醫學影像於數位化人工關節置換手術之研究

The Study on Digitized Total Knee Replacement in the Medical Images

廖漢星(Han-Hsing Liao)

指導教授 ： 王文騰

國立虎尾科技大學/工程學院/機械與電腦輔助工程系碩士班/碩士(2017年)

摘要

台灣隨著科技進步和醫學發達，目前步入高齡化社會，各種因老化所伴隨的疾病如退化性關節炎，因此需要關節手術的老年人相當多，醫學影像目前主要用途作為手術前的規劃和評估，大部分的骨病變病患在手術前都會進行電腦斷層攝影術。電腦斷層影像在醫院大部分只被用於二維的病理判讀，但一組序列式CT影像能夠提供病患身體的三維資訊，因此本研究基於電腦斷層影像提供三維資訊的特性研究項目包含:(1)人工膝關節手術術前規劃系統(2)客製化人工髖關節臼杯。

本研究人工膝關節手術術前規劃系統利用VC++建構生醫軟體之規劃介面及操作，整合本研究開發功能包含自動化下肢長骨分離擷取技術、下肢長骨機械軸及解剖學軸擷取及計算、虛擬截骨及虛擬人工關節裝配，藉此提供三維骨組織圖像顯示及術前規劃資訊，希望能讓醫師對於病人的病理資訊更透明化有助於術中開刀過程進行順利。

本研究發展一種客製化人工髖關節設計方法與設計流程，本研究程序上先進行前處理，透過醫學影像處理進行重建出病人骨盆3D模型，金屬假影造成3D模型失真的修復與PE塑膠襯墊空間上定位。進行完前處理，利用電腦輔助設計軟體進行客製化人工關節設計包含植體設計分析、固定模式分析、分割置分析等。設計完成讓醫師進行最後設計確認，確認完後進行多孔結構設計與STL三角網格檔案輸出，最後透過金屬3D列印生成客製化髖臼杯並且最後在手術時供醫師參考選用。

關鍵字

醫學影像系統 ； 膝關節 ； 客製化設計 ； 髖關節 ； 電腦斷層

並列摘要

With the progress of science, technology and the development of medicine, it has entered the aging society in Taiwan. A variety of diseases is accompanied by aging such as osteoarthritis, so the need for joint replacement surgery in the elderly is quite. The main purpose of medical image is as planning and preoperative evaluation. Most patients with bone disease take computerized tomography before surgery. Most of the computed tomography images are used only in two-dimensional pathologic interpretation, but a set of series CT images can provide the three-dimensional information of the patient body. This study is based on computer tomography images to provide three-dimensional information for (1) preoperative planning system for total knee arthroplasty and (2) customized hip joint cup.

In this study, a preoperative planning system with medical image interface and operation for Total Knee Replacement is developed by VC++. The system contains several functions such as automatic separation & extraction of bone for lower limb, the build of mechanical axis & anatomy axis and virtual osteotomy & virtual assembly of the artificial joint. It provides 3D bone image display and preoperative planning information also. The system can give a doctor more patient pathological information and help the surgery process smoother.

Besides, a design method & process of a customized hip joint is developed. First of all, the patient pelvic 3D model is reconstructed from medical images. Then, the distortion of the 3D model caused by metal artifact is fixed, and the PE plastic liner is positioned. After above pre-processes, the design of customized artificial joints is carried out by using CAD software. It includes implant geometry, fixed pattern, and segmentation. The design has to provide a doctor to make the final verification and confirmation. Then, the porous structure is created and output the STL triangular mesh file. Finally, a physical customized hip cup is generated by using metal 3D printing and is adapted in the surgery by a doctor.

並列關鍵字

Preoperative Planning ； Metal 3D Printer ； Customized Implants ； Revision arthroplasty of the hip ； Artificial Hip Joint

參考文獻

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