CN106667555B - Medical sacral nerve puncture positioning and guiding system - Google Patents

Abstract

The invention relates to a medical sacral nerve puncture positioning and guiding system, which solves the technical problem that in the existing sacral nerve adjustment operation process, the main experience of an operator is still relied on during sacral nerve puncture, and puncture is difficult to complete after one or more times of test. The medical sacral nerve puncture positioning and guiding system comprises an open main frame, wherein a computer host, a first display screen and a keyboard which are connected with the computer host are arranged on the open main frame; one side of the open main frame is connected with an arc-shaped frame, an arc-shaped inner ring of the arc-shaped frame faces downwards, and the arc-shaped inner ring is provided with a slideway; the slide way is provided with a first projection and collection box and a second projection and collection box in a sliding manner; the two projection and collection boxes are internally provided with a miniature projector, an image collector and a beam collecting light source; the cluster light sources of the two projection and collection boxes are directed to the circle center of the circle where the cambered surface is positioned and are not parallel to each other; the open main frame is also provided with a second display screen connected with the computer host at one side provided with the arc frame.

Description

A positioning and guiding system for medical sacral nerve puncture

technical field

The invention relates to a medical sacral nerve puncture positioning and guiding system, in particular to a medical sacral nerve puncture positioning and guiding system by means of 3D preoperative planning and body surface cross projection positioning technology.

Background technique

When the nervous system is lesioned or damaged, a variety of lower urinary tract symptoms (such as urgency, frequency, urinary incontinence, dysuria) and/or intestinal dysfunction (such as fecal incontinence, constipation) will appear, seriously affecting the life of the patient Quality and good health. Sacral neuromodulation (SNM), as an effective treatment method for various refractory lower urinary tract dysfunction and intestinal dysfunction after conservative treatment failure, has been more and more clinically applied in recent years.

The first step in the surgical method of sacral neuromodulation is the installation of test electrodes. The puncture of the third sacral nerve foramen is the key link. Because the surface characteristics of this hole are not obvious, it is difficult to locate the blind puncture. In addition, although part of it is supplemented by intraoperative X-ray or B-ultrasound guidance, although the former is relatively clear in bony anatomical landmarks, it cannot directly and accurately mark the skin puncture point and puncture path, and there are Although the latter is non-radioactive, the bony anatomical landmarks are difficult to identify, and it is difficult to directly and accurately mark the skin puncture point and puncture path. Therefore, these two types of techniques still cannot avoid repeated puncture trials, and even When the anatomical features of the body surface of the puncture area are not obvious due to obesity, etc., or the position of the puncture hole varies greatly due to trauma, etc., the difficulty of puncture will be greatly increased, and even the puncture will fail. The above-mentioned difficulties have limited the application and promotion of sacral neuromodulation to a certain extent, so that the majority of related patients still suffer from diseases and cannot enjoy the curative effect brought by this technology. Therefore, it is urgent to effectively solve this technical problem and realize safe and efficient precise puncture.

Contents of the invention

The present invention aims to solve the problem that in the current sacral neuromodulation operation, the puncture of the sacral nerve mainly depends on the operator's subjective experience, or relies on X-rays and B-ultrasound. In order to solve the technical problem that the surface anatomical features are not obvious, or the position of the puncture hole varies too much due to trauma, etc., and it is difficult to puncture smoothly, a medical sacral nerve puncture positioning and guiding system that can be used to assist puncture is provided.

The present invention is realized by adopting the following technical solutions: a medical sacral nerve puncture positioning and guiding system, comprising an open main frame, on which a computer main frame and a first display screen and keys connected to the computer main frame are arranged. One side of the open main frame is connected with an arc frame, the arc inner ring of the arc frame faces downward and the arc inner ring has a slideway; the first projection and collection box and the second projection and collection box; the two projection and collection boxes are built with a micro-projector, image collector and cluster light source; the cluster light sources of the two projection and collection boxes are all pointing to the center of the circle where the arc surface Parallel; the two projection and acquisition boxes are driven by a stepping motor controlled by the computer host to slide on the arc frame, and the open main frame is equipped with a second arc frame connected to the computer host. display screen;

