Name: augmented reality navigation-guided core decompression for osteonecrosis of femoral head
Uploaded: 2022-04-12T14:00:00
Description: Watch this Scientific Journal Video about Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head at JoVE.com

本研究由北京市自然科学基金（7202183）、国家自然科学基金（81972107）和北京市科委（D171100003217001）资助。

本研究经中日友好医院伦理委员会批准（批准号：2021-12-K04）。以下所有步骤均按照标准化程序进行，以避免对患者和外科医生造成伤害。本研究获得了患者的知情同意。外科医生必须熟练掌握传统的核心减压程序，以确保在导航不准确或其他意外情况下，手术可以以传统方式进行。
1. ONFH的术前诊断和分级
<ol><li>识别具有ONFH临床症状的患者;典型症状，例如腹?...

<ol>
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Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Core+decompression+with+local+administration+of+zoledronate+and+enriched+bone+marrow+mononuclear+cells+for+treatment+of+non-traumatic+osteonecrosis+of+femoral+head.">Core decompression with local administration of zoledronate and enriched bone marrow mononuclear cells for treatment of non-traumatic osteonecrosis of femoral head.</a> Orthopaedic Surgery. 13 (6), 1843-1852 (2021).</li><li>Hu, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+intramedullary+nailing+and+plate+fixation+in+distal+tibial+fractures+with+metaphyseal+damage:+a+meta-analysis+of+randomized+controlled+trials.">Comparison of intramedullary nailing and plate fixation in distal tibial fractures with metaphyseal damage: a meta-analysis of randomized controlled trials.</a> Journal of Orthopaedic Surgery and Research. 14 (1), 30 (2019).</li><li>Pierannunzii, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+and+arthroscopic+assistance+in+femoral+head+core+decompression.">Endoscopic and arthroscopic assistance in femoral head core decompression.</a> Arthroscopy Techniques. 1 (2), 225-230 (2012).</li><li>Salas, A. 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虽然THA近年来发展迅速，成为ONFH的有效终极方法，但髋关节保存疗法在治疗早期ONFH18，19中仍然起着重要作用。CD是一种基础有效的髋关节保留手术，它可以释放髋关节疼痛，延缓股骨头塌陷20的发生。局灶性坏死的穿刺定位是克罗恩病的关键程序，因为它决定了手术的成功或失败。然而，传统的穿刺定位方法仍然含有一些盲点，可能?...

股骨头坏死（ONFH）是一种常见的致残性疾病，发生在年轻人中1。临床上，有必要根据 X 线、CT 和 MRI 确定 ONFH 的分期，以决定治疗策略（图 1）。对于早期ONFH，通常采用髋关节保留疗法2。核心减压（CD）手术是ONFH最常用的髋关节保留方法之一。已有报道，联合或不联合骨移植的核心减压治疗早期 ONFH 的某些疗效，可避免或延迟后续全髋关节置换术 （THA）3，4，5。然而，在以前的研究中，有或没有骨移植的克罗恩病的成功率报告不同，从64%到95%6，7，8，9。手术技术，特别是钻孔位置的准确性，对于髋关节保留的成功非常重要10。由于穿刺和定位程序的失明，传统的CD技术存在几个问题，例如更多的透视时间，使用Kirschner线反复穿刺以及正常骨组织11，12的损伤。
近年来，增强现实（AR）辅助方法已在骨科手术中引入13。AR技术可以直观地显示手术场的解剖结构，指导外科医生规划手术程序，从而降低手术难度。AR技术在椎弓根螺钉植入和关节关节置换术中的应用已有14，15，16，17的报道。在这项研究中，我们的目标是将AR技术应用于CD程序，并验证其在临床实践中的安全性，准确性和可行性。
系统硬件组件 基于AR的导航手术系统的主要部件包括：（1）安装在手术区域正上方的深度摄像头（图2A）;视频从中拍摄并发送回工作站，以便与成像数据进行注册和协作。（2）穿刺装置（图2B）和非侵入性体表标记框架（图2C），均带有被动红外反射器。红外设备可以捕获标记球的特殊反射涂层（图3），以实现对手术区域内手术设备的精确跟踪。（3）红外定位装置（图2D）负责跟踪手术区域的标记物，高精度匹配体表标记框和穿刺装置（图4）。（4）主机系统（图2E）是一个64位工作站，安装了自主研发的AR辅助骨科手术系统。髋关节和股骨头穿刺手术的增强现实显示可以在其辅助下完成。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>AR-assisted Orthopedic Surgery System</td>
			<td>Self development</td>
			<td>None</td>
			<td>An operating software that implements AR for orthopedic surgery</td>
		</tr>
		<tr>
			<td>Depth camera</td>
			<td>Stereolabs</td>
			<td>ZED depth camera(ZED mini)</td>
			<td>shoot video and sent back to the workstation.</td>
		</tr>
		<tr>
			<td>Image processing software</td>
			<td>Adobe Systems Incorporated</td>
			<td>Adobe Photoshop CS6</td>
			<td>Image processing software</td>
		</tr>
		<tr>
			<td>Infrared positioning device</td>
			<td>Northern Digital Inc.</td>
			<td>NDI Polaris Spectra optical tracking device</td>
			<td>Tracking markers in the surgical area.</td>
		</tr>
		<tr>
			<td>Puncture device</td>
			<td>Stryker</td>
			<td>Stryker System 7 Cordless driver and Sabo</td>
			<td>Insert kirschner wire into the necrotic area.</td>
		</tr>
	</tbody>
</table>

