下肢骨折是骨科臨床實務最常處理的骨折之一。這些骨折常造成長期及廣泛的殘疾及失能，尤其是在遭受高強度外傷後可能伴隨多重系統的傷害。骨髓內鋼釘和微創互鎖式骨板被認為是處理下肢長骨骨折的主要固定方式。 雖然脛骨及股骨的骨釘/骨板技術已臻成熟，遠端的固定螺釘對許多骨科醫師來說仍是場惡夢。利用透視X光機找尋「完美圓孔」的徒手技巧仍是最常被採用的定位方式。這種方式的缺點包括較長的手術時間和輻射曝露，還有螺釘錯置的可能性。 許多定位系統和技巧已被提出過，像是延伸型鑽孔導引、電腦導航系統、透光法、遠端定位導線及其他徒手定位技巧，甚至利用兩支骨釘重疊的定位方法。然而上述方法大多昂貴、難以操作或誤差過大以致無法精確的定位螺孔位置。 我們的研究目標為能夠解決體外定位找螺孔的問題，並利用光學方法降低光散射程度，並期待能適用於各種不同廠牌的骨釘/骨板。我們將會比較新的定位方法及傳統徒手定位的效果。我們期待新的定位法可以減少手術時間、減少螺釘錯置機會、並減少來自X光機的輻射量。

Free-hand technique of attaining "perfect-circles" with the assistance of fluoroscopy is most common method for the insertion of distal locking screw. Its pitfalls include increased operative time, increased radiation exposure, and the incidence of distal locking screw misplacement. To solve this problem, a new ideal targeting system should not only be convenient to surgeons to effectively shorten operative duration and lower the chance of screw misplacement, but be cost-effective. Many targeting systems and techniques have been developed as follows: drill guide extensions, computer-aided navigation systems, transillumination methods, distal targeting guidelines, various other free-hand techniques, and even "nail-over" procedures by using two intramedullary nails. However, most of them are expensive, bulky, and may have a steep learning curve for the surgeons. To find positioning in vitro can be solved through-hole problems, and reduce the light scattering method using an optical level, and look forward to for a variety of different brands of bone nail / bone plate. We hoped that this targeting device will decrease operative time, decrease the misplacement rate, and decrease the radiation from fluoroscopy.

論文審定書 (中文 ) ................................ ................................ ........ i
論文審定書 (英文 ) ................................ ................................ ....... ii
論文公開授權書 ................................ ................................ ........ iii
誌謝 ................................ ................................ ............................. iv
中文摘要 ................................ ................................ ...................... v
Abstract ................................ ................................ ...................... vi
目錄 ................................ ................................ ............................ vii
圖目錄 ................................ ................................ ......................... ix
表目錄 ................................ ................................ ........................ xii
第一章 序論 ................................ ................................ .............. 1
1.1前言 ................................ ................................ ................................ .................. 1
1.2研究背景 ................................ ................................ ................................ .......... 1
1.2.1 徒手定位技術 ................................ ................................ ...................... 2
1.2.2 圖像增強定位技術 ................................ ................................ .............. 4
1.2.3 電腦輔助定位技術 ................................ ................................ .............. 5
1.3研究動機 ................................ ................................ ................................ .......... 7
第二章 生物組織之光學特性理論 ................................ ......... 8
2.1生物組織光學特性 ................................ ................................ .......................... 8
2.2 光吸收＆反射 ................................ ................................ ................................ . 9
2.3 光散射 ................................ ................................ ................................ ........... 12
第三章 實驗量測方法與結果 ................................ ............... 14
3.1 實驗方法 &實驗儀器 實驗儀器 ................................ ................................ ................... 14
3.2 利用偏振片來降低光散射 ................................ ................................ ........... 19
3.3利用衰減片來降低光 散射 ................................ ................................ ............ 20
3.4利用光學透鏡增加對比度 ................................ ................................ ............ 21
第四章 臨床實驗 ................................ ................................ ..... 23
4.1 體內定位臨床實驗 ................................ ................................ ........................ 23
4.2 體外定位臨床實驗 ................................ ................................ ........................ 26
4.3 體外定位臨床實驗 ................................ ................................ ........................ 28
第五章 結 論 ................................ ................................ ......... 32
參考文獻 ................................ ................................ .................... 33
附錄 ................................ ................................ ............................ 36