The host computer collects the CT scan image of the patient in the prone position and the length parameters of the puncture needle obtained before the operation, and with the support of the corresponding software, performs three-dimensional analysis of key anatomical structures such as the hip bone, sacrum, coccyx, subcutaneous fat, and skin on the CT scan image. Reconstruction, to obtain the corresponding 3D reconstruction graphics of human body structure;

With the support of corresponding software, the host computer combines the 3D reconstruction graphics of the human body structure and the input puncture needle length parameters to synthesize a 3D reconstruction composite graphics with a virtual puncture needle, and generates corresponding visual images based on the two projections and the actual spatial position of the acquisition box. Two plane images to be projected under different angles; wherein the plane to be projected images corresponding to the first projection and the collection box simulate the skin projection of the 3D reconstruction figure of the human body structure under the angle of view of the first projection and the collection box, and the first projection and the collection box. The shadow Sa formed on the skin after the set cluster light source irradiates the puncture needle; the front end of the shadow Sa is Pa point, the end is Pa1 point, and the middle part is Pa2 point; the second projection and the acquisition box correspond to the plane to be projected. The skin projection of the 3D reconstruction figure of the human body structure from the perspective of the second projection and acquisition box, and the shadow Sb formed on the skin after the beam light source set on the second projection and acquisition box irradiates the puncture needle; the front end of the shadow Sb is point Pb , the end point is Pb1, and the middle point is Pb2; Pa and Pb are respectively the tip points of the shadows of the two puncture needles and overlap, Pa1 and Pb1 are the end points of the needle tails of the shadows of the two puncture needles before puncture respectively, and Pa2 and Pb2 are the needle tail points of the shadows of the two puncture needles respectively. The needle tail endpoints of the last two puncture needle shadows; the first and second projections and acquisition boxes at a certain angle are used to project the two plane images to be projected to the area to be projected, and collect the real projected images and input them into the computer host In 3, the real-time synchronous adjustment of the first and second projections and the position of the acquisition box is performed based on the skin projection of the 3D reconstruction figure and the overlap of Pa1 and Pb1. Further, after the host computer obtains the corresponding 3D reconstruction graphics of the human body structure, it needs to be calibrated first, and the calibration steps are as follows:

After inputting the relative positions of the two projection and acquisition boxes in the actual space and the height of the position to be projected to the host computer, the host computer uses the first projection and acquisition box to transfer the 3D reconstruction figure of the human body structure under the perspective of the first projection and acquisition box to Real prone human skin is projected on the operating bed, and the actual image is collected. The projection image matches the contour of the real human skin as the calibration standard to complete the calibration of the first projection and acquisition box; after that, the host computer uses the second projection and acquisition box to The 3D reconstructed figure of the human body structure from the perspective of the second projection and acquisition box is projected onto the real prone human skin on the operating table, and the actual image is collected. The second projection and acquisition is completed based on the matching of the projected image with the contour of the real human skin as the calibration standard. box calibration.

The working principle of the present invention: the host computer is equipped with a three-dimensional reconstruction image processing subsystem, a preoperative planning analysis subsystem, a virtual reality positioning and projection subsystem, and a database subsystem;

