Computer Assisted Surgery最新文献_第8页

Unsupervised binocular depth prediction network for laparoscopic surgery. 腹腔镜手术无监督双目深度预测网络。

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2019-01-01 DOI: 10.1080/24699322.2018.1560082

Ke Xu, Zhiyong Chen, F. Jia

Minimally invasive surgery (MIS) is characterized by less trauma, shorter recovery time, and lower postoperative infection rate. The two-dimensional (2D) laparoscopic imaging lacks depth perception and does not provide quantitative depth information, thereby limiting precise and complex surgical operations. Three-dimensional (3D) laparoscopic imaging provides surgeons depth perception. This study aims to 3D reconstruction of the surgical scene based on the disparity map generated by the depth estimation algorithm. An unsupervised learning autoencoder method was proposed to calculate the accurate disparity with a 101-layer residual convolutional network. The loss function included three parts: left-right consistency loss, structure similarity loss, and reconstruction error loss, the combination can improve reconstruction accuracy and robustness. The method was validated on a Hamlyn Center Laparoscopic/Endoscopic Video Dataset. The structural similarity index (SSIM) is 0.8349 ± 0.0523 and the peak signal-to-noise ratio (PSNR) is 14.4957 ± 1.9676. The depth prediction network has high accuracy and robustness. The average time to produce each disparity map is about 16 ms. The experimental result shows that the proposed depth estimation method can offer dense disparity map, and can meet surgical real-time requirement. Future work will focus on network structure optimization and loss function design, transfer learning to improve the robustness and accuracy further.

微创手术具有创伤小、恢复时间短、术后感染率低等特点。二维(2D)腹腔镜成像缺乏深度感知，不能提供定量的深度信息，从而限制了精确和复杂的外科手术。三维(3D)腹腔镜成像为外科医生提供深度感知。本研究旨在基于深度估计算法生成的视差图对手术场景进行三维重建。提出了一种基于101层残差卷积网络的无监督学习自编码器方法来精确计算视差。损失函数包括左右一致性损失、结构相似度损失和重构误差损失三部分，结合使用可以提高重构精度和鲁棒性。该方法在Hamlyn中心腹腔镜/内窥镜视频数据集上进行了验证。结构相似指数(SSIM)为0.8349±0.0523，峰值信噪比(PSNR)为14.4957±1.9676。该深度预测网络具有较高的精度和鲁棒性。生成每个视差图的平均时间约为16毫秒。实验结果表明，所提出的深度估计方法能够提供密集的视差图，满足手术实时性的要求。未来的工作将集中在网络结构优化、损失函数设计、迁移学习等方面，进一步提高鲁棒性和准确性。

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引用次数: 0

A non-contact interactive stereo display system for exploring human anatomy. 一种用于探索人体解剖的非接触式交互式立体显示系统。

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2019-01-01 DOI: 10.1080/24699322.2018.1560083

Ziteng Liu, Wenpeng Gao, Yu Sun, Yixian Su, Jiahua Zhu, Lubing Xu, Yili Fu

Stereoscopic display based on Virtual Reality (VR) can facilitate doctors to observe the 3 D virtual anatomical models with the depth cues, assist them in intuitively investigating the spatial relationship between different anatomical structures without mental imagination. However, there is few input device can be used in controlling the virtual anatomical models in the sterile operating room. This paper presents a cost-effective VR application system for demonstration of 3 D virtual anatomical models with non-contact interaction and stereo display. The system is integrated with hand gesture interaction and voice interaction to achieve non-contact interaction. Hand gesture interaction is implemented based on a Leap Motion controller mounted on the Oculus Rift DK2. Voice is converted into operation using Bing Speech for English language and Aitalk for Chinese language, respectively. A local relationship database is designed to record the anatomical terminologies to speech recognition engine to query these uncommon words. The hierarchical nature of these terminologies is also recorded in a tree structure. In the experiments, ten participants were asked to perform the evaluation on the proposed system. The results show that our system is more efficient than traditional interactive manner and verify the feasibility and practicability in the sterile operating room.

