Journal of Biomedical Engineering Research (대한의용생체공학회:의공학회지)

The Korean Society of Medical and Biological Engineering (대한의용생체공학회)
권호 표지

A Study on Computer Aided Surgical Simulation Method for Total Hip Arthroplasty

컴퓨터 응용 인공고관절 모사 시술 방법 연구

  • Kim Sang Hoo (Department of Medical Engineering, Graduate School of East-West Medical Science, Kyung Hee University) ;
  • Han Seung Moo (Department of Medical Engineering, Graduate School of East-West Medical Science, Kyung Hee University)
  • 김상후 (경희대학교 동서의학대학원 의료공학 전공) ;
  • 한승무 (경희대학교 동서의학대학원 의료공학 전공)
  • Published : 2004.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Total hip arthroplasty(THA) considerably depends on high-experienced doctors because of high difficulty of the operation. Selection of acetabular cup's and femoral implant's position is closely related with success or failure of THA. Nevertheless the selection has usually depended on doctor's eye measurement, which makes the position accuracy of artificial joint lower after THA, often resulting in revision of THA. The present study determined a method to select accurately the position of acetabular cup and femoral implant through surgical simulation with 3D characteristic geometrical information of patient's pelvis and femur. We examined the change of femoral anteversion angle and neck-shaft angle accompanied by the change of acetabular cup's position and the insertion position of femoral implant. As result of analyzing geometrical information through different surgical simulations, we found that it was possible to select the accurate position of acetabular cup and femoral implant. It is expected to help doctors get experienced in THA operation through repetitive surgical simulations using the method suggested in the study.

현재 인공고관절 전치환 수술 과정의 높은 난이도 때문에 숙련된 의사의 경험에 상당히 의존하고 있는 실정이다. 비구컵과 대퇴 임플란트의 위치 선정은 수술의 성공 여부와 밀접한 관계가 있지만 아직까지는 의사의 눈대중에 의해 이루어지는 경우가 많다. 이러한 이유로 인하여 인공삽입물(비구컵, 대퇴시스템) 삽입의 정확성이 낮아서 재치환술을 해야 하는 경우가 자주 발생한다. 본 연구에서는 환자 골반골(pelvis)과 대퇴골(femur)의 3차원적인 고유 기하학적 정보를 이용하는 모사 시술을 통하여 비구컵과 대퇴 임플란트의 정확한 위치를 선정하는 방법을 결정하였다. 이를 위하여 우선 비구컵의 위치 변화에 따른 대퇴 전염각 및 대퇴 경간각의 변화 양상을 살펴보았고 또한 대퇴 임플란트의 삽입 위치에 따른 대퇴스템 경부 길이 및 대퇴스템각의 변화 양상을 조사하였다. 본 연구에서 다양한 모사 시술을 통한 기하학적 정보의 분석 결과 비구컵과 대퇴 임플란트의 정확한 위치 선정이 가능함을 확인하였다. 본 연구의 모사 시술 방법을 이용하여 의사가 인공고관절 수술을 선행한다면 수술의 정확도와 숙련도를 향상시킬 수 있을 것으로 기대된다.

