WO2019000270A1 - Method for planning screw placement for three-dimensional simulated operation, and surgical operation simulator - Google Patents

Abstract

Disclosed are a method for planning screw placement for a three-dimensional simulated operation, and a surgical operation simulator, which are applicable to the field of medical instruments. The planning method comprises: carrying out three-dimensional modelling according to a received spine CT image so as to generate a three-dimensional model (S101); generating three sectioning plane images according to the three-dimensional model (S102); displaying the three-dimensional model and the three sectioning plane images of the three-dimensional model (S103); adjusting the positions and sectioning directions of sectioning planes so as to intuitively observe a sectioning plane condition of a spine (S104); determining a screw channel of a screw by means of an intersection line of sectioning planes in two directions (S105); adding the screw to the determined screw channel (S106); and moving the screw in the direction of the screw channel to locate the screw in an actual operation position, thereby completing the planning of the screw (S107). The planning method is simple and convenient, can plan a screw channel more precisely, and makes screw placement safer and more reliable.

Description

 Title: Inventive Name: Planning Method and Surgical Simulator for 3D Simulated Surgical Studing

 [0001] The present invention belongs to the field of medical devices, and in particular, to a three-dimensional simulation surgical nail placement planning method and a surgical simulator.

 Background technique

 [0002] The spine is the central axis of the human body, which plays a role in supporting, protecting, balancing, and exercising. The spine consists of the vertebrae, intervertebral disc, spinal cord, spinal nerve, and autonomic nervous system. There is a spinal canal in the spine that houses the spinal cord and protects the spinal cord. Moreover, 31 pairs of spinal nerves connected to the spinal cord pass through the intervertebral foramen and are protected by the spine. At the same time, the active veins of the human body and the arteries and veins of the neck are distributed around the spine.

 [0003] Since the pedicle is adjacent to more blood vessels and nerve structures, once the screw is improperly inserted into the lamina, the staggered screw can cause severe neurovascular damage. Therefore, in performing spinal column placement, it is necessary to accurately perform surgical planning and accurately perform surgical operations.

 [0004] Normal human spine has 32~34 spine bones: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 vertebrae and 3~5 tail vertebrae. There are 23 discs and 134 joints. The side of the spine is "S" shaped and the front is in a straight line.

 [0005] Due to the different anatomical shapes of the vertebral bodies and the differences and deformities of the individual, the screw insertion point, the nailing direction and the nail placement depth need to be planned. After planning, ensure that the screws do not penetrate the outer wall of the pedicle, otherwise the adjacent nerves and blood vessels will be damaged. The angle of the nail should be varied as the angle of the vertebral arch changes to avoid penetration of the cortical bone in front of the vertebral body. In the same way, in order to ensure the pull-out strength of the screw, the size and length of the appropriate screw should be selected. The entry point is not a point, but an area, and it must be matched with the angle of the nail. The selection of the entry point is to make the screw into the nail reliable and not easy to slide. The direction of the nail should be such that the screw passes exactly through the narrowest part of the pedicle without breaking through the outer wall. The depth of the nail should be such that the screw cannot pass through the vertebral body.

 [0006] An existing method of planning a three-dimensional simulated procedure is to add a device to the three-dimensional model and then move the instrument into a suitable position in a three-dimensional view.

[0007] The domestic BOHOLO surgical simulator firstly introduces a CT image, performs three-dimensional modeling, and then performs three-dimensional planning. After making a three-dimensional plan, first find the device to be added in the instrument library, then add the device to the lower right corner of the 3D model, and then move the device to the appropriate position. [0008] This approach is aimed at general surgery and does not optimize the characteristics of spinal surgery. There is a problem that the planning accuracy is poor and the movement of the device is difficult. Since one instrument has six degrees of freedom in space (the screw is 5 degrees of freedom), and moving the instrument in the PC interface, it can only perform two-dimensional movement and one-angle rotation, so it is necessary to keep the same on the mobile device. The angle of the 3D model is transformed to properly move the instrument to the proper position. Due to the complexity of the movement, the planning accuracy is poor and can only be used as a reference.

