跳到主要內容

簡易檢索 / 詳目顯示

回結果列表
研究生： 俞首安
Shou-An Yu
論文名稱： 電腦輔助骨盆骨折術前評估系統發展
On the development of a computer-assisted preoperative evaluation system for pelvis surgery
指導教授： 賴景義
Jiing-Yih Lai
口試委員:
學位類別： 碩士
Master
系所名稱： 工學院 - 機械工程學系
Department of Mechanical Engineering
畢業學年度： 98
語文別： 中文
論文頁數： 103
中文關鍵詞： 骨盆骨折 、術前規劃 、骨折處重建 、定位
外文關鍵詞： pelvic surgery planning, pelvis fracture, registration, fracture reconstruction
相關次數： 點閱：16  下載：0 
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報

    • 骨釘與骨板為內固定手術中常使用的植入物，通常醫師必須在術中判斷合適的植入物大小與外形後以螺釘鎖入，固定於骨折部位，但當植入物原本的外形與骨折部位差異過大，則必須將植入物彎折至合適的外形後再進行固定。為了讓醫師能夠於術前得到足夠的輔助資訊，本研究擬發展電腦輔助骨盆手術規劃系統，而此系統架構可分為：(1)電腦斷層影像三維顯示，(2)破裂骨骼分離與三維網格模型重建，(3)破裂骨骼復位，(4)骨板安裝模擬，其中以破裂骨骼復位技術的發展為主，提供一自動與手動的方式進行破裂骨骼復位，並實際以數個骨盆資料進行重建與復位，說明本流程之可行性，期望藉由該復位功能的開發，能夠模擬植入物與骨組織的搭配情形，並提供相關的參考資料，讓醫師於手術前可以針對骨骼外形挑選合適的骨釘骨板等植入物。

    Bone nail and bone plate are commonly used in pelvis surgery. In general, the doctor has to determine suitable implants during the surgery and adjust the shape of the plate so that it can be mounted on the broken bone appropriately. In this study, a computer aided preoperative system for the pelvis surgery is developed. It mainly contains the following features: (1) three-dimensional display of CT images, (2) segmentation of bone structures and generation of triangle meshes, (3) registration of broken bones, and (4) bone plate design and simulation. Registration of broken bones is particularly investigated in this study. An automatic registration algorithm and a manual registration algorithm are developed for the alignment of broken bones. The automatic approach is preferred when a reference bone is available. Otherwise, the manual approach is employed. Several examples are used to demonstrate the feasibility of the proposed method. With such a preoperative evaluation system, a three-dimensional preview of the fractured pelvis is feasible and a surgery planning by means of three-dimensional pelvic model can be performed.

    摘要................................................ I Abstract ............................................II 誌謝.................................................III 目錄................................................ IV 圖目錄.............................................. VI 表目錄.............................................. IX 第一章 緒論.........................................1 1.1 前言............................................1 1.2 文獻回顧........................................5 1.2.1 骨盆骨折手術治療方式..........................5 1.2.2 電腦輔助手術系統發展..........................6 1.3 研究目的與方法..................................7 1.3.1 研究目的......................................7 1.3.2 研究方法......................................8 1.4 論文架構........................................11 第二章 電腦輔助骨盆手術規劃.........................12 2.1 前言............................................12 2.2 骨盆骨折分類....................................12 2.3 目前外科手術方式與醫師面臨問題..................15 2.4 電腦輔助骨盆手術規劃系統架構....................25 2.4.1 三維CT 影像顯示...............................27 2.4.2 骨骼區域分離..................................29 2.4.3 網格模型重建..................................29 2.4.4 破裂骨骼復位..................................30 2.4.5 重建型骨板設計與RP 原型製造...................31 第三章 骨盆骨折復位.................................34 3.1 前言............................................34 3.2 自動復位........................................34 3.2.1 鏡射面決定....................................35 3.2.2 點資料定位....................................37 3.3 手動復位........................................61 3.3.1 座標轉置矩陣..................................61 3.3.2 WCS 座標系統定義..............................62 3.4 骨組織復位流程..................................64 第四章 範例驗證及探討...............................76 4.1 前言............................................76 4.2 自動定位演算法驗證..............................76 4.3 骨盆對稱性分析..................................79 4.4 實際骨折案例說明與討論..........................83 第五章 結論與未來展望...............................98 5.1 結論............................................98 5.2 未來展望........................................99 參考文獻............................................100