When using the present invention, after obtaining the CT scanning image of the patient in the prone position before the operation, the thin-layer DICOM file is imported into the system, and in the three-dimensional reconstruction image processing subsystem, key dissections such as the hipbone, sacrum, coccyx, subcutaneous fat, and skin are performed Three-dimensional reconstruction of the structure; the 3D reconstruction graphics obtained through the observation and reading of the first and second display screens, in the preoperative planning and analysis subsystem, based on this image, the preoperative planning of the puncture position, direction, and depth is carried out and stored in the database After the subsystem is output to the positioning guide interface; adjust the system position (beside the operating bed on the opposite side of the operator), adjust the first and second projection and acquisition boxes on the arc frame to the appropriate positions, and the first projection and acquisition box Generally located directly above the target puncture hole, or adjusted according to the preoperative plan, the translucent hip, sacrum, coccyx and skin contours are projected to the body surface, and the projection position and zoom factor are adjusted using a computer host to make it basically consistent with the actual body surface landmarks Matching, the second projection and collection box are between the first projection and collection box and the main frame, and at a certain angle to the first projection and collection box, use the computer host to adjust the projection position and zoom factor, so that it is consistent with the actual body surface marks Basically match, use the host computer to automatically analyze and fine-tune the simultaneous projection images of the first and second projections and the acquisition box, so that they overlap completely; after inputting necessary parameters such as the length of the puncture needle, the combination of projection and acquisition box acquisition has been set in the workstation for automatic analysis The relative positions of the first projection and acquisition box and the body surface, the first projection and acquisition box and the second projection and acquisition box in the actual space are determined, and the virtual reality positioning and projection subsystem intelligently calculates the first and second projection and acquisition The body surface projections of the puncture needles on the skin from the perspective of the box (as shown in Figures 3, 4, and 5), and then simultaneously project the puncture points Pa, Pb and the puncture needle body surface projection line segment Sa to the body surface in a certain color _{( Pa-Pa1)} , Sb _(Pb-Pb1) , parallel automatic calibration (the coincidence of Pa and Pb is regarded as the projection calibration is correct), after the calibration is correct, the needle tail body surface projection Pa ₂ and Pb ₂ after the puncture is projected in another color At this time, the operator holds the puncture needle, puts the needle tip on the puncture point Pa (ie Pb), adjusts the direction of the puncture needle until the shadow on the body surface coincides with the line segment Sa _(Pa-Pa1) , Sb _(Pb-Pb1) , and moves along the For puncture in the current direction, the depth of the projection of the needle tail body surface coincides with Pa ₂ and Pb ₂ . To be successful, to complete the precise positioning guidance.

All the above-mentioned hardware components are available in the market, and the software technology is also the prior art, which is easy to implement. Those skilled in the art can write corresponding software according to the records of the above-mentioned working process, and realize the synthesis of a 3D reconstructed synthetic figure with a virtual puncture needle and two plane images to be projected under two visual angles based on the 3D reconstructed figure, and Project two flat images to be projected at different angles.

The beneficial effect that the present invention has:

1. According to the CT data of the prone position of the patient who is going to undergo the puncture, three-dimensional reconstruction and preoperative puncture planning are performed before the operation, which is not only intuitive and quantified, but also has obvious individual characteristics, and can accurately analyze and judge the puncture plan and perform virtual preview;

2. The application of intraoperative body surface cross-projection positioning technology makes the spatial position of the puncture needle intuitive, accurate, and clearly displayed no matter before the puncture or during the whole puncture process, and can be compared at any time, thereby improving the success rate of puncture;

3. The application of intraoperative body surface cross-projection positioning technology is simple to operate and easy to master. It is not only easy to popularize and promote this technology, but also can reduce the difficulty of puncture in the complicated sacrum.

Description of drawings

Fig. 1 is a schematic diagram of the structure of the present invention.

Fig. 2 is a schematic diagram of the functional structure of the present invention.

Fig. 3 is a schematic diagram of body surface projection (top view) of the present invention.

FIG. 4 is a schematic diagram of an enlarged structure of A in FIG. 3 .

Fig. 5 is a schematic diagram of body surface projection (side view) of the present invention.

Fig. 6 is a left view structural schematic diagram of the medical sacral nerve puncture positioning and guiding system according to the present invention.

Fig. 7 is a top-view structure schematic diagram of the medical sacral nerve puncture positioning and guiding system according to the present invention.

Fig. 8 is a rear view structural schematic diagram (working state) of the medical sacral nerve puncture positioning and guiding system according to the present invention.

Fig. 9 is a schematic diagram of the rear view structure of the medical sacral nerve puncture positioning and guiding system according to the present invention (in the unfolded state).

1-brake universal wheel; 2-open main frame; 3-computer host; 4-key mouse; 5-first display screen; 6-first horizontal axis; 7-display connecting rod; 8-second 2-horizontal axis; 9-vertical slideway; 10-extension arm; 11-second display screen; 12-reverse "L"-shaped shaft; 13-arc-shaped frame; 14-arc-shaped frame; 15-first projection and collection box; 16-second projection and collection box; 17-operating bed; 18-sacrum, 19-puncture needle.

