画像は２次元平面上の画素（ピクセル）ごとの濃淡分布の情報として扱われ、画素ごとに濃淡を数値化して解析すればよい。例えば、濃淡値が横軸に、出現画素数が縦軸に表された濃淡ヒストグラムを用いて解析すればよい。次いで、異常陰影を有する病変部が濃淡分布解析により明らかにされた、切除し人工医用材料に置き換えるべき部分の３次元輪郭を追跡する。この一連の操作は、公知の画像処理エキスパートシステム、例えばIMPRESSを用いて行うことができる。３次元輪郭を追跡し、輪郭面の多項式近似を行い、３次元輪郭モデルを作成する。３次元輪郭の追跡は公知の方法で行うことができ、例えば、濃淡分析の結果濃淡の局所的変化の大きい部分を三次元差分で抽出した後に、しきい値処理で差分画像を２値化し、薄面化処理によって輪郭面の位置を決定すればよい。このように、輪郭面を決定することにより、特異部分の３次元形状に関するデータを得ることができる。また、正常部分についても同様の処理をする。但し、正常部分については、濃淡分布の解析を行う必要はないので、３次元輪郭追跡を行った後に、輪郭面の多項式近似を行い輪郭面を決定すればよい。特異部分と正常部分の輪郭面を決定した後に、両者の輪郭面を合成することにより患者の疾患部の３次元全体形状に関するデータが得られ、組織中の正常部分と特異部分の境界が明らかになる。実際にインプラントの埋め込み手術を行う場合には、該３次元全体形状に関するデータに基づいて、手術計画を立てることができる。 First, the density distribution analysis is performed for the singular part. As for the specific part, the density appears on the image depending on the severity of the lesion in the diseased part, and the density distribution analysis reveals the part where the lesion is severe and should be excised and replaced with the artificial medical material. The image is treated as information on the light and shade distribution for each pixel (pixel) on the two-dimensional plane, and the light and shade may be digitized and analyzed for each pixel. For example, the analysis may be performed using a shading histogram in which the shading value is represented on the horizontal axis and the number of appearing pixels is represented on the vertical axis. Next, the three-dimensional contour of the portion to be excised and replaced with the artificial medical material, in which the lesion having an abnormal shadow is revealed by the gray distribution analysis, is traced. This series of operations can be performed using a known image processing expert system such as IMPRESS. A three-dimensional contour is traced, and a polynomial approximation of the contour surface is performed to create a three-dimensional contour model. The tracking of the three-dimensional contour can be performed by a publicly known method. For example, after extracting a portion having a large local change in light and shade as a result of light and dark analysis with a three-dimensional difference, the difference image is binarized by threshold processing, The position of the contour surface may be determined by the thinning process. Thus, by determining the contour surface, it is possible to obtain data relating to the three-dimensional shape of the singular part. The same process is performed for the normal part. However, since it is not necessary to analyze the light and shade distribution for the normal portion, the contour surface may be determined by performing polynomial approximation of the contour surface after performing three-dimensional contour tracking. After determining the contours of the singular part and the normal part, the data on the three-dimensional shape of the diseased part of the patient is obtained by synthesizing the contours of both, and the boundary between the normal part and the singular part in the tissue is revealed Become. When actually implanting an implant, an operation plan can be made based on the data relating to the overall three-dimensional shape.
（３）予めインプラントの詳細な立体情報をデータベースに登録しておく。インプラントは、市販されている既製品を用いてもよいし、新たに開発されたものでもよい。インプラントとしては、ナカシマプロペラ株式会社の人工関節、京セラ株式会社の人工関節等があり、種々の形状、サイズおよび材質のものがある。 (3) The detailed three-dimensional information of the implant is registered in advance in the database. The implant may be a commercially available off-the-shelf product or may be newly developed. Examples of the implant include an artificial joint manufactured by Nakashima Propeller Co., Ltd., an artificial joint manufactured by Kyocera Corporation, and the like, and there are various shapes, sizes and materials.
