| 摘要: | 一般人人體受傷較大的部位都集中在膝關節、髖關節與脊椎等位置，也因此在骨科門診、住院開刀病例裡，這類的病患就占了絕大多數。近年來台灣人口年齡老化，相關的退化性關節病症或因骨質疏鬆導致椎體塌陷病例也在急劇的增加中。在手術方法的發展方面，為了改善傳統開放式手術的缺點，微創手術以普遍受到重視，不僅手術過程可簡化、時間可縮短、更重要的是，病患在術中受到破壞的身體組織將大幅減少，可有效避免可能引發的後遺症，而術後復原的時間也可以相對地縮短。然而，微創手術由於傷口視野較小，卻也相對地提高了手術執行的困難度，其中椎體成型術手術更為複雜，因為其緊鄰人體的中樞神經系統與動脈血管，因此過程中醫師必須大量仰賴C-arm的拍攝影像，雖然可以提升手術流程的安全性，卻也導致輻射劑量的增加，對醫護人員的健康造成不良的影響。為了降低椎體成型術手術風險，本研究發展電腦輔助椎體成型術術前評估系統，提供醫師更多病灶區的相關資訊，減少手術過程中的不確定性與C-arm拍攝的次數，降低醫護人員累積的輻射量，以落實更健康、安全的醫療行為。本研究針對椎體成型手術具體開發項目說明如下：(1)組織區域分離與三維模型(含病患、手術器械)之建構與顯示，(2)椎體成型術術前評估，(3)術前評估資訊整合與驗證，(4)觸控操作醫學影像系統等，希望藉由本模擬系統輸出的資訊能改善目前術前資訊不足而需大量仰賴醫師經驗的困境。Generally, knees hips and spines are subjected to most compressive stress in human body, which results in most outpatients to receive orthopedic clinics and surgical operations as well. In addition, the increase in aging population also induces the growing cases of degenerative joint disease and bone fracture from osteoporosis. The minimally invasive surgery (MIS) with concise procedures and less time spent can improve the weaknesses of traditional operations with large incisions and has becomes more and more popular. Most important of all, it can reduce the damage of the tissues and organs neighboring the nidus and the time spent for rehabilitation. However, because of the narrowed field of view on the nidus, MIS generally consists of the procedures of high-skilled and even difficult techniques, especially for vertebroplasty surgery. Owing to its nearby nerves and arteries, it is necessary for surgeons to take plenty of C-arm to obtain in-time information. Although it can ensure the patient safety in surgery to certain degree, the increasing radiation exposure will probably bring the nurses and surgeons some diseases in the future, like cancers.To reduce the risk of MIS, this research intends to develop a medical image software platform with the preoperative evaluation module, which reveals more information about the nidus to reduce the uncertainty of vertebroplasty surgery. Also, the quantities of C-arm images and the radiation exposure to nurses and surgeons can be decreased. In this paper, the preoperative evaluation system is mainly composed of the following items: (1)structure segmentation of medical images and construction and display of 3D models, (2)preoperative evaluation for Vertebroplasty, (3)system integration and verification for preoperative evaluation, and (4) Touch operation of the medical imaging system, etc. Hoping information output by the simulation system can improve the current preoperative information insufficient and require rely on the physicians experience problem. |
