臺灣博碩士論文加值系統

X光影像通常為骨創傷手術診斷與治療評估的方式，但對發生於關節面附近或骨盆之嚴重性骨折，X光影像無法提供診斷或治療所需的完整資訊。本研究發展三維術前規劃系統，提供醫師於術前分析、規劃與模擬，突破平面影像的侷限性，提高病灶的顯示及術前規劃的準確率；此外，與醫院醫師合作，蒐集關節面與骨盆等案例。以關節面案例說明三維電腦輔助系統可於術前瀏覽影像，進行手術規劃，協助醫師評估可行的手術方式。以骨盆手術術前規劃流程說明三維術前規劃於臨床上之完整應用，在技術上，改善影像顯示與復位方法，並以數個骨盆手術案例，模擬當骨組織復位後，進行骨板置放與單純置放骨釘的手術方式。以多組臨床範例說明本研究之三維術前規劃系統的可行性，提供醫師術前資訊，協助醫師模擬手術流程，讓醫師在術前便能運用數位化模擬方式，掌握手術中可能面臨的情況，並尋求解決方式，更篤定其所思維的手術方式，以增加其在手術中的信心。

X-Ray image is usually employed for the diagnosis and treatment of orthopedic trauma surgery. However, in serious fracture which occurred in or near the Intra-articular or pelvic, X-Ray image can not fully provide the information required in diagnosis or treatment. In this study, a three-dimensional preoperative planning system is developed, providing preoperative analysis, planning and simulation to break through the limitation of 2D image and improving the display of lesions and the accuracy of the preoperative planning. In addition, this study collaborates with a hospital surgeon to collect Intra-articular and pelvis cases. Intra-articular cases are employed for 3D image observation, surgical planning, and demonstrating the capability of assisting surgeons in determining possible surgery method. The case of pelvis preoperative planning are employed to demonstrate the complete application of the proposed 3D preoperative system. Several clinical examples are presented to illustrate the feasibility of the proposed three-dimensional preoperative planning system. It can provide useful information in surgical and assist the surgeon in decision making before surgery. The surgeon will certainly be more comfortable when the proposed 3D analysis and simulation is used before hand.

摘要 I
Abstract II
致謝 III
圖目錄 VI
表目錄 VI
第一章 緒論 1
1.1 前言 1
1.2 文獻回顧 2
1.3 實驗室發展現況說明 6
1.4 研究目的與方法 10
1.4.1 研究目的 10
1.4.2 研究方法 12
1.5 論文架構 14
第二章 電腦輔助三維影像評估系統改善 16
2.1 前言 16
2.2 骨組織自動復位 16
2.2.1 三點對復位法 17
2.2.2 多點復位法 22
2.2.3 鏡射復位法 24
2.3 CT影像轉網格顯示 27
2.3.1 網格對應CT影像位置 27
2.3.2 強化灰階對比 29
2.3.3 三維線性內插 29
2.3.4 網格依骨質渲染 31
2.4 骨釘鎖入模擬與剖面分析 34
第三章 三維電腦輔助技術於臨床試驗 38
3.1 前言 38
3.2 CT三維重建於臨床骨科應用 38
3.3 上下肢骨折案例模擬 40
3.3.1 股骨案例 40
3.3.2 脛骨案例 43
3.3.3 足部案例 46
3.3.4 肩胛骨案例 50
3.3.5 肱骨案例 50
3.3.6 橈骨案例 54
3.3.7 手肘案例 59
3.3.8 小結 59
第四章 臨床實例驗證與分析 62
4.1 前言 62
4.2 骨盆骨折案例模擬 62
4.2.1 骨盆骨折手術輔助之流程 62
4.2.2 臨床實例 63
4.3 比較整體流程時間 78
第五章 結論與未來展望 83
5.1 結論 83
5.2 未來展望 84
參考文獻 85

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