インプラントの３次元立体情報は、インプラントが接合される患者の組織部分と同様に、３次元の座標系により表される。該立体情報は公開されており、容易に入手可能である。 The three-dimensional solid information of the implant is represented by a three-dimensional coordinate system, similar to the tissue portion of the patient to which the implant is joined. The three-dimensional information is open to the public and can be easily obtained.
（４）（２）の３次元解析システムにより解析されたインプラントが接合される患者の組織部分の３次元データと（３）のインプラントの３次元データを患者の疾患部の人工医用材料を接合すべき組織と形状が適合するインプラントを選択するデータ処理手段に入力する。該手段において、インプラントが接合される患者の組織部分の３次元データとインプラントの３次元データが比較処理され、両者の差分を計算し、インプラントが接合される患者の組織部分とインプラントのデータによりインプラントの形状およびサイズが適合しているかどうかが判定される。 (4) The artificial tissue material of the diseased part of the patient is joined to the three-dimensional data of the tissue part of the patient to which the implant analyzed by the three-dimensional analysis system of (2) is joined and the three-dimensional data of the implant of (3). Input to the data processing means to select an implant that matches the tissue to be shaped. In the means, the three-dimensional data of the tissue part of the patient to which the implant is joined and the three-dimensional data of the implant are compared, the difference between them is calculated, and the implant is obtained from the data of the patient tissue part and the implant to which the implant is joined. It is determined whether the shape and size of the are compatible.
（５）その結果、最適なインプラントを立体画像モデルのデータベースから検索する。 (5) As a result, an optimal implant is searched from a database of stereoscopic image models.
（６）患者に最適な製品番号を医療機関に通知される。 (6) The optimal product number for the patient is notified to the medical institution.
以上のように、本発明のシステムは、(a) 人工医用材料の置換手術を必要とする患者の疾患部の断層画像を入力する手段、
(b) 得られた断層画像データを３次元形状に再構成することにより、３次元形状データを作成する画像解析手段、
(c) (b)の画像解析手段により得られた３次元形状データをあらかじめ構築しておいた人工医用材料の３次元形状データを含むデータベース中の人工医用材料の３次元形状データと適合させ、患者の疾患部の人工医用材料を接合すべき組織と形状が適合する人工医用材料を選択するデータ処理手段、ならびに
(d) 選択した人工医用材料を出力する手段、
とを含む最適形状を有する人工医用材料を検索するシステムである。
As described above, the system of the present invention comprises (a) a means for inputting a tomographic image of a diseased part of a patient that requires a replacement operation for an artificial medical material,
(b) Image analysis means for creating three-dimensional shape data by reconstructing the obtained tomographic image data into a three-dimensional shape;
(c) matching the 3D shape data obtained by the image analysis means of (b) with the 3D shape data of the artificial medical material in the database including the 3D shape data of the artificial medical material that has been constructed in advance; A data processing means for selecting an artificial medical material whose shape is compatible with a tissue to which the artificial medical material of a diseased part of a patient is to be joined; and
(d) means for outputting the selected artificial medical material;
Is a system for searching for an artificial medical material having an optimal shape.
本発明のシステムは、人工医用材料の埋め込み手術を行う医療機関に設置しておいて、手術を行う必要が生じたときに本発明のシステムを用いてもよい。 The system of the present invention may be installed in a medical institution that performs an operation for implanting an artificial medical material, and the system of the present invention may be used when it becomes necessary to perform an operation.
また、医療機関から患者の疾患部の撮像画像の提供を受け、本発明の検索システムを用いて、最適な人工医用材料を選択し、医療機関または人工医用材料メーカーに通知し、最適な医用材料が本発明の検索システムの結果に基づいて提供されるようにしてもよい。すなわち、本発明は以下の工程を含む最適な人工医用材料を提供する方法をも包含する。
（１）関節に異常のある患者の検査を行う（断層画像の発生）。
（２）検査により得られた画像から人口関節の置換を行うかどうかを検討する。
（３）検討の結果置換を行う事に決定した場合、断層画像を画像診断センターに伝送する。
（４）画像診断センターにて３次元形状データの作成を行う（放射線専門医による人的作業）。
（５）「人工医用材料の最適形状検索システム」に（３）の３次元形状データを投入する。
（６）「人工医用材料の最適形状検索システム」が予め搭載されている人工関節の形状データベースと（３）の３次元形状データから最も患者に適した人工関節を抽出する。
（７）結果を医療機関に報告する。
In addition, an image of a diseased part of a patient is provided from a medical institution, an optimal artificial medical material is selected using the search system of the present invention, and the optimal medical material is notified to the medical institution or artificial medical material manufacturer. May be provided based on the results of the search system of the present invention. That is, this invention also includes the method of providing the optimal artificial medical material including the following processes.