Detailed ways

A medical sacral nerve puncture positioning and guiding system includes an open main frame 2, a computer main frame 3 is arranged on the open main frame 2, and a first display screen 5 and a keyboard and mouse 4 connected to the computer main frame 3 (optional wireless keyboard and mouse); one side of the open main frame 2 is connected with an arc frame 14, the arc inner ring of the arc frame 14 faces downward and the arc inner ring has a slideway; slide on the slideway A first projection and collection box 15 and a second projection and collection box 16 are provided; the two projection and collection boxes are equipped with micro-projectors, image collectors and cluster light sources; the cluster light sources of the two projection and collection boxes all point to arc The center of the circle where the surface is located is not parallel to each other; the two projection and acquisition boxes are all driven by a stepping motor controlled by the computer host 3 to slide on the arc frame 14, and the open main frame 2 is provided with an arc frame 14. The side is also equipped with a second display screen 11 connected to the computer host 3;

The host computer 3 collects the CT scan images of the patient in the prone position and the length parameters of the puncture needle obtained before the operation, and with the support of the corresponding software, conducts key anatomical structures such as the hipbone, sacrum, coccyx, subcutaneous fat, and skin on the CT scan images. 3D reconstruction to obtain the corresponding 3D reconstruction graphics of the human body structure;

At this time, it is necessary to calibrate first, and the calibration steps are as follows: After inputting the relative positions of the two projection and collection boxes in the actual space and the height of the position to be projected to the host computer 3, the host computer 3 uses the first projection and acquisition box 15 to The 3D reconstruction figure of the human body structure under the perspective of the first projection and acquisition box 15 is projected onto the real prone human skin on the operating bed 17, and the actual image is collected. The calibration standard is based on the matching of the projected image and the contour of the real human skin, and the first operation is completed. The projection and collection box 15 is calibrated; afterward, the host computer 3 uses the second projection and collection box 16 to project the 3D reconstruction figure of the human body structure under the perspective of the second projection and collection box 16 to the real prone human skin on the operating bed 17, and collect For the actual image, the second projection and acquisition box 16 are calibrated with the projection image matching the contour of the real human skin as the calibration standard.

After the calibration is completed, the host computer 3, with the support of corresponding software, combines the 3D reconstruction graphics of the human body structure and the input puncture needle length parameters to synthesize a 3D reconstruction composite graphics with a virtual puncture needle, and based on the two projections and acquisition boxes 15, 16 The actual spatial position generates two plane images to be projected at corresponding visual angles; wherein the plane image to be projected corresponding to the first projection and the acquisition box 15 simulates the skin projection of the human body structure 3D reconstruction figure under the perspective of the first projection and the acquisition box 15 , and the shadow Sa formed on the skin after the clustered light source set on the first projection and collection box 15 irradiates the puncture needle; the front end of the shadow Sa is point Pa, the end is point Pa1, and the middle part has point Pa2; the second projection The image to be projected on the plane corresponding to the acquisition box 16 simulates the skin projection of the 3D reconstruction figure of the human body structure under this viewing angle, and the second projection and the shadow Sb formed on the skin after the cluster light source set on the acquisition box 16 irradiates the puncture needle ;The front end of the shadow Sb is Pb point, the end is Pb1 point, and the middle part is Pb2 point; Pa and Pb are respectively the tip points of the two puncture needle shadows and overlap, Pa1 and Pb1 are respectively the needle tails of the two puncture needle shadows before puncture The endpoints, Pa2 and Pb2 are respectively the needle tail endpoints of the shadows of the two puncture needles after puncture; the first and second projection and collection boxes 15 and 16 at a certain angle are used to project the two plane images to be projected to the area, and collect real projection images and input them into the computer host 3, and use the skin projection of 3D reconstruction graphics and the overlap of Pa1 and Pb1 as the standard to perform real-time synchronous adjustment of the first and second projections and the positions of the acquisition boxes 15 and 16.

The first and second projection and collection boxes 15 and 16 at a certain angle are used to project the two plane images to be projected to the projected area, and can avoid the operator's hands and other occlusions during projection.

