定量評估表面註冊法於導航系統之準確度–應用於真人內視鏡鼻竇手術

Quantitative Evaluation of the Surface Registration Accuracy of Navigation Systems – in Live Endoscopic Sinus Surgery

張智銘(Chih-Ming Chang)

指導教授 ： 趙福杉

國立臺灣大學/工學院/醫學工程學研究所/博士(2017年)

https://doi.org/10.6342/NTU201701967

摘要

自1980年代起，功能性內視鏡鼻竇手術已廣泛應用於鼻竇疾患之治療。90年代開始，電腦輔助手術日益進展；在內視鏡手術合併即時影像導引之下，幫助醫師更清楚定位術中解剖構造，預防術中併發症發生。進行電腦輔助手術時，導航系統須對已儲存之術前影像及術中特定解剖位置進行連結，完成註冊步驟後，方能進行定位。而使用表面註冊法的導航效能，以及光學導航和電磁導航之比較，無論在活體手術或大體手術的研究則付之闕如。因此，本研究利用表面註冊法進行真人內視鏡鼻竇導航手術，探討導航系統的設置及手術時間，分析光學及電磁導航系統的導航準確度，分享我們臨床進行電腦輔助手術的經驗。
40名雙側慢性全鼻竇炎之患者納入本研究，接受內視鏡鼻竇手術，使用表面註冊法後，以電磁導航系統輔助進行手術。術中測量包含設備設置時間、表面註冊時間、手術時間，以及三個軸向的導航誤差。結果顯示：設備設置時間、表面註冊時間、手術時間分別為179 ± 23 秒、39 ± 4.8秒及114 ± 36分鐘。三個軸向的導航誤差顯示左右軸向的誤差顯著小於前後軸向誤差及頭尾軸向誤差。第二部分的研究納入30名雙側慢性全鼻竇炎之患者，手術醫師隨機於一側鼻腔進行光學導航內視鏡鼻竇手術，另一側鼻腔則進行電磁導航內視鏡鼻竇手術。術中測量包含表面註冊時間、手術時間，以及各軸向的導航誤差。結果顯示：光學導航系統之表面註冊時間顯著大於電磁導航系統，手術時間兩者則無明顯差異。無論在光學導航下或電磁導航下，各軸向的導航誤差皆顯示左右軸向的誤差顯著小於前後軸向誤差及頭尾軸向誤差。除此之外，比較光學導航與電磁導航，同一個解剖定位點測得之兩組導航誤差，相較之下皆無顯著差異。
總結來說，電磁導航系統的設備設置，和使用表面註冊法來進行光學及電磁導航，經研究顯示均為高效、便利且易於操作的。在臨床應用上，兩種導航系統的準確度差距不多，且誤差皆在可容許範圍內。除此之外，相較於前後軸向及頭尾軸向，左右軸向可測得最佳的準確度，光學導航如此，電磁導航亦同。

關鍵字

表面註冊 ； 光學導航系統 ； 電磁導航系統 ； 內視鏡鼻竇手術 ； 電腦輔助手術 ； 導航誤差 ； 導航準確度

並列摘要

Functional endoscopic sinus surgery has gained wide application in the management of sinus disease since the 1980s. The use of computer-aided surgery (CAS) technology was developed to assist surgeons in identifying anatomic landmarks during sinus surgery since the 1990s. In CAS, a correlation between a stored preoperative image data set and specific landmarks in the surgical area is required. However, studies on the performance of surface registration and comparisons between optic and electromagnetic navigation systems were lacking. Hence, the purpose of our study is to investigate time efficiency of system preparation and operation as well as the precision of optic and electromagnetic navigation systems using the surface registration in live endoscopic sinus surgery.
Forty patients with bilateral chronic paranasal pansinusitis underwent endoscopic sinus surgery. The surgeries were performed under electromagnetic navigation guidance after the surface registration had been carried out on all of the patients. The intraoperative measurements indicate the time taken for equipment set-up, surface registration and surgical procedure, as well as the degree of navigation error along the 3 axes. The result revealed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions. In the second part of our study, thirty patients with bilateral chronic paranasal pansinusitis underwent surgery on one side using optic navigation guidance and on the other side using electromagnetic navigation guidance. The intraoperative measurements performed included the time taken for the surface registration and surgical procedure on each side, as well as the navigation errors at the different locations. The result showed that the time for surface registration was significantly longer in the optic navigation group than the electromagnetic group. However, the time for surgical procedure has no significant difference between these 2 groups. A comparison of the navigation errors along the 3 axes showed that the deviation in the medial-lateral direction was significantly less than that in the anterior-posterior and cranial-caudal directions in the optic navigation group as well as the electromagnetic group. Furthermore, in comparison to the navigation error in each specific location, there was no significant difference between the optical and electromagnetic navigation groups.
In conclusion, the procedures of equipment set-up in electromagnetic navigation system, surface registration in both optic and electromagnetic navigation tracking are efficient, convenient and easy to manipulate. The accuracy of both navigation systems is comparable and within acceptable ranges for clinical use. In addition, the best accuracy was measured in the medial-lateral direction compared with the other two axes, either in optic or electromagnetic navigation system.

並列關鍵字

surface registration ； optic navigation system ； electromagnetic navigation system ； endoscopic sinus surgery ； computer-aided surgery ； navigation error ； navigation accuracy

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