基于混合现实与人工智能算法在股前外穿支血管定位中的前瞻性研究

doi:10.7518/hxkq.2024.2024129

华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (6): 795-803.doi: 10.7518/hxkq.2024.2024129

基于混合现实与人工智能算法在股前外穿支血管定位中的前瞻性研究

刘一秀¹(), 汤喜¹, 吴剑¹, 周莲¹, 吴双江²^,³, 瞿杨⁴, 吴小月¹()

^1.重庆大学附属肿瘤医院头颈肿瘤科肿瘤转移与个体化诊治转化研究重庆市重点实验室，重庆 400000
^2.西南医科大学附属口腔医院口腔颌面外科口腔颌面修复重建和再生泸州市重点实验室，泸州 646000
^3.西南医科大学附属医院口腔颌面外科，泸州 646000
^4.瞿杨口腔诊所，重庆 400000

收稿日期:2024-04-08 修回日期:2024-08-29 出版日期:2024-12-01 发布日期:2024-11-29
通讯作者: 吴小月 E-mail:380887688@qq.com;75987795@qq.com
作者简介:刘一秀，副主任医师，博士，E-mail：380887688@qq.com
基金资助:
重庆市教委科学技术研究项目(KJQN202300124);重庆大学附属肿瘤医院重点实验室开放基金项目(cquchkfjj005)

Prospective study on the localization of anterolateral thigh perforator vessel based on mixed reality and artificial algorithm

Liu Yixiu¹(), Tang Xi¹, Wu Jian¹, Zhou Lian¹, Wu Shuangjiang²^,³, Qu Yang⁴, Wu Xiaoyue¹()

^1.Dept. of Head and Neck Oncology, Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translatio-nal Research for Cancer Metastasis and Individualized Treatment, Chongqing 400000, China
^2.Dept. of Oral and Ma-xillofacial Surgery, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Luzhou 646000, China
^3.Dept. of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
^4.Quyang Dental Clinic, Chongqing 400000, China

Received:2024-04-08 Revised:2024-08-29 Online:2024-12-01 Published:2024-11-29
Contact: Wu Xiaoyue E-mail:380887688@qq.com;75987795@qq.com
Supported by:
Scientific and Technological Research Program of Chongqing Municipal Education Commission(KJQN202300124);Open Fund Pro-ject of the Key Laboratory, Chongqing University Cancer Hospital(cquchkfjj005)

摘要/Abstract

摘要：

目的构建混合现实技术与人工智能算法的系统，评估其在股前外穿支皮瓣手术中定位血管的效果，为临床实践提供新的思路。方法选取20例行股前外穿支皮瓣修复的患者，在下肢黏贴定位装置后行CT血管造影（CTA）扫描，将所得二维数据制成定位装置与血管等的三维模型，并通过混合现实技术实现穿支血管三维可视化。在HoloLens 2中开发人工算法，术中使用人工智能算法自动匹配定位装置与其三维模型以实现穿支血管与其三维模型的重叠。记录制取皮瓣区域内定位的穿支血管数量及术中探查的实际数量，以此计算基于CTA数据重建的血管识别正确率；测量系统定位的穿支血管穿出点与实际血管穿出点之间的距离，计算误差值；记录系统辅助下制取股前外穿支皮瓣的手术时间，并与常规方法制取皮瓣的手术时间进行对比分析。探讨该系统的临床实用性。结果 CTA数据重建的穿支血管30个，手术中探查发现实际存在32个，识别正确率为93.75%；系统定位的穿支血管穿出点与实际穿出点的平均距离为（1.65±0.52）mm，系统定位下制取皮瓣的平均手术时间为（43.45±4.6）min，常规方法制取皮瓣的手术时间为（57.6±7.9）min。所有穿支皮瓣均成活，1例皮瓣术后7 d出现感染，1例皮瓣局部坏死，经对症治疗后延迟愈合。结论本研究搭建的系统可以通过混合现实技术实现穿支血管三维可视化，利用人工智能算法提高穿支血管定位精度，在穿支皮瓣制取手术中具有应用潜力。

