腰椎後融合手術之路徑規劃、螺釘植入導引與椎籠設計

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题名:	腰椎後融合手術之路徑規劃、螺釘植入導引與椎籠設計
作者:	胡謙道;Hu, Chien-Tao
贡献者:	機械工程學系
关键词:	腰椎手術;後融合術;螺釘植入導引;椎籠設計;lumbar spine surgery;posterior fusion;screw implantation guide;vertebral cage design
日期:	2021-07-20
上传时间:	2021-12-07 13:22:20 (UTC+8)
出版者:	國立中央大學
摘要:	脊椎是人體支撐最重要的組織，過度使用將會造成不同程度的損傷。其中，腰椎是整個脊椎承受壓力最大的區段，因此手術治療腰椎病變是常見的脊椎手術。微創腰椎手術的趨勢是以機器人手術導航系統來協助定位與穩固手術路徑方向，而最根本的螺釘植入路徑規劃是靠醫師的經驗作決定。但螺釘需要與固定桿進行固定配合，而目前已知的導航系統未見有在規劃植入路徑時有從力學角度考量固定桿與螺釘的最佳固定關係。又現行術中植入螺釘時通常使用金屬導線(K-wire)做引導，但容易因為患者的骨質密度低而導致導線刺穿錐體，傷到中樞神經或動脈血管，而脊椎融合用的椎籠則對於恢復或矯正患者的腰椎前彎結構有著重要的影響。因此本研究提出同步考慮螺釘與固定桿植入的路徑規劃、配合機器人路徑定位後的鑽孔及導引器械的設計、以及新椎籠的設計等。本研究的路徑規劃是以CT影像建構3D脊椎模型並分割出單節椎骨，接著就理想的腰椎橢圓曲線形狀考量螺釘受力方向，以半自動的方法進行椎弓根路徑的規劃，並決定出固定桿與螺釘在椎體上方的適當空間擺放位置，希望能降低術後可能發生的螺釘鬆脫或固定桿斷裂問題。又設計一套配合機器人定位導槽的鑽孔器械組來取代金屬導線(K-wire)與夾附在棘突上的參考座標夾持器，後者的目的是免除額外傷口的問題。最後，根據後融合手術常用的椎體間植入物的功能需求，從機構設計上進行椎體設計的改善。本研究的目的是希望提高醫師的手術品質與降低再次手術的風險，並提升機器人脊椎手術導航系統的功能性與應用價值。 ;The spine is the most important tissue for human body support. Excessive use will cause varying degrees of damage. The lumbar spine is the most stressed section of the entire spine, so surgical treatment of lumbar spine lesions is a common spine surgery. The trend of minimally invasive lumbar spine surgery is to use a robotic surgical navigation system to assist in positioning and stabilizing the direction of the surgical path, and the most fundamental screw implant path planning is determined by the experience of the surgeon. However, the screw needs to be fixed and matched with the fixation rod, and the currently known surgical navigation systems do not provide the path planning function that can plan the optimum fixation relationship between the fixation rod and the screws from the mechanics point of view. In addition, a metal wire (K-wire) is usually used as a guide for tapping and screw implantation in the current operation, but it is easy to cause the wire to pierce the body due to the low bone density of the patient, and damage the central nerve or arterial vessels. Moreover, the spinal cage for spinal fusion plays an important role on the restoration or correction of the patient′s lumbar anterior curvature structure. Therefore, this study proposes the integrated path planning of both screw and fixed rod implantation during path planning, the design of drilling and guiding equipment for use together with the robot path guidance sleeve, and the design of the new vertebral cage. The path planning in this study is to construct a 3D spine model with CT images and to segment each single vertebra. Then, based on the ideal lumbar elliptic curve shape and considering the external force direction of the screw, the pedicle path is planned by a semi-automatic method and determined. The fixed rod and screw should be placed in the appropriate space above the vertebral body, hoping to reduce the problem of screw loosening or fixation rod breakage that may occur after operation. A set of drilling equipment that cooperates with the positioning guide groove of the robot to replace the metal wire (K-wire) and the reference coordinate holder attached to the spinous process. The purpose of the latter is to avoid the problem of additional wounds. Finally, according to the functional requirements of intervertebral cages commonly used in posterior fusion surgery, a new mechanical design of intervertebral cages is proposed. The purpose of this research is to improve the surgeon′s operation quality and reduce the risk of surgicl revision, and to enhance the functionality and application value of the robotic spine surgery navigation system.
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