 [0009] Israel's MAZOR has made some optimizations for spinal implant surgery planning. After the CT image is imported for 3D modeling, it is cut into a single spine according to the structure of the human spine. A three-dimensional visual map is then fixed to the three-dimensional model of the single-segment spine. Then add the spine screws and adjust the screw orientation in each of the three views. However, this method only divides a 3D view into three-dimensional views in three directions. Although it is more convenient than the BOHOLO surgical simulator to adjust the instrument, it still cannot clearly know the planned nail path profile, so the planning accuracy is still not high.

 technical problem

 [0010] It is an object of the present invention to provide a three-dimensional simulated surgical nail placement planning method and a surgical simulator for solving the problem that the three-dimensional view is divided into three directions, and the planning accuracy is still not high.

 Problem solution

 Technical solution

 [0011] In a first aspect, the present invention provides a method for planning a three-dimensional simulated surgical staple, the method comprising:

[0012] performing three-dimensional modeling according to the CT image of the received spine to generate a three-dimensional model;

 [0013] generating three cut-away views according to the three-dimensional model;

 [0014] displaying three cross-sectional views of the three-dimensional model and the three-dimensional model;

 [0015] adjusting the position of the cutting plane and the cutting direction to visually observe the condition of the cut surface of the spine;

[0016] determining the nail path of the screw by the intersection of the cutting planes in the two directions;

[0017] adding a screw to the determined nail path;

 [0018] The screw is moved in the direction of the nail path so that the screw is in the actual surgical position, and the screw planning is completed.

[0019] In a second aspect, the present invention provides a computer readable storage medium storing a computer program executed by a processor to implement a three-dimensional simulated surgical staple as described above. The steps of the planning method. [0020] In a third aspect, the present invention provides a surgical simulator comprising:

[0021] one or more processors;

[0022] a memory;

 [0023] one or more computer programs, wherein the one or more computer programs are stored in the memory and configured to be executed by the one or more processors, the processor executing the computer The program 吋 implements the steps of the three-dimensional simulated surgical nailing planning method as described above.

 Advantageous effects of the invention

 Beneficial effect

 [0024] In the present invention, since three sectional views are generated according to the three-dimensional model, the position and the cutting direction of the cutting surface are adjusted to visually observe the condition of the cutting surface of the spine, and the intersection of the cutting surfaces through the two directions Determining the nail path of the screw, the planning is simple and convenient, and the nail path can be more accurately planned, so that the nail is safer and more reliable.

 DRAWINGS

 1 is a flow chart of a method for planning a three-dimensional simulated surgical nail according to a first embodiment of the present invention.

 2 is a schematic view showing a sagittal plane, a coronal plane, and a horizontal plane of a three-dimensional model and a three-dimensional model in a three-dimensional simulated surgical nail placement planning method according to Embodiment 1 of the present invention.

[0027] FIG. 3 is an initial cross-sectional relationship diagram.

4 is an adjusted cross-sectional view.

[0029] FIG. 5 is a schematic illustration of the addition of a screw to a determined nail path.

[0030] FIG. 6 is a schematic illustration of the screw adjustment in place.

 7 is a schematic view of a surgical simulator provided in Embodiment 3 of the present invention.

Embodiments of the invention

The present invention will be further described in detail below with reference to the accompanying drawings and embodiments. It is understood that the specific embodiments described herein are merely illustrative of the invention and are not intended to limit the invention. [0033] In order to explain the technical solution described in the present invention, the following description will be made by way of specific embodiments.

 [0034] The parameters of the spinal column placement include the placement point, the placement direction, and the placement depth. The key to accurate nail placement is to ensure that the pedicle screw cannot penetrate the pedicle bone wall through the vertebral canal. So choosing the right set of nails and precise nailing is the focus of planning.