基于虚拟现实(VR)的立体显示技术可以方便医生借助深度线索观察三维虚拟解剖模型，帮助医生无需想象，直观地了解不同解剖结构之间的空间关系。然而，无菌手术室中能够控制虚拟解剖模型的输入设备很少。提出了一种具有非接触交互和立体显示功能的三维虚拟解剖模型展示应用系统。该系统集成了手势交互和语音交互，实现非接触交互。手势交互是基于安装在Oculus Rift DK2上的Leap Motion控制器实现的。语音转换为操作，英文使用Bing Speech，中文使用Aitalk。设计了一个局部关系数据库，将解剖术语记录到语音识别引擎中，以查询这些不常见的词汇。这些术语的层次性质也记录在树形结构中。在实验中，10名参与者被要求对所提出的系统进行评估。结果表明，该系统比传统的交互方式更高效，验证了该系统在无菌手术室的可行性和实用性。

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引用次数: 0

Minimally invasive surgical techniques for the therapy of far lateral disc herniation in middle-aged and elderly patients. 微创手术技术治疗中老年远外侧椎间盘突出症。

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2019-01-01 DOI: 10.1080/24699322.2018.1560096

Weijian Ren, Yu Chen, Liangbi Xiang

To examine the clinical results of different minimally invasive techniques for the therapy of far lateral disc herniation in middle-aged and elderly patients. Percutaneous endoscopic lumbar discectomy, MIS-TLIF combined with contralateral translaminar screw and MIS-TLIF combined with bilateral pedicle screws were evaluated via a retrospective chart review. Data from 74 consecutive middle-aged and elderly patients with far lateral disc herniation were analyzed. All patients underwent surgery; 19 with PELD, 24 with MIS-TLIF CTS, and 31 with MIS-TLIF BPS. Clinical data included the length of the incision, duration of the operation, blood loss, hospitalization time, operation cost, recurrence rate, and fusion rate. Preoperative and postoperative patient outcomes including the VAS, ODI scores and MacNab criteria were assessed and recorded. The mean follow-up time was 26.4 months (range from 14 to 46 months). Compared with the internal fixation groups, the length of the incision, duration of operation, blood loss, and hospitalization time were obviously lower in the PELD group. The difference in operation cost among the three methods was statistically significant. The postoperative VAS scores for LBP and LP decreased significantly as compared with those recorded preoperatively. The postoperative ODI scores were lower than those recorded preoperatively. MacNab criteria rating excellent, good and fair results were in 27, 37 and 10 patients, respectively. PELD, MIS-TLIF CTS, and MIS-TLIF BPS are all effective minimally invasive techniques for the therapy of single segment far lateral lumbar disc herniation in middle-aged and elderly patients. PELD had a shorter operation time and less surgical trauma, being a less invasive and more economical method; however, there was no recurrence of disc herniation after fixation. Compared with MIS-TLIF BPS, MIS-TLIF CTS obtained a similar fusion rate and certain costs were saved.

目的探讨不同微创技术治疗中老年椎间盘远外侧突出症的临床效果。经皮内镜下腰椎间盘切除术、MIS-TLIF联合对侧椎板间螺钉和MIS-TLIF联合双侧椎弓根螺钉通过回顾性图表复习进行评估。本文分析了74例中老年远外侧椎间盘突出症患者的资料。所有患者均接受手术治疗;19例为PELD, 24例为MIS-TLIF CTS, 31例为MIS-TLIF BPS。临床资料包括切口长度、手术时间、出血量、住院时间、手术费用、复发率、融合率。评估并记录术前和术后患者预后，包括VAS评分、ODI评分和MacNab标准。平均随访时间26.4个月(14 ~ 46个月)。与内固定组比较，PELD组切口长度、手术时间、出血量、住院时间均明显低于内固定组。三种方法的手术费用差异有统计学意义。与术前相比，术后腰痛和腰痛VAS评分明显下降。术后ODI评分低于术前。根据MacNab标准，分别有27例、37例和10例患者获得优秀、良好和公平的结果。PELD、MIS-TLIF CTS和MIS-TLIF BPS都是治疗中老年单节段远外侧腰椎间盘突出症的有效微创技术。PELD手术时间短，手术创伤小，创伤小，经济实惠;然而，固定后没有复发的椎间盘突出。与MIS-TLIF BPS相比，MIS-TLIF CTS获得了相似的融合率，并节省了一定的成本。