(1) Examining a patient with an abnormal joint (generation of a tomographic image).
(2) Consider whether to replace the artificial joint from the image obtained by the examination.
(3) When it is decided to perform replacement as a result of the examination, the tomographic image is transmitted to the diagnostic imaging center.
(4) Three-dimensional shape data is created at the diagnostic imaging center (human work by a radiologist).
(5) The three-dimensional shape data of (3) is input to the “optimum shape search system for artificial medical material”.
(6) An artificial joint most suitable for the patient is extracted from the shape database of the artificial joint in which the “optimum shape search system for artificial medical material” is mounted in advance and the three-dimensional shape data of (3).
(7) Report the result to a medical institution.
Claims (11)
(a) 人工医用材料の置換手術を必要とする患者の疾患部の断層画像を得る工程、
(b) 得られた断層画像データを３次元形状に再構成することにより、３次元形状データを作成する工程、
(c) 工程(b)で得られた３次元形状データをあらかじめ構築しておいた人工医用材料の３次元形状データを含むデータベース中の人工医用材料の３次元形状データと適合させる工程、
(d) 患者の疾患部の人工医用材料を接合すべき組織と形状が適合する人工医用材料を選択する工程、
とを含む最適形状を有する人工医用材料を検索する方法。 A method for searching for an artificial medical material having an optimal shape when performing a replacement operation for the artificial medical material,
(a) obtaining a tomographic image of a diseased part of a patient in need of replacement surgery for an artificial medical material;
(b) a step of creating three-dimensional shape data by reconstructing the obtained tomographic image data into a three-dimensional shape;
(c) a step of matching the three-dimensional shape data obtained in step (b) with the three-dimensional shape data of the artificial medical material in the database including the three-dimensional shape data of the artificial medical material that has been constructed in advance;
(d) selecting an artificial medical material that matches the shape of the tissue to which the artificial medical material of the diseased part of the patient is to be joined;
A method for searching for an artificial medical material having an optimal shape including:
(a) 人工医用材料の置換手術を必要とする患者の疾患部の断層画像を入力する手段、
(b) 得られた断層画像データを３次元形状に再構成することにより、３次元形状データを作成する画像解析手段、
(c) (b)の画像解析手段により得られた３次元形状データをあらかじめ構築しておいた人工医用材料の３次元形状データを含むデータベース中の人工医用材料の３次元形状データと適合させ、患者の疾患部の人工医用材料を接合すべき組織と形状が適合する人工医用材料を選択するデータ処理手段、ならびに
(d) 選択した人工医用材料を出力する手段、
とを含む最適形状を有する人工医用材料を検索するシステム。 A system for searching for an artificial medical material having an optimum shape when performing a replacement operation on the artificial medical material,
(a) means for inputting a tomographic image of a diseased part of a patient in need of replacement surgery for an artificial medical material;
(b) Image analysis means for creating three-dimensional shape data by reconstructing the obtained tomographic image data into a three-dimensional shape;
(c) matching the 3D shape data obtained by the image analysis means of (b) with the 3D shape data of the artificial medical material in the database including the 3D shape data of the artificial medical material that has been constructed in advance; A data processing means for selecting an artificial medical material whose shape is compatible with a tissue to which the artificial medical material of a diseased part of a patient is to be joined; and
(d) means for outputting the selected artificial medical material;
A system for searching for an artificial medical material having an optimal shape including:
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