CN115105201B - Sacral nerve foramen positioning method and positioning system based on holographic image and application thereof - Google Patents
Sacral nerve foramen positioning method and positioning system based on holographic image and application thereof Download PDFInfo
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- CN115105201B CN115105201B CN202210489955.2A CN202210489955A CN115105201B CN 115105201 B CN115105201 B CN 115105201B CN 202210489955 A CN202210489955 A CN 202210489955A CN 115105201 B CN115105201 B CN 115105201B
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- 210000005036 nerve Anatomy 0.000 title claims abstract description 51
- 238000000034 method Methods 0.000 title claims abstract description 30
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- 238000012545 processing Methods 0.000 claims description 9
- 210000000988 bone and bone Anatomy 0.000 claims description 6
- 238000005259 measurement Methods 0.000 claims description 5
- 230000003187 abdominal effect Effects 0.000 claims description 4
- 238000001914 filtration Methods 0.000 claims description 4
- 239000011521 glass Substances 0.000 claims description 4
- 206010033675 panniculitis Diseases 0.000 claims description 4
- 210000004304 subcutaneous tissue Anatomy 0.000 claims description 4
- 210000001015 abdomen Anatomy 0.000 claims description 2
- 238000009499 grossing Methods 0.000 claims description 2
- 230000000877 morphologic effect Effects 0.000 claims description 2
- 239000003550 marker Substances 0.000 claims 1
- 238000005516 engineering process Methods 0.000 abstract description 4
- 206010002091 Anaesthesia Diseases 0.000 description 9
- 230000037005 anaesthesia Effects 0.000 description 9
- 230000033228 biological regulation Effects 0.000 description 4
- 238000002591 computed tomography Methods 0.000 description 4
- 238000012549 training Methods 0.000 description 4
- 238000001467 acupuncture Methods 0.000 description 3
- 238000010146 3D printing Methods 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
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- 238000004519 manufacturing process Methods 0.000 description 2
- 230000004007 neuromodulation Effects 0.000 description 2
- 210000003903 pelvic floor Anatomy 0.000 description 2
- 230000035515 penetration Effects 0.000 description 2
- 230000000153 supplemental effect Effects 0.000 description 2
- 230000000007 visual effect Effects 0.000 description 2
- 208000014540 Functional gastrointestinal disease Diseases 0.000 description 1
- 206010020853 Hypertonic bladder Diseases 0.000 description 1
- 208000005615 Interstitial Cystitis Diseases 0.000 description 1
- 208000000693 Neurogenic Urinary Bladder Diseases 0.000 description 1
- 206010029279 Neurogenic bladder Diseases 0.000 description 1
- 208000009722 Overactive Urinary Bladder Diseases 0.000 description 1
- 208000000921 Urge Urinary Incontinence Diseases 0.000 description 1
- 206010046555 Urinary retention Diseases 0.000 description 1
- 230000002159 abnormal effect Effects 0.000 description 1
- 230000032683 aging Effects 0.000 description 1
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- 230000009286 beneficial effect Effects 0.000 description 1
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- 230000004064 dysfunction Effects 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 230000004807 localization Effects 0.000 description 1
- 210000004705 lumbosacral region Anatomy 0.000 description 1
- 230000027939 micturition Effects 0.000 description 1
- 230000007433 nerve pathway Effects 0.000 description 1
- 230000000414 obstructive effect Effects 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 208000020629 overactive bladder Diseases 0.000 description 1
- 230000036407 pain Effects 0.000 description 1
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- 238000002360 preparation method Methods 0.000 description 1
- 230000005855 radiation Effects 0.000 description 1
- 230000011514 reflex Effects 0.000 description 1
- 238000007789 sealing Methods 0.000 description 1
- 239000007787 solid Substances 0.000 description 1
- 210000005070 sphincter Anatomy 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
- 238000012360 testing method Methods 0.000 description 1
- 210000003708 urethra Anatomy 0.000 description 1
- 206010046494 urge incontinence Diseases 0.000 description 1
- 238000012795 verification Methods 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/101—Computer-aided simulation of surgical operations
- A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/107—Visualisation of planned trajectories or target regions
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2065—Tracking using image or pattern recognition
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Medical Informatics (AREA)
- Robotics (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
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Abstract
The invention relates to a sacral nerve hole positioning method based on a holographic image technology, which comprises the steps of determining the position of a sacral nerve hole in a three-dimensional space in a human body and determining the position of the sacral nerve hole in body surface projection.