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引用次数: 0

Three-dimensional fluoroscopic navigation-assisted surgery for tumors in patients with tumor-induced osteomalacia in the bones 三维透视导航辅助肿瘤手术治疗肿瘤引起的骨软化症

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2017-01-01 DOI: 10.1080/24699322.2017.1282044

Hiroshi Kobayashi, T. Akiyama, Tomotake Okuma, Yusuke Shinoda, H. Oka, N. Ito, S. Fukumoto, Sakae Tanaka, H. Kawano

Abstract Purpose: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumors. Segmental resection has been recommended for these tumors in the bones because curettage was found to be associated with a high local recurrence rate. Navigation-assisted surgery provides radiological information to guide the surgeon during surgery. No previous study has reported on the efficacy of navigation-assisted surgery for tumors in patients with TIO. Therefore, the present study aimed to evaluate the efficacy of navigation-assisted surgery for tumors in patients with TIO. Methods: The study included seven patients with TIO who were treated between January 2003 and December 2014 at our hospital. All patients underwent surgical treatment with or without the use of a 3-dimensional (3D) fluoroscopy-based navigation system. The laboratory data and oncological outcomes were evaluated. Results: The follow-up period was 8–128 months. The tumors were located at the femur (n = 4), ischium, spine and ilium (n = 1). Of the seven patients, five underwent navigation-assisted surgery and two underwent surgery without navigation assistance. In the two patients who underwent surgery without navigation assistance, a complete cure was not obtained and osteomalacia did not resolve. One of these two patients and the other five patients who underwent navigation-assisted surgery, one patient had incomplete resection due to massive invasion of the tumor into the spinal canal, but five patients achieved complete excision and recovered from osteomalacia. Conclusions: Navigation-assisted surgery using a 3D fluoroscopy-based navigation system is effective for tumors in patients with TIO.

摘要目的:肿瘤诱导骨软化症(TIO)是一种罕见的副肿瘤综合征，通常由磷质间充质肿瘤引起。部分切除已被推荐用于骨内肿瘤，因为发现刮除与高局部复发率相关。导航辅助手术提供放射学信息来指导外科医生进行手术。以前没有研究报道导航辅助手术治疗TIO患者肿瘤的疗效。因此，本研究旨在评估导航辅助手术治疗TIO患者肿瘤的疗效。方法:选取2003年1月至2014年12月在我院治疗的7例TIO患者作为研究对象。所有患者都接受了手术治疗，有或没有使用基于三维(3D)透视的导航系统。对实验室数据和肿瘤结果进行评估。结果:随访8 ~ 128个月。肿瘤位于股骨(n = 4)、坐骨、脊柱和髂骨(n = 1)。在7名患者中，5名接受了导航辅助手术，2名接受了没有导航辅助的手术。在没有导航辅助的情况下进行手术的两名患者，没有得到完全治愈，骨软化也没有解决。其中1例患者和另外5例患者行导航辅助手术，1例患者因肿瘤大量侵入椎管而未完全切除，但5例患者完全切除并从骨软化症中恢复。结论:基于三维透视的导航系统导航辅助手术治疗TIO患者的肿瘤是有效的。

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引用次数: 13

Erratum 勘误

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2017-01-01 DOI: 10.1080/24699322.2016.1275268