[0035] Embodiment 1:

 [0036] Please refer to FIG. 1. The method for planning a three-dimensional simulated surgical staple provided by the first embodiment of the present invention includes the following steps:

 [0037] S101. Perform three-dimensional modeling according to a CT (Computed Tomography) image of the received spine to generate a three-dimensional model.

[0038] A CT image is a technique for acquiring an object mode cross-section information by performing ray projection measurement of an object at different angles, and a set of sliced DICOM format two-dimensional medical images is obtained.

[0039] In the first embodiment of the present invention, S101 may specifically include the following steps:

[0040] converting the DICOM image of the CT into a BMP bitmap file;

[0041] performing image smoothing on the BMP bitmap file to filter out noise;

 [0042] sharpening and enhancing the image after filtering the noise to enhance the image of the bone portion; [0043] dividing the enhanced image, and using the gray value of the cross section of the object and the gray value belonging to the back image a threshold is separated;

Extracting a vector contour of the segmented image;

[0045] Perform face rendering or volume rendering to generate a three-dimensional model.

[0046] S102. Generate three cross-sectional views according to the three-dimensional model.

 [0047] In the first embodiment of the present invention, the three cross-sectional views include a sagittal plane, a coronal plane, and a horizontal plane.

 [0048] S103. Display three cross-sectional views of the three-dimensional model and the three-dimensional model (as shown in FIG. 2).

 [0049] In the first embodiment of the present invention, the sagittal plane, the coronal plane and the horizontal plane all pass through the center position of the original image, as shown in FIG.

 [0050] S104, adjusting the position of the cutting plane and the cutting direction to visually observe the condition of the cut surface of the spine.

In the first embodiment of the present invention, in each of the three cross-sectional views, each of the cut-away views has a cut line of two other cut-away views. The section plane can be translated and rotated.

[0052] S 104 may specifically be: [0053] when the mouse selects a section line within the image range of the section plane, and then moves up and down or left and right, and translates the section plane of the three-dimensional model;

 [0054] When the mouse selects the cutting line outside the image range of the cutting plane and then moves up and down or left and right, the intersection position of the cutting line does not change, and the coordinates of the selected point of the cutting line move with the movement of the mouse, so that the cutting line surrounds the intersection point. And rotating;

 [0055] After changing the section line of one section view, the other two section views are also changed accordingly.

[0056] S105. Determine the nail path of the screw by the intersection line of the cutting planes in the two directions.

 [0057] With the addition of a screw 吋, the nail path of the screw is the intersection of the transverse section (initially horizontal) and the anterior and posterior section (initial sagittal plane). In this way, by adjusting the cutting plane, the details of the nail path can be observed, so that the planning of the nailing is more precise.

[0058] By adjusting the cutting plane, the nail path can be more accurately planned, making the nailing safer and more reliable. The adjusted cutaway view is shown in Figure 4.

[0059] S106. Add a screw on the determined nail path.

 [0060] The cutting plane is adjusted, and the nail insertion point and the nail insertion direction are planned. The entry point is the intersection of the screw along the nail path from the outside to the bone tissue of the three-dimensional model and the nail contact with the bone tissue. The direction of the nail is from the point of the nail to the direction of the nail. This way, you can add screws directly.

[0061] After selecting the screw size (diameter and length), you can add screws. Add screws as shown in Figure 5.

[0062] S107. Move the screw in the direction of the nail path so that the screw is in the actual surgical position, and the screw is planned.

 [0063] In the first embodiment of the present invention, S107 is specifically: moving the screw in the direction of the nail path, moving the screw root of the screw to the position of the nail insertion point, so that the screw is in the actual surgical position, completing the screw planning, such as Figure 6 shows.

 [0064] Since one screw is placed in one operation, the next screw needs to be planned after completing one screw. Therefore, in the first embodiment of the present invention, the following steps may be further included after S107:

 [0065] The planned screw is superimposed with the three-dimensional model as an integral three-dimensional model to participate in the planning of the next screw. This allows for better planning of each screw to avoid mutual interference.

