带前柱顺行拉力螺钉导向装置髋臼后方解剖钢板的研制与应用

发布时间：2018-06-22 05:16

本文选题：拉力螺钉 + 数字模型　；参考：《南方医科大学》2017年博士论文

【摘要】：目的设计带顺行前柱拉力螺钉导向装置的髋臼后方解剖钢板,并验证其可行性及疗效。方法随机选取南方医院2014年8月至2015年12月56例完成骨盆(排除解剖学异常和骨质病变)CT扫描数据导入医学影像处理软件Mimics15.0,重建骨盆三维数字模型,将骨盆三维模型向对侧旋转90°,予半透明化处理,在髋臼前柱模拟顺行置入三维圆柱体,调整其位置,逐步增大圆柱体的直径,在虚拟三维圆柱体进入髋臼或穿出骨皮质之前即为拉力螺钉的最大直径。同时向各个方向旋转三维重建模型观察圆柱体,确保圆柱体未穿出骨皮质或者进入髋关节。测量出螺钉进钉点、进钉方向、可置入拉力螺钉的最大直径和长度。利用CT图像三维重建和逆向工程技术,探讨个性化顺行髋臼前柱拉力螺钉固定治疗髋臼前柱骨折的最优钉道并在标本进行有限元验证。获取1位健康成年男性志愿者骨盆CT薄扫数据建立三维髋臼前柱拉力螺钉的钉道模型根据拉力螺钉的几何尺寸及力学参数,在Solidwoks 2012软件中绘制出螺钉模型,用UG Imageware 12.0软件将髋臼前柱和拉力螺钉进行装配,设计出几何算法钉道、"in-out-in"钉道、自由钉道三种固定方式,分别测定在重力负荷(600N、1200N、2400N)下髋骨和螺钉的VonMises应力峰值和形变量等各项参数,最后确定最优钉道。根据测量出的进钉解剖学参数,确定前柱拉力螺钉的最佳钉道。提取髋臼后柱后方表面解剖学形态特征设计出带前柱顺行拉力螺钉导向装置的髋臼后方解剖钢板模板。利用3D打印技术打印出带前柱顺行拉力螺钉导向装置的髋臼后方解剖钢板模型,输人数码铣床获得实体钢板,并在骨盆干性标本和新鲜尸体标本进行验证。结果(1)顺行拉力螺钉的进钉点至坐骨大切迹顶点的距离(OA)平均为(21.11±4.19)mm;至坐骨棘的距离(OB)平均为(56.18±2.01)mm;螺钉与直线OP之间的夹角∠φ平均为(68.51±4.52)°;螺钉与直线OT之间的夹角∠θ平均为(73.67±3.17)°。最大直径平均为(7.31±2.42)mm;最大长度平均为(109.75±8.22)mm。(2)正常髋骨的位移明显高于置入了螺钉的髋骨的位移,且螺钉在几何算法钉道中髋骨所受的应力最小,位移最小。(3)成功设计制作出带前柱顺行拉力螺钉导向装置的髋臼后方解剖钢板,实验组采用带前柱顺行拉力螺钉导向装置的髋臼后方解剖钢板置钉方法成功率可达到84.21%,对照组采用传统的置钉方法成功率只有31.58%,实验组置钉成功率明显高于对照组。结论1.成功设计出可临床应用的带前柱顺行拉力螺钉导向装置的髋臼后方解剖钢板;2.利用该髋臼后方解剖钢板的前柱顺行拉力螺钉导向装置能显著提高拉力螺钉置钉的成功率和准确性。
[Abstract]:Objective to design the posterior acetabular anatomic plate with anterograde anterior column screw guide, and to verify its feasibility and curative effect. Methods from August 2014 to December 2015, 56 cases of pelvis (excluding anatomical abnormalities and bone lesions) were selected randomly and imported into medical image processing software Mimics 15.0 to reconstruct the three-dimensional digital model of pelvis. The three-dimensional model of pelvis was rotated 90 掳to the opposite side and treated with translucency. The anterior column of the acetabular was simulated and placed in a straight line. The position of the three-dimensional cylinder was adjusted, and the diameter of the cylinder was gradually increased. The maximum diameter of the pull screw is before the virtual three-dimensional cylinder enters the acetabulum or penetrates the bone cortex. At the same time, the three-dimensional reconstruction model is rotated in all directions to observe the cylinder to ensure that the cylinder does not penetrate the cortex of bone or enter the hip joint. The point and direction of screw entry are measured, and the maximum diameter and length of the screw can be inserted. Using 3D reconstruction of CT images and reverse engineering technique, the optimal nail path for the treatment of acetabular anterior column fractures with individualized anterograde anterior column screw fixation was investigated and verified by finite element method. The pelvic CT thin scan data of a healthy adult male volunteer were used to establish the screw model of 3D acetabular anterior column lag screw. According to the geometric dimensions and mechanical parameters of the screw, the screw model was drawn in Solidwoks 2012 software. Using UG Imageware 12.0 software, the acetabular anterior column and pull screw were assembled, and three fixing methods were designed, such as geometric algorithm, "in-out-in" nail channel and free nail channel. The parameters of Von Mises stress peak value and shape variable of hip and screw were measured under gravity load (600N ~ 1200Nm ~ 2400N) respectively. Finally, the optimal nail path is determined. According to the anatomical parameters of the screw, the optimal nail path of the anterior column lag screw was determined. The anatomical features of the posterior surface of the posterior column of the acetabulum were extracted. The model of acetabular posterior dissecting plate was printed by 3D printing technique, and the solid plate was obtained by digital milling machine, and verified in pelvis dry specimens and fresh cadavers. Results (1) the average distance from the point of forward pull screw to the point of great notch of ischium (OA) was (21.11 卤4.19) mm, the distance to sciatic spine (OB) was (56.18 卤2.01) mm, the angle of angle between screw and straight op was (68.51 卤4.52) 掳, and the angle between screw and straight line OT was (73.67 卤3.17) 掳. The average maximum diameter was (7.31 卤2.42) mm, and the average maximum length was (109.75 卤8.22) mm. (_ 2). The displacement of the normal hip bone was significantly higher than that of the screw placed in the hip bone, and the stress of the hip bone was the smallest in the geometric algorithm. (3) successful design and manufacture of the posterior dissecting plate with the guide device of the front column forward pull screw, The success rate of posterior acetabular anatomic plate nail placement was 84.21 in the experimental group and 31.58 in the control group. The success rate of the experimental group was significantly higher than that of the control group. Conclusion 1. The posterior acetabular anatomic plate with anterior column anterograde lag screw guide device was successfully designed for clinical use. The success rate and accuracy of screw placement can be significantly improved by using the anterior column anterograde lag screw guide device of the posterior acetabular anatomic plate.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R687.3

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