Description
The present invention claims priority to chinese patent application No. c 202110500790.X, the contents of which are set forth in the specification, drawings of the specification and claims are incorporated in their entirety into the specification of the present invention and are incorporated as part of the original description of the present invention. The applicant further states that the applicant has the right to modify the description and claims of the invention based on this priority file.
Technical Field
The invention relates to a sacral nerve hole positioning method based on a holographic image technology, which comprises the steps of determining the position of a sacral nerve hole in a three-dimensional space in a human body and determining the position of the sacral nerve hole in body surface projection.
Background
With the increasing aging of the society in China, the incidence of urination dysfunction is gradually increased, and more patients receiving sacral N regulation treatment are more and more.
The sacral nerve regulation is a nerve regulation technology which uses an interventional technology to continuously apply low-frequency electric pulses to specific sacral nerves, excite or inhibit nerve pathways and regulate abnormal sacral nerve reflex arcs so as to influence and regulate functions of sacral nerve innervating target organs such as bladder, urethra/anal sphincter, pelvic floor and the like, thereby achieving a treatment effect. Sacral neuromodulation has been used in recent years as an effective treatment for refractory overactive bladder, urge incontinence, non-obstructive urinary retention and bowel dysfunction, interstitial cystitis, pelvic floor pain syndrome, neurogenic bladder, and the like.
The sacrum is formed by fusing 5 sacral vertebrae, and 4 pairs of anterior sacral foramina and 4 pairs of posterior sacral foramina are formed by respective superior and inferior trajectories. The sacral nerve foramina are distributed on both sides of the sacrum on the dorsal aspect of the sacrum, are substantially symmetrically distributed, and have the posterior branches of the sacral nerve passing through. The first step in the surgical approach to sacral neuromodulation is to install a test electrode, wherein the 3 rd sacral foraminal penetration is the key element. The sacral nerve hole is deeper, the aperture is narrow, the angle is changeable, the body surface characteristics are not obvious, and the blind penetration positioning is difficult.
At present, X-ray, B-type ultrasonic or 3D printing models are used for positioning the sacral foramina, but the methods have defects of different degrees. For example, B-type ultrasonic waves have the problems of low penetrating power, repeated reflection during reflection and the like, 3D printing has the problems of high cost, long preparation time and the like, and are difficult to popularize at present, and in addition, the x-ray positioning method commonly applied clinically at present causes harm to doctors and patients due to large radiation quantity.
In addition, the accurate positioning of the sacral nerve foramen has great application value for traditional Chinese medicine massage, acupuncture, self-rehabilitation training, sacral nerve block through the sacral nerve foramen or external anesthesia and supplementary anesthesia of sacral canal. In practice, the position of the sacral foramen can be found accurately on the body surface, and plays a decisive role in anesthesia or sealing effect.
Therefore, there is an urgent need in the art for a method of precisely, quickly and conveniently locating the sacral foramen.
Disclosure of Invention
The inventors have unexpectedly found that the application of holographic imaging techniques to locate the sacral foramina can effectively achieve accurate and convenient location of the sacral foramina.
In this regard, the inventors creatively propose a "biplane positioning method" whereby accurate positioning of the sacral foramen can be achieved. According to the principle of solid geometry correlation, a line can be defined through two space planes, a point is defined through two intersecting lines, or anatomical feature points are defined by a method of directly picking up three-dimensional coordinate points by a mouse, and the linear distance between the two space points and the projection length of the linear distance on another reference plane are measured. However, since the human spine bone is a complex and variable special structure, the three-dimensional reconstruction model is also difficult to precisely quantify and formulate the measurement standard according to certain anatomical feature points, so that the measurement of the complex and currently non-measurable three-dimensional image of the human spine bone is still a hot spot and difficulty in three-dimensional measurement.
Specifically, the inventor finds that the object pelvic data is obtained through CT or MRI, the data is subjected to three-dimensional reconstruction through holographic image processing to obtain a virtual image, and the holographic image is subjected to specific processing to obtain the projection point of the central point of the sacral nerve hole on the body surface, so that the relative position relation between the projection point and the real point can be determined, and the purpose of positioning the sacral nerve hole through the holographic image is further realized.