 [0066] In the first embodiment of the present invention, the following steps may be further included after S107:

[0067] When a screw needs to be re-planned, remove the screw and return to S104. [0068] Embodiment 2:

 [0069] Embodiment 2 of the present invention provides a computer readable storage medium, where the computer readable storage medium stores a computer program, and the computer program is executed by a processor to implement a three-dimensional simulation provided by Embodiment 1 of the present invention. The steps of the planning method for surgical nail placement.

 [0070] Embodiment 3:

 7 is a block diagram showing a specific structure of a surgical simulator according to Embodiment 3 of the present invention. A surgical simulator includes:

[0072] one or more processors 101;

[0073] the memory 102;

 [0074] one or more computer programs, wherein the one or more computer programs are stored in the memory and configured to be executed by the one or more processors, the processor executing the computer The program 吋 implements the steps of the three-dimensional simulated surgical nail placement planning method provided by the first embodiment of the present invention.

 The above description is only the preferred embodiment of the present invention, and is not intended to limit the present invention. Any modifications, equivalents, and improvements made within the spirit and scope of the present invention should be included in the present invention. Within the scope of protection of the invention.

Claims

Claim  [Claim 1] A method for planning a three-dimensional simulated surgical staple, the method comprising: performing three-dimensional modeling according to a CT image of a received spine to generate a three-dimensional model; and generating three cut-away images according to the three-dimensional model ;  Display three cutaway views of the 3D model and the 3D model;  Adjust the position and cutting direction of the section to visually observe the condition of the section of the spine. Determine the nail path of the screw by the intersection of the cutting planes in two directions; add screws to the determined nail path;  Move the screw in the direction of the nail path so that the screw is in the actual surgical position and complete the screw planning.  [Claim 2] The method according to claim 1, wherein the three cross-sectional views include a sagittal plane, a coronal plane, and a horizontal plane.  [Clave 3] The method according to claim 2, wherein the sagittal plane, the coronal plane, and the horizontal plane pass through a center position of the original image. [Claim 4] The method according to claim 1, wherein in the three cross-sectional views, each of the cut-away views has a cut line of two other cut-away views, and the cut-away surface can be translated and rotated. [Claim 5] The method according to claim 4, wherein the adjusting the position and the cutting direction of the cutting plane is specifically as follows:  When the mouse selects the cutting line in the image range of the section plane, and then moves up and down or left and right, the plane of the three-dimensional model is translated;  When the mouse selects the cutting line outside the image range of the cutting plane and moves up and down or left and right, the intersection position of the cutting line does not change, and the coordinates of the selected point of the cutting line move with the movement of the mouse, so that the cutting line rotates around the intersection;  When the section line of a section view is changed, the other two section views are also changed accordingly. [Claim 6] The method according to claim 1, wherein the screw is moved in the direction of the nail path so that the screw is in the actual surgical position, and the planning of the completed screw is specifically as follows: Move the screw in the direction of the nail path, move the screw root of the screw to the position of the nail point, make the screw in the actual surgical position, and complete the screw planning.  [Claim 7] The method according to claim 1, wherein the moving the screw in the direction of the nail path to place the screw in the actual surgical position, after the screw is planned, the method further includes:  The planned screws are superimposed with the 3D model and participate in the planning of the next screw as a whole 3D model.  [Claim 8] The method according to claim 1, wherein the moving the screw in the direction of the nail path to place the screw in the actual surgical position, after the screw is planned, the method further includes:  When the screw needs to be re-planned, remove the screw and return to the step of adjusting the position and cutting direction of the cutting plane.  [Claim 9] A computer readable storage medium storing a computer program, wherein the computer program is executed by a processor, implementing the method of any one of claims 1 to The steps of the 3D simulation surgical placement method of the nail.  [Claim 10] A surgical simulator comprising:  One or more processors;  Memory;  One or more computer programs, wherein the one or more computer programs are stored in the memory and configured to be executed by the one or more processors, wherein the processor performs the The computer program is the step of implementing the method of planning a three-dimensional simulated surgical staple according to any one of claims 1 to 8.