Keywords

References

  1. Knight JL, Atwater RD, 'Preoperative planning for total hip arthroplasty: quantitating its utility and precision', J. Arthroplasty, 7: pp. 403-409, 1992
  2. Bargar, W. L., 'Shape the implant to the patient, A raionale for the use of custom-fit cementless total hip implants', Clinical orthopaedics and related research, 249: pp. 73-78, 1989
  3. Terosch T, Peuker E, von Hasselbach C, Lahmer A, Filler T, Witzel U, 'Computer assisted implantation of the femoral stem in THA - an experimental study', Int Orthop, 23(4): pp. 224-226, 1999 https://doi.org/10.1007/s002640050356
  4. Bongini, D., Carfagni, M., et aI., 'Hippin: a semiautomatic computer program for selecting hip prosthesis femoral components, Computer methods and programs in biomedicine', 2(63): pp. 105-115, 2000 https://doi.org/10.1016/S0169-2607(00)00078-X
  5. Leonard Ruby, Morisder A. Mital, John O'connor, Upendra Patel, 'Anteversion of the Femoral Neck', The journal of Bone and Joing Surgery, pp. 46-51, 1979
  6. Miller, F., Merlo, M., Liang Y., Kupcha, P., Jamison, J., Harke, T., 'Femoral version and neck shaft angle', Journal of Pediatric Ortopaedics, 13: pp. 382-388, 1993 https://doi.org/10.1097/01241398-199305000-00021
  7. Rogers, S.P, 'A Method for Determining the Angle of Torsion of the Neck of Femur', J. Bone Joint Surg., Vol. 13, pp. 821, 1981
  8. LaGasse, D.J. and Staheli, T.L, 'The Measurement of Femoral Anteversion', Clin. Orthop., Vol. 86, pp. 13, 1972 https://doi.org/10.1097/00003086-197207000-00003
  9. Rubby L., Mital, M.V., O'conner, J. and Patel, U., 'Anteversion of the Femoral Neck', J. Bone Joint Surg, Vol. 61, No. A, pp. 46, 1976
  10. Dunlap, C.K., Shands, A.R. Jr. , Holister, L.C. Jr. , Gaul, J.S. Jr. and Streit, H.A, 'A New Method for Determination of Torsion of the femur', J. Bone and Joint Surg, Vol. 35, No. A, pp. 289, 1953 https://doi.org/10.2106/00004623-195335020-00002
  11. Magilligan, D.J, 'Calculation of the Angle of Anteversion by means of Horizontal Lateral Roentgenography', J. Bone and Joint Surg, Vol. 38, No. A, pp. 1231, 1956 https://doi.org/10.2106/00004623-195638060-00005
  12. Ryder, C.T. and Crane, L., 'Measuring Femoral Anteversion. The Problem and a Method', J. Bone and Joint Surg, Vol. 35, No. A, pp. 321, 1953 https://doi.org/10.2106/00004623-195335020-00004
  13. Schultz., J, 'Die Darstellung der Torsiomswinkel νom Femur mit llilfe von Rontgenstraheln', Z. Orthop. Chir, Vol. 44, pp. 325, 1924
  14. Dunn, D.M, 'Anteversion of the Neck of the Femur. A Method of Measurement', J. Bone and Joint Surg., Vol. 34, No. B, pp. 181, 1952
  15. Dunlap K., Shands Jr A. J., Hollister Jr L. C, Gaul Jr J. S. and Streit H. A., 'A new method for detennination of torsion of the femur', The Journal of Bone Joint Surgery, Vol. 35, No. A, pp. 289, 1953 https://doi.org/10.2106/00004623-195335020-00002
  16. Budin, E. and Chandler, M.E., 'Measurement of Femoral Neck Anteversion', Radiology, Vol 69, pp. 209, 1957 https://doi.org/10.1148/69.2.209
  17. Dennis S. Weiner and Albert J. Cook, 'Practical considerations in the use of computed tomography in the measurement of femoral anteversion', The Journal of Medical Science, Vol. 16, No.1, pp. 288 - 294, 1980
  18. A. Hoiseth, O. Reikeras and E. Fonstelien, 'Evaluation of three methods for measurement of femoral neck anteversion', Acta Radiologica, Vol. 30, No.1, pp. 69 -73, 1989 https://doi.org/10.3109/02841858909177461
  19. O. Reikeras, A. Hoiseth and A. Reigstad, 'Femoral anteversion measured by the dunlap/Rippstein and norman methods', Acta Radiologica Diagnosis, Vol. 26, No.3, pp. 303 - 305, 1985 https://doi.org/10.1177/028418518502600314
  20. Reinhard J. Tomczak, Klaus P. Guenther, Andrea Rieber, Patricia Mergo, Pablo R. Ros, Hans-Joachim Brambs, 'MR imaging measurement of the femoral anteversion angle as a new technique: comparison with CT in Children and Adults', The American Journal of Radiology, Vol. 168, pp. 791 -794, 1997
  21. B. Schneider, J. Laubenberger, S. Jemilish, K. Groene, HM. Weber, M. Langer, 'Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging', The British Journal of Radiology, Vol. 70, pp. 575 - 579, 1997 https://doi.org/10.1259/bjr.70.834.9227249
  22. Terje Terjesen, Svein Anda, 'Ultrasound measurement of femoral anteversion', Journal of Bone and Surgery[Br], Vol. 72, No. B, pp. 726 - 727, 1990
  23. Hui Taek Kim, and Dennis R. Wenger, 'Functional retroversion of the femoral head in Legg-Calve-Perthes disease and epiphyseal Dysplasia: Analysis of Head-Neck deformity and its effect on limb position using three-dimensional computed tomography', Journal of Pediatric Orthopaedics, Vol. 17, No.2, pp. 240 - 246, 1997 https://doi.org/10.1097/00004694-199703000-00019
  24. 김용호, 최귀원, 김중규, '3차원 의료영상에 기반한 인공고관절 모의시술시스템 개발 및 새로운 정합도 측정방법에 관한 연구', 대한의용생체공학회 의공학회지, 21권, 2호, 201 - 212, 2000
  25. Khang Gon, Choi Kuiwon, Kim Cheol-Sang, Yang Jong Soo and Bae Tae-Soo, 'A Study of Korean Femoral Geometry', Clinical Orthopaedics & Related Research, Vol. 1, No. 406, pp. 116 -122, 2003