关键词: 混合现实, 人工智能算法, 股前外穿支皮瓣, 穿支血管

Abstract:

Objective This paper aims to construct a system integrating mixed reality technology with artificial algorithm and to evaluate its effectiveness in vascular localization during anterolateral thigh perforator flap surgery to provide new insights for clinical practice. Methods Twenty patients undergoing anterolateral thigh perforator flap repair were selected. After attaching positioning devices on the lower limb, CT angiography (CTA) scans were performed. The 2D data obtained were converted into a 3D model of the positioning device and vessels. Mixed reality technology was utilized to achieve 3D visualization of perforator vessels. An artificial algorithm was developed in HoloLens 2 to match the positioning device automatically with its 3D model intraoperatively to overlap the perforator vessels with their 3D models. The number of perforator vessels identified within the flap harvesting area and the actual number detected during surgery were recorded to calculate the accuracy rate of vessel identification based on CTA data reconstruction. The distance between the perforator vessel exit points located by the system and the actual exit points was measured, and the error values were calculated. The surgical time required for the system to harvest the anterolateral thigh perforator flap was documented and compared with the surgical time required by conventional methods. The clinical applicability of the system was discussed. Results The CTA data reconstruction identified 30 perforator vessels, while the actual number found during surgery was 32, resulting in an identification accuracy rate of 93.75%. The average distance between the perforator vessel exit points located by the system and the actual exit points was (1.65±0.52) mm. The average surgical time for flap harvesting with the assistance of the system was (43.45±4.6) min compared with (57.6±7.9) min required by conventional methods. All perforator flaps survived the procedure. One case of flap infection occurred seven days postoperatively, and one case of partial flap necrosis was treated with symptomatic therapy, resulting in delayed healing. Conclusion The system constructed in this paper can achieve 3D visualization of perforator vessels through mixed reality technology and improve the accuracy of perforator vessel localization using artificial algorithms, hence demonstrating potential application in anterolateral thigh perforator flap harvesting surgeries.

Key words: mixed reality, artificial algorithm, anterolateral thigh perforator flap, perforator vessel

中图分类号:

R782.05

刘一秀, 汤喜, 吴剑, 周莲, 吴双江, 瞿杨, 吴小月. 基于混合现实与人工智能算法在股前外穿支血管定位中的前瞻性研究[J]. 华西口腔医学杂志, 2024, 42(6): 795-803.

Liu Yixiu, Tang Xi, Wu Jian, Zhou Lian, Wu Shuangjiang, Qu Yang, Wu Xiaoyue. Prospective study on the localization of anterolateral thigh perforator vessel based on mixed reality and artificial algorithm[J]. West China Journal of Stomatology, 2024, 42(6): 795-803.