[1] Levin PE, Schoen RW, Browner BD. “Radiation exposure to surgeon during closed interlocking intramedullary nailing.” The Journal of Bone & Joint Surgery, Vol. 69, No. 5, pp.761-766, 1987
[2] Christian Krettek, Jurgen MannB “Deformation of Femoral Nails with Intramedullary Insertion” Journal of Orthopaedic Research Vol. 16, No. 5, pp. 572–575, 1998
[3] Thierry Leloup, Wissam El Kazzi “A Novel Technique for Distal Locking of Intramedullary Nail Based on Two Non-constrained Fluoroscopic Images and Navigation ” IEEE TRANSACTIONS ON MEDICAL IMAGING, Vol. 27, No. 9 ,pp1202-1212., 2008
[4] Y. Arlettaz , A. Akiki “Targeting device for intramedullary nails: A new high-stable mechanical guide” Injury-International Journal Of The Care Of The Injured, Vol. 39, No. 2 , pp.170-175, 2008
[5] Langfitt MK, Halvorson JJ” Distal locking using an electromagnetic field-guided computer-based real-time system for orthopaedic trauma patients” Journal of Orthopaedic Trauma , VOL. 26, NO. 11, pp. 367-372 , 2012
[6] B.K. Moor , M. Ehlinger “ Distal locking of femoral nails. Mathematical analysis of the appropriate targeting range ” Orthopaedics & Traumatology: Surgery & Research, Vol.98 , No.1, pp.85-89, 2012
[7] Lukas L. Negrin , Vilmos Vécsei “Is a Magnetic-Manual Targeting Device an Appealing Alternative for Distal Locking of Tibial Intramedullary Nails?” Archives of trauma research , Vol. 2, No.1, pp.16-20, 2008
[8] Rajesh Rohilla , Roop Singh “Nail over nail technique for distal locking of femoral intramedullary nails” International Orthopaedics (SICOT), Vol.33, No.4, pp.1107–1112, 2009
[9] William Chu, Jyhpyng Wang “Reducing radiation exposure in intra-medullary nailing procedures: Intra-medullary endo-transilluminating (iMET)” Injury-International Journal Of The Care Of The Injured, Vol. 40, No. 10 , pp.1084-1087, 2009
[10] 朱惟勤,朱惟廉“附照明定位裝置之髓腔導針”中華民國專利2001
[11] 朱惟勤,曾尹俊”可與髓腔導針接合之側向發光裝置”中華民國專利2013
[12] Rudolf Steiner “Laser-Tissue Interactions” Laser and IPL Technology in Dermatology and Aesthetic Medicine, pp.23-36, 2011
[13] Elina A. Genina; Alexey N. Bashkatov “Optical clearing of human cranial bone by administration of immersion agents” SPIE Proceedings Vol. 6163, pp.1-9, 2006
[14] R.L.P. van Veen, H.J.C.M. Sterenborg, A. Pifferi, A. Torricelli, and R. Cubeddu, OSA Annual BIOMED Topical Meeting, 2004
[15] ASHLEY J. WELCH” The Thermal Response of Laser Irradiated,Tissue ” IEEE Journal of Quantum Electronics, Vol. 20, No. 12, pp. 1471 – 1481, 1984
[16] 常樹全、湯曉斌 “光在生物組織中的傳輸與分佈研究” 中國科技論文在線 2005
[17] Lihong Wang, Steven L. Jacques “Monte Carlo Modeling of Light Transport in Multi-layered Tissues in Standard C” University of Texas M. D. Anderson Cancer Center 1992
[18] 侯比學, 陳果夫 “採用最早到達光透過高散射介質成像” 光子學報第28卷第3期, pp.173-178, 1999

[19] Yuhu Ren, Wenjiang Tan “Ultrafast optical Kerr gate imaging in a polydisperse turbid medium” Journal of Modern Optics Vol. 63, No. 6, pp. 513-518, 2016
[20] S.K . GAYE N AND R.R. ALFANO ” Emerging Optical Biomedical Imaging Techniques ” Optics & Photonics News , Vol.7, No.3, pp.16-22, 1996
[21] Wang L, Ho PP “Ballistic 2-D Imaging Through Scattering Walls Using an Ultrafast Optical Kerr Gate” Science, Vol. 253, No.5021, pp.769-771, 1991
[22] Chen J, Intes X. “Time-gated perturbation Monte Carlo for whole body functional imaging in small animals” OSA Optics Express, Vol.17, No.22, pp.19566-19579, 2009
[23] 徐新,張鎮西 ”激光作用於肌肉的部分偏振現象及探測” 激光技術 Vol.14 , No.6, pp.61-63, 1990
[24] Yvan Arlettaz, MD, Alexander Dominguez ” Distal Locking of Femoral Nails: Evaluation of a New Radiation-Independent Targeting System ” Journal of Orthopaedic Trauma , Vol.26 , No.11, pp.633-637 , 2012