引用次数: 0

Efficacy of a novel iPod-based navigation system compared to traditional navigation system in total knee arthroplasty 基于ipod的新型导航系统与传统导航系统在全膝关节置换术中的疗效比较

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2017-01-01 DOI: 10.1080/24699322.2016.1276630

A. Mullaji, G. Shetty

Abstract Background: This prospective study aimed to verify the efficacy of a novel, hand-held, iPod-based navigation system in comparison to traditional navigation system for total knee arthroplasty (TKA). Methods: Limb alignment, tibial and distal femoral bone cut thickness and plane were recorded intraoperatively using both iPod-based and traditional navigation system in 36 knees undergoing primary TKAs. Results: Intraoperatively, the iPod-based navigation system showed good to excellent correlation and reliability for tibial and distal femoral bone cut thickness, plane of the femoral cut and limb alignment when compared to the traditional navigation system. Conclusions: Despite its quick registration feature, the iPod-based system has an efficacy similar to traditional navigation system and is a positive step towards making navigation systems for TKA more compact, user-friendly, time and cost-effective.

摘要背景：本前瞻性研究旨在验证新型手持iPod导航系统与传统导航系统在全膝关节置换术（TKA）中的疗效。方法：在36例接受TKA的膝关节患者中，使用基于iPod和传统导航系统在手术中记录肢体对齐、胫骨和股骨远端骨切割厚度和平面。结果：术中，与传统导航系统相比，基于iPod的导航系统在胫骨和股骨远端骨切口厚度、股骨切口平面和肢体对齐方面显示出良好的相关性和可靠性。结论：尽管具有快速注册功能，但基于iPod的系统具有与传统导航系统类似的功效，是朝着使TKA导航系统更紧凑、用户友好、时间和成本效益迈出的积极一步。

引用次数: 3

Evaluation of actuation compatibility and homogeneities for MRI-powered ferromagnetic sphere 核磁共振驱动铁磁球的驱动兼容性和均匀性评价

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2016-12-16 DOI: 10.1080/24699322.2016.1240312

Peng Zhang, Wendong Wang, Yikai Shi, Xiaoqing Yuan

Abstract MR-compatibility actuations have been widely investigated for the development of robot-assisted devices under the magnetic resonance imaging (MRI). Ferromagnetic components of MRI-powered can be manipulated remotely using the magnetic force or torque induced by MRI or magnetic field environment. However, (1) numerical analysis of the related factors, geometry and magnitude, influencing the ferromagnetic components, and (2) field non-homogeneities when placed in a uniform main magnetic field B0 are rarely reported. To address the relationship between magnetic force/torque and parameters, different radii of ferromagnetic spheres are required to exert magnetic force and torque with variable magnetic field. Comparison of the field homogeneities error (FHE) under various locations and parameters was investigated. In this study, we present the equivalent model of magnetic field and compare the magnetic force and torque of ferromagnetic sphere under different conditions and provide a safety distance of drive source (ferromagnetic sphere). The numerical models between parameters are established and significant factors were analyzed. Through various parameters of the ferromagnetic sphere, the performance of the numerical model in the magnetic field was evaluated. Cubic polynomial equations were developed to relate magnetic properties of ferromagnetic sphere with R2 > 0.9506. Field homogeneity was not significantly affected when actuation source was installed in 32 cm away from the isocenter.

摘要磁共振成像(MRI)下的机器人辅助装置开发中，核磁共振兼容驱动已被广泛研究。MRI驱动的铁磁元件可以利用MRI或磁场环境产生的磁力或扭矩进行远程操作。然而，(1)对影响铁磁分量的相关因素、几何形状和大小的数值分析，以及(2)置于均匀主磁场B0时的磁场非均匀性很少有报道。为了解决磁力/转矩与参数之间的关系，在变磁场条件下，要求不同半径的铁磁球施加磁力和转矩。比较了不同位置和参数下的场均质误差(FHE)。本文建立了磁场等效模型，比较了不同条件下铁磁球的磁力和转矩，并给出了驱动源(铁磁球)的安全距离。建立了参数间的数值模型，并对影响因素进行了分析。通过铁磁球的各种参数，对数值模型在磁场中的性能进行了评价。建立了与R2 > 0.9506有关的铁磁球磁性能的三次多项式方程。当驱动源安装在距离等心32 cm处时，对磁场均匀性影响不显著。