The shadows Sa and Sb and Pa, Pa1, Pa2, Pb, Pb1, Pb2 are displayed and projected in different colors.

The first and second display screens 5 and 11 can display the 3D reconstruction figure of the human body structure and the 3D figures of the puncture needle in two different positions throughout the whole process, as well as two planes under the corresponding visual angles of the two projections and the collection boxes 15 and 16 Image to be projected.

The open main frame 2 comprises a base, a vertical plate installed on one side near the base and a top platform installed on the top of the vertical plate; the main computer 3 is arranged on the base, and the first display screen 5 and the keyboard 4 are arranged on the top platform Have a vertical slideway 9 on the vertical plate, slide on the vertical slideway 9 and be provided with an extension arm 10 extending in the horizontal direction, and one end of the extension arm 10 is slidably connected on the vertical slideway 9, and the arc The frame 14 is installed on the other end of the extension arm 10 and is positioned on the opposite side with the open main frame 2; the vertical plane of the arc frame 14 is perpendicular to the vertical plane of the extension arm 10; the extension arm 10 is also passed through the corresponding The stepper motor drive realizes sliding up and down, and the stepper motor is also controlled by the computer mainframe 3;

The arc-shaped frame (generally transverse) and the extension arm (generally tilted to the cephalic side, with an angle of about 80° between the cephalic side and the horizontal plane, to avoid the connection between the intraoperative X-ray and the target hole of the sacrum, or to adjust according to preoperative planning.

The extension arm 10 is connected with an anti-"L"-shaped shaft 12, and the anti-"L"-shaped shaft 12 is connected with an arc-shaped frame 13; the arc-shaped frame 14 is installed on the arc-shaped frame 13. The arc-shaped stand 13 can rotate around the anti-"L"-shaped shaft 12, as shown in Figure 8, which is a schematic structural diagram of the present invention in the working state, and in Fig. .

The bottom of the open main frame 2 is provided with brakeable universal wheels 1 . The first display screen 5 is made on the top platform through the display screen connecting rod 7, the first display screen and the display screen connecting rod 7 are connected by the first horizontal axis 6, and the display screen connecting rod 7 passes through the second horizontal shaft 8 Connected to the top platform.

Claims (7)

