椎體成型術骨髓針穿刺術前規劃與模擬

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許晉瑋(Chin-wei Hsu) 查詢紙本館藏

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機械工程學系

論文名稱

椎體成型術骨髓針穿刺術前規劃與模擬

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摘要(中)

椎體成型術為目前治療骨質疏鬆所引起之脊椎壓迫性骨折最安全的手術方式，但在決定骨髓針穿刺路徑方面仍有一定的難度，且術中需大量使用C-arm，醫護人員長期暴露在具有放射線的環境下，恐影響身體健康。為協助醫師於術前決定骨髓針穿刺路徑、降低放射線對醫護人員的影響，本研究提出一術前規劃流程，並設計一骨髓針穿刺模擬方式，以電腦輔助醫師進行診斷與模擬骨髓針穿刺路徑，於術前即取得充分的手術資訊，此外更與術中輔助系統結合，運用術前規劃資訊輔助手術進行。本研究以多組案例進行骨髓針穿刺模擬，並實際與術中輔助系統結合，進行豬背骨穿刺試驗，驗證該術前規劃流程的可行性，更驗證運算資料的正確性，確保手術模擬的可信度。以本研究提出之術前規劃流程，能協助醫師於術前更充分了解手術資訊，增加醫師進行手術時的信心，並可望加快手術進行速度與減少術中C-arm的使用次數。

摘要(英)

Percutaneous vertebroplasty is the safest surgical approach to treat vertebral compression fractures caused by osteoporosis, but it is still difficult to determine the path of puncture. The surgeons generally require extensive use of C-arm images during surgery, which will increase the risk of radiation exposure in the long term. In this study, a computer aided preoperative planning system for the percutaneous vertebroplasty is developed, which aims to assist the surgeon to simulate and plan the path of puncture before surgery, and to combine with the intraoperative auxiliary system to reduce the impact of radiation for this kind of surgery. Several examples, including simulated human’s vertebral cases and real pig spine puncture tests are presented, to demonstrate the feasibility of the proposed method. Furthermore, this study demonstrates the accuracy of several kinds of data to ensure the credibility of the proposed surgical simulation method. It is expected that study can assist surgeons to get more information before surgery, and accelerate the operation speed in reducing the excessive use of C-arm images.

關鍵字(中)

★ 椎體成型術
★ 骨髓針穿刺
★ 術前規劃
★ 血管辨識

關鍵字(英)

★ percutaneous vertebroplasty
★ path of puncture
★ surgery planning
★ vessel identification

論文目次

摘要 I
Abstract II
誌謝 III
目錄 IV
圖目錄 VI
表目錄 VIII
第一章緒論 1
1.1 前言 1
1.2 文獻回顧 2
1.3 研究目的與方法 5
1.3.1 研究目的 5
1.3.2 研究方法 8
1.4 論文架構 12
第二章椎體成型術簡介及術前規劃系統架構 13
2.1 前言 13
2.2 脊椎與脊椎壓迫性骨折介紹 13
2.2.1 脊椎構造 13
2.2.2 脊椎壓迫性骨折 15
2.3 脊椎壓迫性骨折外科手術方式 17
2.3.1 脊椎融合術 17
2.3.2 椎體成型術 18
2.4 椎體成型術術前規劃系統架構 22
2.4.1 椎體成型術手術流程 22
2.4.2 椎體成型術術前規劃流程 26
第三章椎體成型術術前模擬技術 29
3.1 前言 29
3.2 骨組織區域分離正確性驗證 30
3.3 虛擬X光對網格差別顯示 31
3.3.1 血管自動辨識 31
3.3.2 網格虛擬X光擬真顯示 34
3.4 椎體成型術術前骨髓針穿刺路徑規劃 39
3.4.1 骨髓針穿刺路徑規劃介面設計 39
3.4.2 理想穿刺方向與安全通道 42
3.4.3 皮膚穿刺角度 45
第四章範例模擬與驗證 50
4.1 前言 50
4.2 區域成長正確性驗證 50
4.3 血管自動辨識驗證 52
4.4 椎體成型術術前規劃 57
4.4.1 術前規劃流程案例測試 57
4.4.2 理想穿刺方向與安全通道驗證 63
4.4.3 豬背骨穿刺試驗 67
第五章結論與未來展望 74
5.1 結論 74
5.2 未來展望 75
參考文獻 76

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指導教授

賴景義(Jiing-yih Lai)

審核日期

2013-7-10

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