augmented reality navigation-guided core decompression for osteonecrosis of femoral head

股骨头坏死（ONFH）是中青年患者中常见的关节疾病，严重负担他们的生活和工作。对于早期ONFH，核心减压手术是一种经典而有效的髋关节保护疗法。在Kirschner线核心减压的传统程序中，仍然存在许多问题，例如X射线暴露，反复穿刺验证以及对正常骨组织的损伤。穿刺过程的盲目性和无法提供实时可视化是这些问题的关键原因。
为了优化这一程序，我们的团队在增强现实（AR）技术的基础上开发了一种术中导航系统。该手术系统可以直观地显示手术区域的解剖结构，并将术前图像和虚拟针头实时渲染到术中视频中。在导航系统的引导下，外科医生可以准确地将Kirschner导线插入目标病变区域，并将附带损伤降至最低。我们用这个系统进行了10例核心减压手术。与传统程序相比，定位和透视的效率大大提高，穿刺的准确性也得到了保证。

操作特点 手术导航系统应用于9例患者的连续10个髋关节。手术平均总定位时间为10.1分钟（中位数9.5分钟，范围8.0-14.0分钟）。平均C-ARM透视率为5.5倍（中位数为5.5倍，范围为4-8倍）。穿刺精度的平均误差为1.61 mm（中位数为1.2 mm，范围为-5.76-19.73 mm; 表 1）。结果表明，与传统程序相比，定位时间和透视时间明显缩短。
临床结局评估 入...

Watch this Scientific Journal Video about Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head at JoVE.com

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

将增强现实技术应用于股骨头坏死的核心减压，实现该外科手术的实时可视化。该方法可有效提高岩心减压的安全性和精度。

增强现实导航引导的股骨头坏死核心减压

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For ...