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参考文献 32

1	Kushida-Contreras BH, Manrique OJ, Gaxiola-García MA. Head and neck reconstruction of the vessel-deple-ted neck: a systematic review of the literature[J]. Ann Surg Oncol, 2021, 28(5): 2882-2895.
2	梁再卿, 吴宁. 股前外侧穿支皮瓣的临床应用研究进展[J]. 中华骨与关节外科杂志, 2019, 12(12): 1020-1024.
	Liang ZQ, Wu N. Review on clinical application of anterolateral thigh perforator flap[J]. Chin J Bone Joint Surg, 2019, 12(12): 1020-1024.
3	Kozusko SD, Liu X, Riccio CA, et al. Selecting a free flap for soft tissue coverage in lower extremity reconstruction[J]. Injury, 2019, 50 (): S32-S39.
4	Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications[J]. Ann Plast Surg, 2003, 50(1): 90-99.
5	唐举玉, 卿黎明, 贺继强, 等. 数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣设计的初步应用[J]. 中华显微外科杂志, 2016, 39(2): 123-126.
	Tang JY, Qing LM, He JQ, et al. Application of compu-ter assisted technique to desgin polyfoliate perforator flappedicled on the descending branch of the circumflex femoral lateral artery[J]. Chin J Microsurg, 2016, 39(2): 123-126.
6	Zhan Y, Zhu H, Geng P, et al. Revisiting the blood supply of the rectus femoris: a case report and computed tomography angiography study[J]. Ann Plast Surg, 2020, 85(4): 419-423.
7	吴双江, 王雷, 刘一秀, 等. CT血管成像及三维重建辅助设计与彩色多普勒超声在口腔癌术后缺损股前外侧皮瓣修复重建中的应用比较[J]. 中华整形外科杂志, 2022, 38(10): 1102-1110.
	Wu SJ, Wang L, Liu YX, et al. Comparative study on anterolateral thigh flap by three-dimensional CT angiog-raphy assisted design and color Doppler ultrasound in reconstruction after oral cancer[J]. Chin J Plast Surg, 2022, 38(10): 1102-1110.
8	Pelanis E, Kumar RP, Aghayan DL, et al. Use of mixed reality for improved spatial understanding of liver anatomy[J]. Minim Invasive Ther Allied Technol, 2020, 29(3): 154-160.
9	Pereira N, Kufeke M, Parada L, et al. Augmented reality microsurgical planning with a smartphone (ARM-PS): a dissection route map in your pocket[J]. J Plast Reconstr Aesthet Surg, 2021, 72(5): 759-762.
10	Ramalhinho J, Yoo S, Dowrick T, et al. The value of Augmented Reality in surgery—A usability study on laparoscopic liver surgery[J]. Med Image Anal, 2023, 90: 102943.
11	Eckert M, Volmerg JS, Friedrich CM. Augmented reality in medicine: systematic and bibliographic review[J]. JM-IR Mhealth Uhealth, 2019, 7(4): e10967.
12	莫勇军, 许林, 程志琳, 等. 增强现实技术联合数字化设计在股前外侧穿支皮瓣的应用[J]. 中华显微外科杂志, 2019, 42(2): 189-192.
	Mo YJ, Xu L, Cheng ZL, et al. Application of augmen-ted reality technology combined with digital design in the anterolateral thigh perforator flap[J]. Chin J Microsurg, 2019, 42(2): 189-192.
13	Pratt P, Ives M, Lawton G, et al. Through the HoloLens^TM looking glass: augmented reality for extremity reconstruction surgery using 3D vascular models with perforating vessels[J]. Eur Radiol Exp, 2018, 2(1): 2.
14	Zhou Z, Yang Z, Jiang S, et al. Surgical navigation sy-stem for low-dose-rate brachytherapy based on mixed reality[J]. IEEE Comput Graph Appl, 2021, 41(3): 113-123.
15	Heinrich F, Schwenderling L, Becker M, et al. Holoinjection: augmented reality support for CT-guided spinal needle injections[J]. Healthc Technol Lett, 2019, 6(6): 165-171.
16	Liebmann F, Roner S, von Atzigen M, et al. Pedicle screw navigation using surface digitization on the Mic-rosoft HoloLens[J]. Int J Comput Assist Radiol Surg, 2019, 14(7): 1157-1165.
17	Gibby JT, Swenson SA, Cvetko S, et al. Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography[J]. Int J Comput Assist Radiol Surg, 2019, 14(3): 525-535.
