术中X线导航下髋臼周围截骨骨折块的位姿估计
Pose Estimation of Periacetabular Osteotomy Fragments with Intraoperative X-Ray Navigation
摘要：
目的：骨盆截骨术的最新导航系统使用具有外部基准的光学系统。我们建议使用X射线导航的髋臼周围碎片没有基准的姿态估计。方法：采用2D/3D配准流水线进行碎片姿态恢复。通过广泛的模拟研究和6例尸体手术对该管道进行了测试。使用透视图像中的截骨边界，术前计划被细化以更准确地匹配术中形状。结果如下：在模拟中，当计划碎片与术中碎片匹配时，平均碎片姿态误差为1.3°/1.7 mm，当计划未更新以匹配真实形状时为2.2°/2.1 mm，当术中估计碎片形状时为1.9°/2.0 mm。在尸体实验中，当与实际碎片形状、术前计划和术中细化计划配准时，平均位姿误差分别为2.2°/2.2 mm、3.8°/2.5 mm和3.5°/2.2 mm。在模拟和尸体实验中，所有碎片形状的外侧中心边缘角的平均误差小于2°。结论：申报产品线能够在临床确定的长期关节存活率范围内准确报告股骨头覆盖率。意义：人类对碎片姿势的解释具有挑战性，通常仅限于围绕单个解剖轴旋转。所提出的管道提供相对于所有解剖轴的刚性姿势的术中估计，与微创切口兼容，并且不依赖于外部基准。
英文摘要：
Objective: State of the art navigation systems for pelvic osteotomies use optical systems with external fiducials. We propose the use of X-Ray navigation for pose estimation of periacetabular fragments without fiducials. Methods: A 2D/3D registration pipeline was developed to recover fragment pose. This pipeline was tested through an extensive simulation study and 6 cadaveric surgeries. Using osteotomy boundaries in the fluoroscopic images, the preoperative plan is refined to more accurately match the intraoperative shape. Results: In simulation, average fragment pose errors were 1.3°/1.7 mm when the planned fragment matched the intraoperative fragment, 2.2°/2.1 mm when the plan was not updated to match the true shape, and 1.9°/2.0 mm when the fragment shape was intraoperatively estimated. In cadaver experiments, the average pose errors were 2.2°/2.2 mm, 3.8°/2.5 mm, and 3.5°/2.2 mm when registering with the actual fragment shape, a preoperative plan, and an intraoperatively refined plan, respectively. Average errors of the lateral center edge angle were less than 2° for all fragment shapes in simulation and cadaver experiments. Conclusion: The proposed pipeline is capable of accurately reporting femoral head coverage within a range clinically identified for long-term joint survivability. Significance: Human interpretation of fragment pose is challenging and usually restricted to rotation about a single anatomical axis. The proposed pipeline provides an intraoperative estimate of rigid pose with respect to all anatomical axes, is compatible with minimally invasive incisions, and has no dependence on external fiducials.
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