我们的系统可以提高股骨头坏死的核心减压手术的成功率和效率。它还显着减少了术中定位时间和荧光镜源。借助VR技术，我们可以利用穿刺过程，降低手术难度，并且比传统手术结果对患者造成的额外伤害更少。该系统可以扩展到其他涉及穿刺手术的骨科手术。它已被用于获得经皮内镜下经椎间孔椎间盘切除术。该系统是专门为股骨头的早期骨坏死而设计的，因为传统的手术不够精确，可能会给患者带来更多的继发性损伤，如正常的组织损伤或过度的辐射。应仔细遵守协议和操作，了解系统的原理和步骤，以尽量减少指示的风险。股骨头核心减压的技术要点将证明有助于成功游览。首先将计划的手术额叶区域划分为上部和下部。这些空间信息将自动输入到软件系统中。为每个级别分配10个匹配点，并将其分成三个相等的部分，其中两个部分各有三个点，其余部分有四个点。要求助手根据各点放置无创体面标记框。完成后，单击匹配。系统用于配准的特殊图像将自动叠加在标记框上。在手术区域随机移动穿刺装置，以检测虚拟针的匹配度和跟踪延迟。在手术室中，要求患者以仰卧姿势躺下，并固定患侧的下肢。用碘和75%酒精准备手术部位。将C型臂荧光镜移至手术台的一侧，并将源头放在髋关节上方。将源与深度摄像头对齐，并将手术台的位置记录为位置 1。在AR辅助骨科手术系统中，单击文件正面X射线图像并选择图像一。系统将自动识别标记框，并将该图像叠加到手术视频中的髋关节。使用X射线图像的AR显示并基于实时视频，规划穿刺路径。站在受影响的一侧执行该过程，握住穿刺装置，并确定最佳插入角度。在手术视频中，在虚拟Kirschner线和髋关节的X射线图像的指导下，在皮肤表面上标记插入点。使用Kirschner导线，刺穿插入点。观察视频中的插入深度和角度，并及时调整。当虚拟针到达坏死的目标区域时，停止穿刺过程并将屏幕截图保留为图像二，以便后续的穿刺准确性评估。穿刺后，拉出钻头，将Kirschner线暂时留在骨头中。将手术台移动到第二个透视的位置，以验证Kirschner导线的实际穿刺情况。记录图像文件。当Kirschner线的位置满足外科医生的所有要求时，穿刺是成功的。然后，使用柳叶刀切割针头周围的皮肤，并分离每一级软组织，直到转子下骨暴露在大约三厘米的深度。用五毫米的环锯沿着Kirschner线钻入坏死区域，以完成后续操作。完成所有程序后，用三根丝线闭合皮肤，并用无菌敷料覆盖。手术导航系统应用于9例患者的连续十个髋关节。手术期间平均总定位时间为10.1分钟，平均C臂透视为5.5次。穿刺精度的平均误差为1.61毫米。通过评估的臀部，两个臀部处于ARCO I阶段，四个臀部处于ARCO IIA阶段，四个处于ARCO IIB阶段。术前VAS平均评分为6分，术后平均评分为3.75。Harris术前平均评分为77.5，术后平均评分为85.5。未发现感染、血肿或神经损伤等术后并发症。也可以将该程序与CT三维重建技术相结合，以便从三维角度实现穿刺，这是我们未来的工作。我们提供将AI技术与骨科手术相结合的创新理念。这个想法也可以用来提高未来其他骨科手术的精度。

Research

JoVE Journal

Medicine

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

微血管减压：突出的手术原则和技术的细微差别

Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of the trigeminal nerve. Previous reports ...

科研

医学

Femoral Bone Marrow Aspiration in Live Mice

股骨骨髓的愿望在活体小鼠

Serial sampling of the cellular composition of bone marrow (BM) is a routine procedure critical to clinical hematology. This protocol describes a detailed ...

A Simple Critical-sized Femoral Defect Model in Mice

一个简单的临界尺寸股骨缺损模型小鼠

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all ...

A Repetitive Concussive Head Injury Model in Mice

重复震荡颅脑损伤模型小鼠

Despite the concussion/ mild traumatic brain injury (mTBI) being the most frequent occurrence of traumatic brain injury, there is still a lack of ...

Ultrasonic-augmented Primary Adult Fibroblast Isolation

超声波增强原成人成纤维细胞隔离

Primary adult fibroblasts have become an important tool to study fibrosis, fibroblast interactions and inflammation in all body tissues. Since primary ...

Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis

在乳腺癌相关淋巴水肿预测和诊断中集成增强现实工具

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients ...

Immunofluorescence Labelling of Human and Murine Neutrophil Extracellular Traps in Paraffin-Embedded Tissue

石蜡内嵌组织中人与鼠中性粒细胞外陷阱的免疫荧光标记

Neutrophil granulocytes, also called polymorphonuclear leukocytes (PMN) due to their lobulated nucleus, are the most abundant type of leukocytes. They ...

Combining Augmented Reality and 3D Printing to Display Patient Models on a Smartphone

结合增强现实和 3D 打印，在智能手机上显示患者模型

Augmented reality (AR) has great potential in education, training, and surgical guidance in the medical field. Its combination with three-dimensional (3D) ...

Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access

使用跨女性访问将人类大小的冠状动脉支架植入大鼠腹主动脉

Percutaneous coronary intervention (PCI), combined with the deployment of a coronary stent, represents the gold standard in interventional treatment of ...

Virtual Reality Tools for Assessing Unilateral Spatial Neglect: A Novel Opportunity for Data Collection

用于评估单边空间忽视的虚拟现实工具：数据收集的新机遇

Unilateral spatial neglect (USN) is a syndrome characterized by inattention to or inaction in one side of space and affects between 23-46% of acute stroke ...