1. A medical sacral nerve puncture positioning and guiding system, comprising an open main frame (2), on which a computer main frame (3) and a first computer connected to the computer main frame (3) are arranged. Display screen (5) and mouse and keyboard (4); it is characterized in that an arc frame (14) is connected to one side of the open main frame (2), and the inner circle of the arc surface of the arc frame (14) faces and the inner ring of the curved surface has a slideway; the first projection and collection box (15) and the second projection and collection box (16) are slid on the slideway; the two projection and collection boxes are equipped with micro projections instrument, image collector and cluster light source; the cluster light sources of the two projection and acquisition boxes point to the center of the circle where the arc surface is located, and are not parallel to each other; the two projection and acquisition boxes are controlled by a stepping motor controlled by the computer host (3) The drive slides on the arc frame (14), and the open main frame (2) is also equipped with a second display screen (11) connected to the computer host (3) on the side of the arc frame (14); The host computer (3) collects the CT scan image of the patient in the prone position and the length parameters of the puncture needle obtained before the operation, and with the support of the corresponding software, performs key anatomical structures of the hip bone, sacrum, coccyx, subcutaneous fat, and skin on the CT scan image. 3D reconstruction to obtain the corresponding 3D reconstruction graphics of the human body structure; With the support of corresponding software, the host computer (3) combines the 3D reconstruction graphics of the human body structure and the input puncture needle length parameters to synthesize a 3D reconstruction composite graphics with a virtual puncture needle, and based on the two projection and acquisition boxes (15, 16) The actual spatial position generates two plane images to be projected at corresponding visual angles; the plane image to be projected corresponding to the first projection and the collection box (15) simulates the 3D reconstruction of the human body structure under the perspective of the first projection and the collection box (15) The skin projection of the graphics, and the shadow Sa formed on the skin after the clustered light source set on the first projection and collection box (15) irradiates the puncture needle; the front end of the shadow Sa is point Pa, the end is point Pa1, and the middle part has Pa2 point; the second projection and the image to be projected on the plane corresponding to the acquisition box (16) simulate the skin projection of the 3D reconstruction figure of the human body structure under the perspective of the second projection and acquisition box (16), and the second projection and the acquisition box (16) The shadow Sb formed on the skin after the set cluster light source irradiates the puncture needle; the front end of the shadow Sb is Pb point, the end is Pb1 point, and the middle part is Pb2 point; Pa and Pb are respectively used as the tip points of the two puncture needle shadows And coincident, Pa1 and Pb1 are the needle tail endpoints of the two puncture needle shadows before the puncture respectively, Pa2 and Pb2 are the needle tail endpoints of the two puncture needle shadows after the puncture respectively; the first and second projections at a certain angle and the collection box ( 15, 16) are used to project the two plane images to be projected to the area to be projected, and collect the real projected images and input them into the computer host (3), reconstruct the skin projection of the graphics in 3D, and the overlap of Pa1 and Pb1 Real-time synchronous adjustment of the positions of the first and second projections and the acquisition boxes (15, 16) is carried out as a standard. 2. A medical sacral nerve puncture positioning and guiding system according to claim 1, characterized in that after the host computer (3) obtains the corresponding 3D reconstruction graphics of the human body structure, it needs to be calibrated first, and the calibration steps are as follows: After inputting the relative positions of the two projection and acquisition boxes in the actual space and the height of the position to be projected to the host computer (3), the host computer (3) uses the first projection and acquisition box (15) to combine the first projection and acquisition box (15) The 3D reconstruction figure of the human body structure from the perspective is projected to the real prone human skin on the operating bed (17), and the actual image is collected. The projection image matches the contour of the real human skin as the calibration standard, and the first projection and The acquisition box (15) is calibrated; afterward, the host computer (3) uses the second projection and acquisition box (16) to present the 3D reconstruction figure of the human body structure under the perspective of the second projection and acquisition box (16) to the operating bed (17). The prone human skin is projected, and the actual image is collected, and the second projection and the acquisition box (16) are calibrated with the matching of the projected image and the contour of the real human skin as the calibration standard. 3. A medical sacral nerve puncture positioning and guiding system as claimed in claim 1 or 2, wherein the shadows Sa and Sb and Pa, Pa1, Pa2, Pb, Pb1, Pb2 are all given in different colors. Display and project. 4. A medical sacral nerve puncture positioning and guiding system according to claim 1 or 2, characterized in that, the first and second display screens (5, 11) can display 3D reconstruction graphics of human body structure and two 3D graphics of puncture needles in different positions, and two plane images to be projected under the corresponding visual angles of the two projection and collection boxes (15, 16). 5. A medical sacral nerve puncture positioning and guiding system according to claim 1 or 2, characterized in that the open main frame (2) includes a base, a vertical plate installed on the side close to the base, and a vertical plate installed on the The top platform at the top of the vertical board; the computer host (3) is arranged on the base, the first display screen (5) and the keyboard and mouse (4) are arranged on the top platform; a vertical slideway (9) is arranged on the vertical board, An extension arm (10) extending in the horizontal direction is provided for sliding on the straight slideway (9), and one end of the extension arm (10) is slidably connected to the vertical slideway (9), and the arc frame (14) is installed At the other end of the extension arm (10) and on the opposite side to the open main frame (2); the vertical plane where the arc frame (14) is located is perpendicular to the vertical plane where the extension arm (10) is located; the extension arm (10) is also driven by a corresponding stepping motor to slide up and down, and the stepping motor is also controlled by the computer host (3); the second display screen (11) is installed in the middle of the extension arm (10) and the open main frame (2) Opposite side. 6. A medical sacral nerve puncture positioning and guiding system according to claim 5, characterized in that the extension arm (10) is connected with an anti-"L"-shaped shaft (12), and the anti-"L"-shaped shaft (12 ) is connected with an arc-shaped frame (13); the arc-shaped frame (14) is installed on the arc-shaped frame (13). 7. A medical sacral nerve puncture positioning and guiding system according to claim 6, characterized in that, the bottom of the open main frame (2) is provided with brakeable universal wheels (1).

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