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Sistema de visão para apoio à cirurgia ortopédica de trocleoplastia

December, 27 2016 2 minute read


Pedro Gil Fantasia Lourenço


Cristina Manuela Peixoto Santos, Victor Alves & Manuel Vieira da Silva


Displasia Troclear, Trocleoplastia, Planeamento cirúrgico, 3D Slicer, Trochlear dysplasia, Trochleoplasty, Surgical planning, 3d Slicer

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Surgery force the surgeons to a detailed work which often depends on his experience and insight into it. Best results may be obtained if these professionals are supported by imaging systems or robotic systems. This project deals with the first one, in a preparation before surgery, providing to the doctor a perspective by a pre-operative plan. Surgery requires a study on the patient who will be subject, so as to produce a surgical planning. This is done through image, through xrays, computed tomographys (CT) and magnetic resonances (MRI). This preparation is based on calculation of measurements and angles of the human anatomy that are required to study to address the problem that the person suffers. Currently, these measurements are made by surgeons in digital imaging systems, and therefore planning is dependent on the surgeon's experience and skill, using methods of "trial and error" during surgery. So it would be interesting to provide to surgeon a tool which somehow become more accurate the surgical planning, ideally by providing a cutting guide. This project addresses the trochleoplasty. The trochleoplasty is an orthopaedic surgery which consists in cutting the trochlea - distal part of the femur - deepening it, in order to stabilize the patellofemoral joint. It is required to provide to the doctor a cutting guide of the trochlea. The motivating force for this research comes from the need to remove the pressure at which surgeons are subject. There are already some pre-operative plannning surgery supporting softwares as OrthoView or PreOperativePlan, however it not refer trochleoplasty. In order to obtain a good bone repair a three dimensional imaging system is required. In a general perspective, it is intend to develop a previously customized cutting guide according to the anatomical characteristics of the patient. However, to achieve this objective, the design of a correction should aim to an anatomically normal knee, to perform a correction that approaches the characteristics as much as possible as the general population (without patellar instability). Thus, the overall objective of this work is to develop a software application that provides to the surgeon a preoperative and post-operative vision of surgery in three dimensions. Software should also make the calculation of the necessary measures and angles of the human anatomy, as well as check the patella-femoral relations that are necessary to know. Tests will be done to calculations made by software, comparing them to the calculations made by radiologists. Based on the above and with the aid of literature a bone cutting is simulated. This will need to do a comprehensive survey of the type of information used by surgeons to make the cut, and turn them into rules that can be used in planning. The cutting planning and the possible generation of guiding cuts provided by the program will also be discussed with surgeons. The cut is simulated and the three dimensional volume of the new form of the trochlea after correction is presented.

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