Based on the above findings, in a first aspect, the present invention provides a sacral nerve foramen positioning method, characterized in that the method comprises the steps of:
Step A, determining the position of a sacral nerve hole center point in a three-dimensional space in a human body;
And B, determining the position of the central point of the sacral nerve hole at the body surface projection point A', wherein the method specifically comprises the following steps:
1) Performing pelvic CT or MRI examination on the prone position object to obtain data;
2) Using CT or MRI acquired data to make pelvic cavity holographic image;
3) The method comprises the steps of applying treatment to a prone position object, wherein the treatment comprises the step of rotating a holographic image to the back side of an observed human body by using a workstation with buttocks as the center;
4) Marking the tip of the tail bone of a human body as a point A, and making a vertical longitudinal section A surface through the point A, wherein the A surface passes through the sacrum midline of the spine;
5) Removing skin and subcutaneous tissue from the hologram, exposing the sacrum;
6) Marking the center points of left and right third sacral nerve holes as a point B and a point B 'respectively by utilizing a holographic image, marking the vertical intersection point of a straight line BB' and the central line of the sacrum of the spine as a point C, measuring the distance BC, and making a cross section BC through the straight line BC, wherein the cross section BC is vertical to the vertical longitudinal section A;
7) The perpendicular distance from the center point B of the third sacral foramina to the buttock skin surface is measured using a holographic sagittal plane map.
In the sacral foramen locating method of the present invention, the location of the sacral foramen can be determined based on the cross section BC and the vertical longitudinal section a and the vertical distance from the center point B of the third sacral foramen to the skin surface of the buttocks.
Preferably, using a holographic image, the angle of inclination of the real sacral foramina relative to the virtual vertical foramina can be measured based on the virtual vertical foramina, and the angular relationship can be used to assist in determining the location of the sacral nerve foramina.
In the sacral nerve hole positioning method of the present invention, preferably, the workstation is mounted on a personal computer, a mobile phone or a tablet computer, more preferably, the workstation is mounted on a mobile phone or a tablet computer, and the tablet computer may be, for example, an iPad.
In a preferred embodiment of the invention, in step B) 3), an abdominal cushion is placed over the abdomen of the subject to maintain the subject in the same posture as when the CT/MRI examination was performed prior to sacral foramen positioning. Preferably, the subject abdominal cushion comprises two sizes, each size comprising two identical abdominal cushions, suitable for application in CT/MRI examinations and operating rooms, respectively.
In a preferred embodiment of the invention, in step 2) of step B, pelvic holograms are produced using DICOM data of CT.
In a preferred embodiment of the present invention, the sacral foramen localization method further comprises the step of morphological processing of the image, specifically comprising:
median filtering is carried out on the image;
performing an opening operation on the image after the median filtering to obtain a specific sacral foramen region image;
performing gaussian smoothing on the specific sacral foramen region image;
and performing opening operation on the Gaussian smoothed sacral foramen region image to obtain the sacral foramen region image.
In a second aspect of the invention, there is also provided a sacral nerve foramina positioning system, characterized in that the system comprises a graphics measurement module, a CT system or MRI system, a three-dimensional reconstruction module, holographic image glasses, and a holographic image processing module.
Preferably, the sacrum positioning system further comprises a positioning mark patch or a body surface positioning two-dimensional code patch for marking. In some preferred embodiments, the positioning mark patches are body surface positioning mark patches, preferably 3, and in other preferred embodiments, the positioning mark patches are body surface positioning two-dimensional code patches, preferably 3.
The holographic image glasses used in the sacral nerve foramina positioning system of the present invention are preferably holonens 2 glasses.
Particularly preferably, the sacral foramen positioning system of the present invention is for the purpose of sacral nerve puncture positioning guidance. Accordingly, the system may additionally include a surgical presentation module and/or a pre-operative planning module.
The sacral foramen positioning system of the present invention can also be used in anesthesia, acupuncture, self-rehabilitation training, post-sacral Kong Zuzhi anesthesia, or supplemental anesthesia for the epidural anesthesia of the sacral canal.
Accordingly, in a third aspect, the present invention provides the use of the sacral positioning system of the invention for sacral nerve puncture positioning guidance, sacral nerve modulation surgery training, anesthesia, acupuncture, self-rehabilitation training, post-sacral Kong Zuzhi anesthesia, or supplemental anesthesia for sacral canal epidural anesthesia.
