臺灣博碩士論文加值系統

在現今醫療領域中，傳統的手術導航依賴於光學追蹤技術，此方式使醫生在手術中需多次轉移視線至外部顯示器，以獲取導航資訊。這一分散注意力的需求可能影響手術操作的精確性與直覺性。擴增實境(Augmented Reality，AR）技術的引入，則提供一種將數位資訊直接覆蓋於醫生視野的方法，改進傳統手術導航系統的局限。本研究利用Microsoft Hololens 2 頭戴式裝置實施三維空間的手術場景導航，透過Unity3D規劃三個場景：術前規劃、定位註冊及實時AR導航來進行脊椎植釘手術。術前規劃階段，醫生能夠在虛擬環境中擺放椎弓根釘，經過微調達到最佳位置。定位註冊階段，利用迭代最近點(Iterative Closest Point，ICP）進行虛擬和實體模型的重疊。實時AR導航階段，系統即時更新手術路徑，將規劃路徑顯示於醫生視野中，增強手術的直觀性與精確度。最後將掃描出的實體模型和虛擬模型使用Geomagic Studio軟體進行最佳擬合來計算椎弓根釘進入點與角度的誤差值。實驗結果顯示，使用本AR導航系統進行脊椎植釘手術，椎弓根釘進入點位置的平均誤差為2.16毫米，角度的平均誤差為6.13度。驗證後發現，主要誤差為QRcode的偵測精度不足及操作者的手部震動，為改善誤差值，本研究將手持骨鑽套筒改成使用機器臂扶持，重複三組實驗得到進入點的平均誤差為1.07毫米和角度的平均誤差為3.26度，精度有顯著提升，但角度誤差並未達到標準的2度內，未來將探討透過程式控制機器臂自動移動到手術導航路線，從而達到更高的手術導航精度。本研究證明AR結合三維視覺化工具和實時導航在提高手術直覺性和精確性方面的重要潛力，隨著技術的進一步發展和更廣泛的臨床應用，AR導航對於提升手術安全性和效率方面發揮關鍵作用。

In the current medical field, traditional surgical navigation relies on optical tracking technology, which requires surgeons to frequently divert their gaze to an external monitor to access navigation information during surgery. This necessity to divert attention can affect the precision and intuitiveness of surgical operations. The introduction of Augmented Reality (AR) technology offers a method to overlay digital information directly onto the surgeon's field of view, improving the limitations of traditional surgical navigation systems. This study employs the Microsoft Hololens 2 head-mounted device to implement three-dimensional spatial navigation for spinal pedicle screw placement surgery, using Unity3D to plan three scenarios: preoperative planning, localization registration, and real-time AR navigation. During the preoperative planning phase, surgeons can place pedicle screws in a virtual environment and adjust them to optimal positions. In the localization registration phase, the virtual and physical models are aligned using the Iterative Closest Point (ICP) algorithm. In the real-time AR navigation phase, the system updates the surgical path in real-time, displaying the planned path within the surgeon’s view, enhancing both the intuitiveness and accuracy of the surgery. Finally, the physical and virtual models are optimally fitted using Geomagic Studio software to calculate the errors in the entry points and angles of the screws. Experimental results show that using this AR navigation system for spinal pedicle screw placement surgery, the average error in screw entry point location is 2.16mm, and the average error in angle is 6.13 degrees. It was found that the main sources of error were insufficient QR code detection accuracy and the operator's hand tremor. To improve accuracy, this study modified the handheld bone drill sleeve to be supported by a robotic arm, repeating three sets of experiments which resulted in an average error of 1.07mm in entry points and 3.26 degrees in angles, significantly enhancing precision. However, the angular error did not meet the standard within 2 degrees. Future studies will explore controlling the robotic arm automatically through software to move along the surgical navigation path, thereby achieving higher surgical navigation precision. This research demonstrates the significant potential of AR combined with three-dimensional visualization tools and real-time navigation in enhancing the intuitiveness and accuracy of surgeries. With further technological development and broader clinical applications, AR navigation is poised to play a crucial role in improving surgical safety and efficiency.