    [1] C. Moreno, E. E. Moore, A. Rosenberger and H. C. Cleveland, “Hemorrhage associated with major pelvic fracture: a multi specialty challenge”, The Journal of Trauma, Vol. 26, No. 11, pp. 955-1063, November 1986.
    [2] L. Flint, G. Babikian, M. Anders, J. Rodriguez and S. Steinberg, “ Definitive control of mortality from severe pelvic fracture”, Annals of Surgery, Vol. 211, No. 6, pp. 703-707, June 1990.
    [3] G. F. Pennal, M. Tile and J. P. Waddell, “Pelvic disruption: assessment and classification”, Clinical Orthopaedics and Related Research, Vol. 151, pp. 12-21, 1980.
    [4] M. Tile, Fractures of the pelvis and acetabulum, Williams& Wilkins, 1984.
    [5] J. W. Young, A. R. Burgess, R. J. Brumback and A. Poka, “Pelvic fractures: value of plain radiography in early assessment and management”, Radiology, Vol. 160, pp. 445-451, August 1986.
    [6] M. Tile, “Pelvic ring fractures: should they be fixed”, The Journal of Bone and Joint Surgery(Br), Vol. 70-B, pp. 1-12, 1988.
    [7] M. Tile, “The management of unstable injuries of the pelvic ring”, The Journal of Bone and Joint Surgery(Br), Vol. 81-B, No. 6, pp. 941-943, November 1999.
    [8] M. Tile, “Pelvic fractures: operative versus nonoperative treatment”, The Orthopedic clinics of North America, Vol. 11, No. 3, pp. 423-464, July 1980.
    [9] M. Tile, “Acute pelvic fractures. I. Causation and classification”, Journal of the American Academy of Orthopaedic Surgeons, Vol. 4, No. 3, pp. 143-151, 1996.
    [10] R. J. Goris, J. S. Gimbrère, J. L. van Niekerk, F. J. Schoots and L. H. Booy, “Improved survival of multiple injured patients by early external fixation and prophylactic mechanical ventilation”, Injury, Vol. 12, pp. 39-47, 1982.
    [11] A. M, Mohsen and R. Phillips, “Letter of the reviewers–—update on CAOS projects”, Injury, Vol. 35, pp. S-A2-S-A5, 2004.
    [12] H. Handels, J. Ehrhardt, W. Plotz and S. J. Poppl, “Three-dimensional planning and simulation of hip operations and computerassisted construction of endoprostheses in bone tumor surgery”, Computer Aided Surgery, Vol. 6, No. 2, pp. 65-76, 2001.
    [13] F. Langlotz, R. Bächler, U. Berlemann, L. P. Nolte and R. Ganz, “Computer assistance for pelvic osteotomies”, Clinical Orthopaedics and Related Research, Vol. 354, pp. 92-102, 1998.
    [14] J. Bruns, C. R. Habermann , W. Ru¨ther and D. Delling, “The use of CT derived solid modelling of the pelvis in planning cancer resections”, European Journal of Surgical Oncology, 2009.
    [15] C. Matej and K. Anze, “Preoperative planning in pelvic and acetabular surgery: The value of advanced computerized planning modules”, Injury, Vol. 38, pp. 442-449, 2007.
    [16] L. P. Nolte, L. Zamorano, Z. Jiang, Q. Wang, F. Langlotz and U. Berlemann, “Image-guided insertion of transpedicular screws : A Laboratory Set-Up”, Spine, Vol. 20, pp. 497-500, 1995.
    [17] L. P. Nolte, L. Zamorano, H. Visarius, U. Berlemann, F. Langlotz, E. Arm and O. Schwarzenbach, “Clinical evaluation of a system for precision enhancement in spine surgery”, Clinical Biomechanics, Vol. 10, No. 6, pp. 293-303, 1995.
    [18] L. P. Nolte, H. Visarius, E. Arm, F. Langlotz, O. Schwarzenbach and L. Zamorano, “Computer-aided fixation of spinal implants”, Computer Aided Surgery,Vol. 1, pp. 88-93, 1995.
    [19] P. Peters , F. Langlotz and L. P. Nolte, “Computer assisted screw insertion into real 3D rapid prototyping pelvis models”, Clinical Biomechanics,Vol. 17, pp. 376-382, 2002.
    [20] T. Laine, T. Lund, M. Ylikoski, J. Lohikoski and D. Schlenzka, “Accuracy of pedicle screw insertion with and without computer assistance: a randomized controlled clinical study in 100 consecutive patients”, European Spine Journal, Vol. 9, pp. 235-240, 2000.
    [21] O. Schwarzenbach, U. Berlemann, B. Jost, H. Visarius, E. Arm, F. Langlotz, L. P. Nolte and C. Ozdoba “Accuracy of computer assisted pedicle screw placement an in vivo computed tomography analysis”, Spine, Vol. 22, pp. 452-458, 1997.
    [22] 經筋手療思路(YCT), http://yct99.pixnet.net/blog/post/26114293.
    [23] 吳嘉莉, “下肢骨折之護理”, 1995.
    [24] 張發元, 段廣斌, 「不穩定骨盆骨折手術內固定19例分析」, 長治醫學院學報, 2007.
    [25] 羅賴均, “醫學影像之三維顯示與骨組織三角網格重建技術探討”, 國立中央大學機械工程學系碩士論文, 2009.
    [26] 莊曜瑋, “電腦輔助下顎骨切割與重建手術規劃”, 國立中央大學機械工程學系碩士論文, 2010.
    [27] K. S. Arun, T. S. Huang and S. D. Blostein, “Least-squares fitting of two 3-D point sets”, IEEE Transactions on Pattern Analysis and Machine Intelligence, Vol. 9, No. 5, pp. 698-700, 1987.
    [28] J. Y. Lai, S. H. Shu and Y.C. Huang, “A cell subdivision strategy for r-nearestneighbors computation”, Journal of the Chinese Institute of Engineers, Vol. 29, No. 6, pp. 953-965, 2006.

    QR CODE
    :::