In the method of the invention, a scanned image of the patient's back can also be acquired using MRI, and the patient's spinal length and sacral width can be measured from the scanned image obtained. An equilateral triangle can be constructed with the patient's sacral width as the base, with the apex of the equilateral triangle (BB' C) located on the lumbar spine
Drawings
Fig. 1 is a schematic view of a sacral foramen center point projected at a location of point a' on a body surface;
FIG. 2 is a schematic illustration of the coccyx tip marked as point A;
FIG. 3 is a schematic view of a vertical longitudinal section A taken through the point A of the coccyx tip as determined in accordance with the present invention;
fig. 4 is a schematic view of the central points of the left and right third sacral foramina of the present invention, labeled as point B and point B', respectively;
fig. 5 is a schematic view illustrating the determination of a straight line BB' and its vertical intersection point C with the sacral midline of the spinal column in the positioning method of the present invention;
fig. 6 is a schematic view of a cross section BC taken through line BC perpendicular to the vertical longitudinal plane a in the positioning scheme of the present invention.
Detailed Description
It should be understood that the detailed description is presented by way of example only and is not intended to limit the invention.
The following description of the embodiments of the present invention is provided to facilitate understanding of the present invention by those skilled in the art, but it should be understood that the present invention is not limited to the scope of the embodiments, and that all the inventions using the inventive concept are within the scope of the present invention as long as various changes are apparent to those skilled in the art within the spirit and scope of the present invention as defined and defined in the appended claims.
Unless otherwise indicated, terms used in this disclosure have the ordinary meaning as understood by one of ordinary skill in the art.
The invention is further described and illustrated below with reference to the accompanying drawings.
In one embodiment of the invention, the position of the central point of the sacral nerve foramen in the three-dimensional space in the human body is determined firstly, and then the position of the central point of the sacral nerve foramen in the body surface projection point A' is determined by the following steps:
1) The clinical patient adopts prone position, adopts CT to carry out pelvic examination, and obtains CT scanning data;
2) Uploading the DICOM data of the CT scanning to a data processing module (a three-dimensional reconstruction module) to manufacture a pelvic cavity holographic image;
3) The method comprises the steps of carrying out application treatment on a prone patient, taking buttocks as the center, and rotating a holographic image to the back side of an observed human body by using a workstation, wherein in actual treatment, the holographic image can be observed in a three-dimensional, visual and multi-angle manner, and can be subjected to various operations such as zooming in, zooming out, moving, transparency adjustment and the like;
4) Marking the tip of the tail bone of a patient as a point A, and making a vertical longitudinal section A surface through the point A so that the A surface passes through the sacrum midline of the spine (see figure 3);
5) Removing skin and subcutaneous tissue from the pelvic hologram to expose the sacrum;
6) Marking the center points of the left and right third sacral nerve holes as a point B and a point B ' respectively by utilizing a holographic image, making a straight line BB ', marking the vertical intersection point of the straight line BB ' and the central line of the sacrum of the spine as a point C, measuring the distance of the BC, and making a cross section BC through the straight line BC so as to be vertical to the vertical longitudinal section A (see figures 4 and 5);
7) The perpendicular distance from the center point B of the third sacral foramina to the buttock skin surface is measured using a holographic sagittal plane map.
The location of the sacral foramen can be determined from the transverse plane BC and the vertical longitudinal plane a, as well as the vertical distance from the center point B of the third sacral foramen to the skin surface of the buttocks.
In another embodiment of the present invention, the location of the central point of the sacral foramen in the stereoscopic space in the human body is first determined, and then the location of the central point of the sacral foramen in the body surface projected point A' is determined by the steps of:
1) The clinical patient adopts prone position, adopts CT to carry out pelvic examination, and obtains CT scanning data;
2) Uploading the DICOM data of the CT scanning to a data processing module (a three-dimensional reconstruction module) to manufacture a pelvic cavity holographic image;
3) The method comprises the steps of carrying out application treatment on a prone patient, taking buttocks as the center, and rotating a holographic image to the back side of an observed human body by using a workstation, wherein in actual treatment, the holographic image can be observed in a three-dimensional, visual and multi-angle manner, and can be subjected to various operations such as zooming in, zooming out, moving, transparency adjustment and the like;
4) Marking the tip of the tail bone of a patient as a point A, and making a vertical longitudinal section A surface through the point A so that the A surface passes through the sacrum midline of the spine (see figure 3);
5) Removing skin and subcutaneous tissue from the pelvic hologram to expose the sacrum;
6) Marking the center points of the left and right third sacral nerve holes as a point B and a point B ' respectively by utilizing a holographic image, making a straight line BB ', marking the vertical intersection point of the straight line BB ' and the central line of the sacrum of the spine as a point C, measuring the distance of the BC, and making a cross section BC through the straight line BC so as to be vertical to the vertical longitudinal section A (see figures 4 and 5);
7) Measuring the vertical distance from the central point B of the third sacral nerve hole to the buttock skin surface by utilizing the holographic image sagittal plane map;
8) And measuring the inclination angle of the real sacral foramina relative to the virtual vertical foramina based on the virtual vertical foramina by using the holographic image.