摘要.....i
Abstract.....ii
誌謝.....iv
目錄.....v
表目錄.....vii
圖目錄.....viii
第一章 緒論.....1
1.1 背景.....1
1.2 研究動機與目的.....2
1.3 文獻回顧.....2
1.3.1 脊椎植釘導航手術.....2
1.3.2 椎弓根釘放置臨床要求.....3
1.3.3 Microsoft Hololens 2在醫療上應用.....4
1.3.4 脊椎植釘AR導航手術.....4
1.3.5 Vuforia在醫療上應用.....6
1.4 研究方法.....7
1.5 論文架構.....8
第二章 脊椎植釘手術與擴增實境原理.....9
2.1 脊椎植釘手術.....9
2.1.1 脊椎植釘手術的臨床功效.....10
2.1.2 脊椎植釘手術的種類.....10
2.1.3 脊椎植釘手術的導航應用.....11
2.2 擴增實境.....12
2.2.1 AR的基本原理.....12
2.2.2 AR的硬體種類.....13
2.2.3 Unity3D在AR上的應用.....13
2.2.4 結合AR之脊椎植釘手術流程說明.....14
2.3 數學原理與演算法.....15
第三章 AR手術導航系統設計與建置.....20
3.1 AR脊椎植釘手術導航系統規劃.....20
3.2 系統硬體.....21
3.2.1 Hololens 2的設定與連結.....22
3.2.2 骨鑽及相關器械.....23
3.3 虚擬環境軟體設計.....25
3.3.1 術前規劃.....25
3.3.2 定位註冊.....29
3.3.3 實時AR導航.....33
第四章 AR手術導航系統的性能驗證.....35
4.1 性能驗證的實驗設計與流程.....35
4.1.1 椎弓根釘植入手術設計.....35
4.1.2 性能驗證的流程.....36
4.2 實驗設備.....40
4.2.1 Geomagic Studio.....40
4.2.2 熱熔融層積3D列印(Fused Deposition Modeling, FDM).....40
4.2.3 3D結構光光柵掃描器(Shining3D EinScan-Pro).....42
4.2.4 扶持協作機器臂.....43
第五章 系統建置成果與驗證結果分析.....44
5.1 AR脊椎植釘手術導航系統的建置成果.....44
5.2 性能驗證結果.....45
5.2.1 椎弓根釘進入點誤差.....46
5.2.2 椎弓根釘進入角度誤差.....46
5.3 性能驗證誤差原因分析.....47
5.3.1 Vuforia QRcode偵測誤差.....47
5.3.2 3D掃描誤差.....48
5.3.3 Geomagic studio模型對齊誤差.....50
5.3.4 3D列印誤差.....51
5.3.5 ICP誤差.....52
5.3.6 手持與機器臂扶持誤差.....52
第六章 結論與未來展望.....55
6.1 結論.....55
6.2 未來展望.....56
參考文獻.....57
Extended Abstract.....59

1.Hagan, M.J., et al., Navigation techniques in endoscopic spine surgery. BioMed Research International, 2022. 2022(1): p. 8419739.
2.Otomo, N., et al., Computed tomography-based navigation system in current spine surgery: a narrative review. Medicina, 2022. 58(2): p. 241.
3.Wu, B., et al., A real-time 3D electromagnetic navigation system for percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a retrospective study. BMC Musculoskeletal Disorders, 2022. 23(1): p. 57.
4.Hussain, I., et al., Evolving navigation, robotics, and augmented reality in minimally invasive spine surgery. Global Spine Journal, 2020. 10(2_suppl): p. 22S-33S.
5.Zhang, Z.f., Freehand pedicle screw placement using a universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spines. Orthopaedic surgery, 2020. 12(1): p. 141-152.
6.Farshad, M., et al., Accuracy of patient-specific template-guided vs. free-hand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine: a randomized cadaveric study. European Spine Journal, 2017. 26: p. 738-749.