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引用次数: 2

Three-dimensional digitalized virtual planning for saphenous artery flap: a pilot study. 隐动脉皮瓣三维数字化虚拟规划的初步研究。

IF 1.5 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2016-12-01 DOI: 10.1080/24699322.2016.1209243

Yuan Z Zhang, Shu Z Wen, Hui Q Zhang, Ya G Li, Jian M Zhao, Yong Yang

Objective: Since the 1970s, research and applications on flap and muscle flap had solved many problems in microsurgical reconstruction. However, the traditional flap design is completely dependent on two-dimensional (2D) images. The purpose of this study was to discuss the methods in the visualization of saphenous artery flap by digitalized technique and its applications by digitalized technique.

Methods: Two adult fresh cadaver specimens, one male and one female, were subject to radiographic computerized tomography (CT) scanning before and after perfused with lead oxide-gelatine mixture, whose collimation are 0.625 mm (120 kV, 110 mA, 512 × 512 matrix). Through Amira 5.4.1 software, the 2D images in DICOM format were transformed into the 3D models of the entire region. The structures of saphenous artery were observed and the digitized visible models of saphenous artery flap were established through three-dimensional (3D) computerized reconstructions methods from these data using Amira 5.4.1 software. Next six cases of soft-tissue defects of the tibia region, involving the exposure bones underwent contrast-enhanced CT angiography of lower limbs utilizing a 64-row multi-slice spiral CT after median cubital vein injection with Ultravist (3.5 ml/s). 2D images from these data in DICOM format were transformed into computer. The structures of saphenous artery flap were observed and measured using Amira 5.4.1 software. Then, all cases were treated by saphenous artery flap.

Results: The 3D reconstructed visible models established from these datasets perfectly displayed the saphenous artery flap anatomy. In six cases, the main trunk and branched of the blood vessels in the designed flap were consistent with the surgical findings. The starting point of the saphenous artery to the average distance of the knee clearance were 119.2 ± 9.6 mm, the average diameter of the saphenous artery from the starting point were 1.5 ± 0.3 mm. The range of flap was 8.0 × 5.0 cm to 20.0 × 8.0 cm. All flaps survived well. After 8-24 months' follow-up the knee flexion was 120-140°, the straight 0-10°. There was no case appeared incision infection.

Conclusions: The preoperative use of 3D digitalized virtual planning for the saphenous artery flap improves the surgical accuracy, decreases the operation time and increases the survival rate of the flap.

目的：自20世纪70年代以来，皮瓣和肌皮瓣的研究和应用解决了显微外科重建中的许多问题。然而，传统的皮瓣设计完全依赖于二维图像。本研究旨在探讨隐动脉瓣数字化显示的方法及其在隐动脉瓣数字化显示中的应用。方法：对2例成年新鲜尸体标本（男、女各1例）进行x线计算机断层扫描（CT），分别灌注准直为0.625 mm （120 kV, 110 mA， 512 × 512矩阵）的氧化铅-明胶混合物。通过Amira 5.4.1软件，将DICOM格式的二维图像转换为整个区域的三维模型。观察隐动脉结构，利用Amira 5.4.1软件通过三维（3D）计算机重建方法建立隐动脉皮瓣数字化可见模型。6例胫骨区软组织缺损，累及暴露骨，在肘正中静脉注射3.5 ml/s紫外线后，行64排多层螺旋CT下肢血管造影。将这些数据的二维图像以DICOM格式转换到计算机中。采用Amira 5.4.1软件对隐动脉皮瓣结构进行观察和测量。所有病例均行隐动脉皮瓣治疗。结果：建立的三维可视化重建模型能较好地显示隐动脉瓣的解剖结构。6例皮瓣的主干和分支血管与手术表现一致。隐动脉起始点至膝关节间隙的平均距离为119.2±9.6 mm，隐动脉起始点至膝关节间隙的平均直径为1.5±0.3 mm。皮瓣范围为8.0 × 5.0 cm ~ 20.0 × 8.0 cm。所有襟翼都完好无损。随访8-24个月，膝关节屈曲120-140°，直0-10°。无一例出现切口感染。结论：术前应用三维数字化虚拟规划进行隐动脉瓣手术，可提高手术精度，缩短手术时间，提高皮瓣成活率。