The location of the sacral foramen is determined based on the transverse plane BC and the vertical longitudinal plane a and the vertical distance from the center point B of the third sacral foramen to the skin surface of the buttocks, and with reference to the inclination angle of the real sacral foramen with respect to the virtual vertical foramen.
The sacral nerve hole position determined according to the embodiment can well realize the sacral nerve hole positioning through multiple times of operation practice verification, and the expected purpose of operation is completed. The method is accurate and convenient, is beneficial to realizing planning and demonstration of operations such as sacral nerve regulation and control operation and the like, and uses the planning demonstration result as navigation of operation.
The holographic image information obtained by the processing is fused with the actual affected part of the patient, so that the purposes of preoperative planning, intraoperative demonstration and navigation can be realized.
Claims (9)
1. A method of locating a sacral foramen, the method comprising the steps of:
Step A, determining the position of a sacral nerve hole center point in a three-dimensional space in a human body;
And B, determining the position of the central point of the sacral nerve hole at the body surface projection point A', wherein the method specifically comprises the following steps:
1) Performing pelvic CT or MRI examination on the prone position object to obtain data;
2) Using CT or MRI acquired data to make pelvic cavity holographic image;
3) The method comprises the steps of applying treatment to a prone position object, wherein the treatment comprises the step of rotating a holographic image to the back side of an observed human body by using a workstation with buttocks as the center;
4) Marking the tip of the tail bone of a human body as a point A, and making a vertical longitudinal section A surface through the point A, wherein the A surface passes through the sacrum midline of the spine;
5) Removing skin and subcutaneous tissue from the hologram, exposing the sacrum;
6) Marking the center points of left and right third sacral nerve holes as a point B and a point B 'respectively by utilizing a holographic image, marking the vertical intersection point of a straight line BB' and the central line of the sacrum of the spine as a point C, measuring the distance BC, and making a cross section BC through the straight line BC, wherein the cross section BC is vertical to the vertical longitudinal section A;
7) The perpendicular distance from the center point B of the third sacral foramina to the buttock skin surface is measured using a holographic sagittal plane map.
2. The sacral foramen positioning method as recited in claim 1, wherein the location of the sacral foramen is determined based on the transverse plane BC and the vertical longitudinal plane a and the vertical distance from the center point B of the third sacral foramen to the skin surface of the buttocks.
3. The sacral nerve foramen positioning method according to claim 1 or 2, wherein the workstation is mounted on a cell phone or tablet computer.
4. The sacral foramen positioning method according to claim 1 or 2, wherein in step B) an abdominal cushion is placed on the abdomen of the subject so that the subject remains in the same posture as when the CT examination was performed prior to the sacral foramen positioning.
5. The sacral nerve foramen positioning method according to claim 1 or 2, further comprising morphological processing of the image, specifically comprising:
median filtering is carried out on the image;
performing an opening operation on the image after the median filtering to obtain a specific sacral foramen region image;
performing gaussian smoothing on the specific sacral foramen region image;
and performing opening operation on the Gaussian smoothed sacral foramen region image to obtain the sacral foramen region image.
6. A sacral nerve foramen positioning system for implementing the sacral nerve foramen positioning method according to claim 1, wherein the system comprises a graphics measurement module, a CT system or MRI system, a three-dimensional reconstruction module, holographic image glasses, and a holographic image processing module.
7. The sacral nerve foramen positioning system according to claim 6, further comprising a positioning marker patch for marking.
8. The sacral nerve foramen positioning system according to claim 6 or 7 for use in sacral nerve puncture positioning guidance.
9. The sacral nerve foramen positioning system according to claim 6 or 7, further comprising a pre-operative planning module.
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| CN109549689A (en) * | 2018-08-21 | 2019-04-02 | 池嘉昌 | A kind of puncture auxiliary guide device, system and method |
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| CN110891488B (en) * | 2017-03-09 | 2023-05-23 | 史密夫和内修有限公司 | sagittal rotation determined |
| CN108143501B (en) * | 2017-12-15 | 2021-11-30 | 苏州科灵医疗科技有限公司 | Anatomical projection method based on body surface vein features |
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