7.Jiang, B., et al., Three-dimensional assessment of robot-assisted pedicle screw placement accuracy and instrumentation reliability based on a preplanned trajectory. Journal of Neurosurgery: Spine, 2020. 33(4): p. 519-528.
8.Sun, Q., et al., Fast and accurate online calibration of optical see-through head-mounted display for AR-based surgical navigation using Microsoft HoloLens. International journal of computer assisted radiology and surgery, 2020. 15: p. 1907-1919.
9.Heining, S.-M., et al., Augmented reality-based surgical navigation of pelvic screw placement: an ex-vivo experimental feasibility study. Patient Safety in Surgery, 2024. 18(1): p. 3.
10.Tu, P., et al., Augmented reality based navigation for distal interlocking of intramedullary nails utilizing Microsoft HoloLens 2. Computers in Biology and Medicine, 2021. 133: p. 104402.
11.Pose-Díez-de-la-Lastra, A., et al., Real-time integration between Microsoft HoloLens 2 and 3D Slicer with demonstration in pedicle screw placement planning. International Journal of Computer Assisted Radiology and Surgery, 2023. 18(11): p. 2023-2032.
12.Kong, H., et al., Augmented Reality Navigation Using Surgical Guides Versus Conventional Techniques in Pedicle Screw Placement. Journal of Shanghai Jiaotong University (Science), 2023: p. 1-8.
13.Müller, F., et al., Augmented reality navigation for spinal pedicle screw instrumentation using intraoperative 3D imaging. The Spine Journal, 2020. 20(4): p. 621-628.
14.Cao, B., et al., A Pilot Human Cadaveric Study on Accuracy of the Augmented Reality Surgical Navigation System for Thoracolumbar Pedicle Screw Insertion Using a New Intraoperative Rapid Registration Method. Journal of Digital Imaging, 2023. 36(4): p. 1919-1929.
15.Elmi-Terander, A., et al., Pedicle screw placement using augmented reality surgical navigation with intraoperative 3D imaging: a first in-human prospective cohort study. Spine, 2019. 44(7): p. 517-525.
16.Elmi-Terander, A., et al., Surgical navigation technology based on augmented reality and integrated 3D intraoperative imaging: a spine cadaveric feasibility and accuracy study. Spine, 2016. 41(21): p. E1303-E1311.
17.Dennler, C., et al., Augmented reality-based navigation increases precision of pedicle screw insertion. Journal of orthopaedic surgery and research, 2020. 15: p. 1-8.
18.Bian, D., et al., The application of extended reality technology-assisted intraoperative navigation in orthopedic surgery. Frontiers in Surgery, 2024. 11: p. 1336703.
19.Moreta-Martinez, R., et al., Combining augmented reality and 3D printing to display patient models on a smartphone. JoVE (Journal of Visualized Experiments), 2020(155): p. e60618.
20.García-Sevilla, M., et al., Augmented reality as a tool to guide PSI placement in pelvic tumor resections. Sensors, 2021. 21(23): p. 7824.
21.Schneider, M., et al., Augmented reality–assisted ventriculostomy. Neurosurgical focus, 2021. 50(1): p. E16.
22. GLOBUS MEDICAL，CREO MIS® Stabilization System，Product Overview2024/6/20
https://www.globusmedical.com/products/creo-mis/
23. 股哥論壇：脊椎的常見疾病2024/6/20
https://bonebro.com/spine-co毫米on-symptom/
24. 頸椎退化：最常見的症狀居然不是肩頸不適！2024/6/20
https://azingstudio.weebly.com/cervical-spondylosis-symptoms.html
25. 脊椎手術治療椎間盤突出、脊椎滑脫：手術原理、費用、後遺症2024/6/20
https://www.presurgmedia.com/knowledge/spine-surgery
26. 廣告主應該開始關注AR 2024/6/20
https://www.brain.com.tw/news/articlecontent?ID=48476#TOutvC77
27. FDM和光固化3D列印技術如何選擇2024/6/20
https://3dlabstore.com.hk/blog/3d-printing-guide/how-to-choose-fdm-and-resin-3d- printing-technologies