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引用次数: 0

Corrigendum.

IF 1.5 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2016-12-01 Epub Date: 2016-08-02 DOI: 10.1080/24699322.2016.1218199

引用次数: 0

Force–torque intraoperative measurements for femoral shaft fracture reduction 股骨干骨折复位术中力-扭矩测量

IF 2.1 4区医学 Q3 SURGERY

Computer Assisted Surgery

Pub Date : 2016-11-06 DOI: 10.1080/24699322.2016.1240311

Qing Zhu, B. Liang, Xingsong Wang, Xiaogang Sun, Liming Wang

Abstract Background: The minimally invasive technique of closed intramedullary (IM) nailing fixation is currently considered the standard of treatment for the operative management of displaced traumatic fractures of the femur, with fracture reduction and repositioning being the first and most important step of the procedure. Skeletal-muscle traction and alignment of the fracture fragments are always performed as individual components of the reduction and repositioning phase of the procedure. Methods: As use of high traction force and repositioning forces and torques can cause additional soft tissue injury, we developed a sensor-based system to monitor these forces and torques during the treatment of diaphyseal fractures of the femur, including the monitoring of traction forces during the entire procedure, from reduction to IM nail implantation and fixation. Results: Based on a local coordinate system localized at the center of the fracture, maximum forces of 203 N along the medial-lateral (X) axis, 517 N along the anterior–posterior (Y) axis and 505 N along the shaft of the femur (Z-axis) were identified, with maximum torques of 16.4 Nm calculated around Y-axis and 38.3 Nm around X-axis. The pressure between the counteraction post and the perineum was also recorded, with magnitudes as high as 523 N being recorded. Excessive forces were identified and the difference in force–torque magnitudes during different stages of the reduction and fixation procedure were calculated. Conclusion: The measurement system provides surgeons with real-time information which can assist them in performing effective repositioning of fracture fragments within safe margins of applied forces and torques.

背景:闭式髓内钉(IM)微创技术目前被认为是外伤性股骨移位骨折手术治疗的标准技术，骨折复位和复位是手术的第一步也是最重要的一步。骨骼肌牵引和骨折碎片的对准总是作为复位和复位手术阶段的单独组成部分进行。方法:由于使用高牵引力和重定位力和扭矩会导致额外的软组织损伤，我们开发了一种基于传感器的系统来监测股骨骨干骨折治疗过程中的这些力和扭矩，包括从复位到内钉植入和固定整个过程中的牵引力监测。结果:基于位于骨折中心的局部坐标系，确定了沿内侧-外侧(X)轴的最大力为203 N，沿前后(Y)轴的最大力为517 N，沿股骨轴(z)轴的最大力为505 N，沿Y轴计算的最大扭矩为16.4 Nm，沿X轴计算的最大扭矩为38.3 Nm。还记录了反作用力桩与会阴之间的压力，最高可达523 N。确定了过大的力，并计算了复位和固定过程中不同阶段的力-扭矩大小的差异。结论:该测量系统为外科医生提供了实时信息，可帮助他们在安全的外力和扭矩范围内有效地重新定位骨折碎片。

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引用次数: 8