18	Al Janabi HF, Aydin A, Palaneer S, et al. Effectiveness of the HoloLens mixed-reality headset in minimally invasive surgery: a simulation-based feasibility study[J]. Surg Endosc, 2020, 34(3): 1143-1149.
19	Fotouhi J, Unberath M, Song T, et al. Interactive Flying Frustums (IFFs): spatially aware surgical data visualization[J]. Int J Comput Assist Radiol Surg, 2019, 14(6): 913-922.
20	Assem Y, Mobbs RJ, Pelletier MH, et al. Radiological and clinical outcomes of novel Ti/PEEK combined spinal fusion cages: a systematic review and preclinical evaluation[J]. Eur Spine J, 2017, 26(3): 593-605.
21	Mavioso C, Araújo RJ, Oliveira HP, et al. Automatic detection of perforators for microsurgical reconstruction[J]. Breast, 2020, 50: 19-24.
22	Berger MF, Winter R, Tuca AC, et al. Workflow assessment of an augmented reality application for planning of perforator flaps in plastic reconstructive surgery: game or game changer[J]. Digit Health, 2023, 9: 20552076231173554.
23	Javidan AP, Li A, Lee MH, et al. A systematic review and bibliometric analysis of applications of artificial intelligence and machine learning in vascular surgery[J]. Ann Vasc Surg, 2022, 85: 395-405.
24	Li R, Si W, Liao X, et al. Mixed reality based respiratory liver tumor puncture navigation[J]. Comput Vis Media, 2019, 5: 363-374.
25	林承重, 张勇, 董韶, 等. 基于混合现实的手术导航系统在颅颌面创伤骨整复中的应用研究[J]. 华西口腔医学杂志, 2022, 40(6): 676-684.
	Lin CZ, Zhang Y, Dong S, et al. Application of mixed reality-based surgical navigation system in craniomaxillofacial trauma bone reconstruction[J]. West China J Stomatol, 2022, 40(6): 676-684.
26	Masterton G, Miller R, Patel J, et al. HoloLens in breast reconstruction: what is the future[J]. Plast Reconstr Surg, 2023, 151(6): 915e-917e.
27	Meulstee JW, Nijsink J, Schreurs R, et al. Toward holographic-guided surgery[J]. Surg Innov, 2019, 26(1): 86-94.
28	Thimmappa ND. MRA for preoperative planning and postoperative management of perforator flap surgeries: a review[J]. J Magn Reson Imaging, 2024, 59(3): 797-811.
29	Sun Q, Mai Y, Yang R, et al. Fast and accurate online calibration of optical see-through head-mounted display for AR-based surgical navigation using Microsoft HoloLens[J]. Int J Comput Assist Radiol Surg, 2020, 15(11): 1907-1919.
30	Tu P, Gao Y, Lungu AJ, et al. Augmented reality based navigation for distal interlocking of intramedullary nails utilizing Microsoft HoloLens 2[J]. Comput Biol Med, 2021, 133: 104402.
31	陆浩, 薛明宇, 强力, 等. CTA联合彩色多普勒超声技术在尺动脉腕上皮支皮瓣穿支血管定位中的临床应用[J]. 中华手外科杂志, 2022, 38(4): 315-318.
	Lu H, Xue MY, Qiang L, et al. Clinical application of CTA combined with color Doppler ultrasound in the localization of perforating vessels of flap based on above wrist cutaneous branch of the ulnar artery[J]. Chin J Hand Surg, 2022, 38(4): 315-318.
32	Moore R, Mullner D, Nichols G, et al. Color Doppler Ultrasound versus computed tomography angiography for preoperative anterolateral thigh flap perforator imaging: a systematic review and meta-analysis[J]. J Reconstr Microsurg, 2022, 38(7): 563-570.

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基于混合现实与人工智能算法在股前外穿支血管定位中的前瞻性研究

Prospective study on the localization of anterolateral thigh perforator vessel based on mixed reality and artificial algorithm

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参考文献 32

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患者编号	定位的血管与实际的距离/mm	识别的血管数量/支	实际血管数量/支	制取皮瓣时间/min
合计	33	30	32	869
1	1.5	1	1	40
2	2.5	2	2	51
3	1	1	1	47
4	2	2	3	52
5	1.5	2	2	45
6	1.5	1	1	38
7	2	1	1	51
8	2.5	2	2	45
9	2	1	1	39
10	1.5	2	2	40
11	1	1	1	38
12	2	1	1	41
13	1.5	1	1	40
14	1.5	2	2	42
15	2	1	1	48
16	1.5	2	2	38
17	2.5	1	1	42
18	1	2	2	44
19	1	2	2	41
20	1	2	3	47