CT影像導引顴骨復位手術｜國立中央大學博碩士論文系統

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研究生：	蔡坤霖 Kun-lin Cai
論文名稱：	CT影像導引顴骨復位手術
指導教授：	曾清秀 Ching-shiow Tseng
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
論文出版年：	2014
畢業學年度：	102
語文別：	中文
論文頁數：	59
中文關鍵詞：	顴骨復位、快速成型技術、手術導引
外文關鍵詞：	zygoma reduction, rapid prototyping, surgical navigation
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現今以傳統手術方式為顴骨骨折進行復位，還有其無法達成的困難，
在醫師不能見到頭骨全貌的情況下，將斷面相銜接實不能稱為正確的復位，
若斷面有所缺損，可能會復位至較凹陷的位置而失去兩頰對稱性。本研究
旨在開發一套導引顴骨復位手術導引系統，使用光學定位器作為術中導引
的系統，由自行編寫的復位規劃程式，使醫師在操作容易的環境，直接在
影像中達成正確的復位，之後以快速成型技術製作病人的假體，在假體上
進行復位手術的模擬，得到預彎折骨板和骨釘位置，利用本研究的註冊方
式使其與真實病患作結合，達成復位手術的導引。實驗結果證實本研究開
發出來的導引系統，可以復位骨塊至術前規劃的位置，解決傳統微創手術
方式無法克服的困難。

The traditional minimally invasive treatments for zygoma reduction are still
not able to solve some clinical problems. Without seeing the whole skull
appearance, and the fracture surface has already lost some bones, surgeons are
unable to place zygomatic bone to the correct alignment. Our purpose is
developing a new surgical navigation system that solves these problems. By our
visual alignment program, we can achieve ideal pre-surgical planning in 3D
reconstruction. We apply rapid prototyping technique to manufacturing a
phantom that zygoma has been restored, so we can practice surgical simulation
on the phantom to acquire prebent plates and the screw potions. With our
algorithm for registration, we can place zygoma to be as the same position as in
simulation in actual surgery. The results prove that post-surgical outcome
reappear our pre-surgical planning, and the system overcomes the traditional
problems.

摘要 ........................................................................................................................ I
Abstract ................................................................................................................ II
目錄 ..................................................................................................................... III
圖目錄 ................................................................................................................. VI
表目錄 ................................................................................................................. IX
第1章 緒論 ......................................................................................................... 1
1-1 研究動機與目的 ....................................................................................... 1
1-2 文獻回顧.................................................................................................... 4
1-3 研究方法簡介 ........................................................................................... 7
1-4 章節概敘.................................................................................................... 9
第2章 以ICP 演算法對位註冊之方法 .......................................................... 10
2-1 系統簡介.................................................................................................. 10
2-1-1 光學定位器 ........................................................................................ 10
2-1-2 最近點疊代演算法 ............................................................................ 11
2-1-3 模擬病患的假體 ................................................................................ 11
2-2 應用ICP 配合光學定位器作註冊方法 ................................................. 12
2-2-1 初始對正 ............................................................................................ 12
IV
2-2-2 以ICP 演算法進行細對正 ............................................................... 14
2-3 註冊方法的評估 ..................................................................................... 15
2-3-1 光學定位器可能產生的誤差 ............................................................ 15
2-3-2 特徵點選取範圍的誤差比較 ............................................................ 17
2-3-3 中止條件的設定 ................................................................................ 20
2-3-4 註冊花費時間 .................................................................................... 22
2-4 使用本方法註冊的結論 ......................................................................... 24
第3章 應用RP 假體模擬手術導引方式 ........................................................ 26
3-1 導引方法簡介 ......................................................................................... 26
3-2 重建影像處理 ......................................................................................... 28
3-3 復位規劃程式 ......................................................................................... 29
3-4 快速成型假體 ......................................................................................... 31
3-5 假體模擬手術 ......................................................................................... 31
3-5-1 模擬手術註冊 .................................................................................... 31
3-5-2 固定骨釘骨板 .................................................................................... 32
3-5-3 紀錄鑽孔點 ........................................................................................ 33
3-6 顴骨復位手術 ......................................................................................... 33
3-6-1 復位手術註冊 .................................................................................... 33
3-6-2 手術導引 ............................................................................................ 34
第4章 實驗結果與討論 ................................................................................... 38
4-1 距離評估方式 ......................................................................................... 38
4-2 質心平移和旋轉量 ................................................................................. 40
4-2-1 計算方法 ............................................................................................ 40
4-2-2 計算結果 ............................................................................................ 42
4-3 由直接外觀評估 ..................................................................................... 47
4-4 討論 .......................................................................................................... 51
第5章 結論與未來展望 ................................................................................... 56
5-1 結論 .......................................................................................................... 56
5-2 未來展望.................................................................................................. 57
參考文獻 ............................................................................................................. 58
                                

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