面向开胸手术的超声辅助干锯切胸骨机理及减温降损策略

Heart disease is the most common health problem worldwide. Thoracotomy involving sternum sawing plays a vital role in the treatment of heart diseases because the quality and efficiency of the sternum sawing is associated with therapeutic and rehabilitative effects of patients. However, in the current thoracotomy, the cutting-induced thermal-mechanical damages in bone can lead to dreadful sternal infection or cracking complications. For improving sternotomy with reduced thermal and mechnical damages in sawing sternal bone, a novel ultrasonic-assisted sawing of sternum is proposed. The kinematics and kinetics of ultrasonic-assisted sawing process will be approached. The surface/subsurface generation mechanisms in ultrasonic-assisted sawing of sternum will be established. The ultrasonic vibration, sawing operational parameters, surface/subsurface generation mechanisms, biomechanical compatibility will be approached. The interactive relationships between ultrasonic vibration, sawing operations, surface integrity, clinical comfortability and biomechanical compatibility will be presented. The method and strategy of reducing temeperature and damage in bone cutting will be proposed. The stable and efficient ultrasonic-assisted sawing system with large vibration amplitude will be designed and built. This work will not only provide scientific insights for safe, rapid and high-quality sawing of bone, but also have great significance for developing a new type of ultrasonic-assisted thoracotomy.

心脏疾病是世界公认的高发高危疾病，而开胸手术作为开放性心脏手术的标准入路方式已经成为外科临床上必不可少的关键基础技术。然而，目前的胸骨往复干锯切开胸手术，切口界面组织损伤大、温度高、易产生灼伤炭化等问题，严重影响了术后骨愈合，容易引发胸骨感染或开裂并发症，给患者带来了巨大痛苦与生命危险。本项目面向外科手术低创伤、快愈合的需求，提出一种超声辅助往复锯切胸骨手术的新方法、新思路。针对胸骨梯度异构复合生物组织结构特征，建立其力学仿生物理模型，揭示超声复合锯切胸骨运动学与动力学规律及其界面切削分割机理与热力学特性，阐明超声复合干锯切工艺优化与减温降损策略，构建高效稳定大振幅超声复合锯切系统的设计理论与方法。该研究不仅为实现安全、高效、低损超声辅助锯切胸骨手术提供科学的理论依据与技术支持，而且对于医疗超声骨切割技术的发展起到重要支撑和推动作用，同时研究成果可完善和深化骨切削与超声复合加工理论。

开胸手术作为开放性心脏手术的标准入路方式已经成功为外科临床上必不可少的关键基础技术。然而目前的胸骨往复干锯切开胸手术，切口界面组织损伤大, 严重影响术后骨愈合，甚至引发胸骨感染或开裂并发症。本项目面向外科手术低创伤、快愈合的需求，提出一种超声辅助往复锯切胸骨手术的新方法。.项目重点针对胸骨梯度异构复合生物组织结构特征，建立了其力学仿生物理模型，揭示了超声复合锯切胸骨运动学与动力学规律及其界面分割机理与热力学特性；构建了一维/二维超声辅助胸骨锯切有限元模型；搭建了体外一维超声振动辅助胸骨锯切实验平台的搭建；开展了基于临床高效低损的超声复合胸骨锯切技术力学实验研究；测试并分析了基于临床安全性的超声复合胸骨锯切温度，阐明了超声复合干锯切手术工艺优化与减温降损策略，构建了超声复合锯切系统的设计理论与方法。目前在对超声辅助胸骨锯切过程进行大量理论与实验研究基础上，构建了适用于胸骨正中锯切术的新型超声复合胸骨锯切理论和手术工艺体系，为实现安全、高效、低损的新型超声复合锯切开胸手术提供科学的理论依据与指导，并开发了一种新型的一维/二维超声复合的医用手术用胸骨锯，为新型超声辅助胸骨锯切手术的临床应用提供了新器械新设备。