三维重建及快速成型技术在室间隔缺损手术中的应用

发布时间：2018-06-01 10:22

本文选题：三维重建 + 快速成型技术　；参考：《新乡医学院》2016年硕士论文

【摘要】：背景3D打印技术出现于20世纪80年代中期,它是一种以数字模型文件为基础,运用粉末状金属或塑料等可粘合材料,通过逐层打印的方法来构造物体的技术。3D打印技术与医学相结合,由临床需求为导向从而衍生出来的一系列医学模型是近年来医学领域的新突破。目的基于256CT数据行室间隔缺损患儿病变部位三维重建并制作患儿的室间隔缺损的实体模型,探讨其在小儿室间隔缺损修补手术中的应用价值,为临床室间隔缺损修补术提供崭新的诊疗视角。方法选取2014年9月至2015年7月郑州市心血管病医院收治的经彩色超声确认的干下型室间隔缺损患儿30例,男17例,女13例,年龄2岁5个月~3岁,平均年龄2岁8个月,体重9.6±2.6kg。30例室间隔缺损患儿均行彩色超声与增强256CT心脏影像学检查,设备由郑州市心血管病医院提供,设备型号为荷兰Philips Brilliance iCT,层厚0.45mm,获得256CT连续断层平扫医学数字成像和通信(Digital Imaging and Communications in Medicine,DICOM)图像数据,然后将得到的DICOM图像数据导入到比利时Materialise公司医用Mimics19.0软件,优化图像,以减少256CT因素及呼吸运动、心脏跳动产生的阴影、斑点。根据CT成像原理确定心脏造影剂、心肌、脂肪的阈值范围,并标示。利用医用Mimics软件中的再利用区域生长及动态区域生长算法对目标区域进行分割。而后利用Mimics软件编辑蒙面,利用编辑命令功能进行精细分割,分离内部造影剂,保留正常组织结构及病变部位图像。得到30例患儿的三维重建数据,依据三维重建数据利用美国3DP Unlimited X1000工业打印机打印出3D模型。结果30例行三维重建及快速成型技术指导室间隔缺损修补手术患儿均取得理想的CT原始数据,而后根据医用Mimics软件处理所得的数据进行3D打印。术中所见与术前三维重建模型的病灶结构变化及室间隔缺损大小一致。术前三维重建模型测量室间隔缺损大小平均直径为7.10±0.2mm,术中实测室间隔缺损平均直径为7.20±0.2mm,两者比较差异无统计学意义(t=0.82,P=0.43)。30例患儿均按手术前手术规划完成手术,手术过程顺利,室间隔缺损补片均缝合良好,补片形态、大小满意。30例患儿均未出现房室传导阻滞及三尖瓣功能异常等并发症。左右流出道形态正常,未出现流出道梗阻改变及室间隔修补术后残余漏。结论1.通过三维重建及快速成型技术可以获得病理器官的三维模型,包含心脏腔室内部结构、心脏房室壁及心脏血管解剖结构关系。2.根据三维模型,可以完成病变部位任意角度观察及测量、便捷术前沟通、规划手术路径、设计手术方案、指导室间隔缺损手术、对比手术效果等。3.三维重建及快速成型技术还可以对法洛氏四联症、右心室双出口、主动脉夹层等复杂心血管疾病提供诊断全新视角,辅助手术,降低手术时间、提高手术成功率。
[Abstract]:Background 3D printing technology was developed in the mid-1980s. It is based on digital model files and uses adhesible materials such as powder metal or plastics. In recent years, a series of medical models derived from the combination of 3D printing technology and medical science, which are based on the method of layer by layer printing, are a new breakthrough in the field of medicine. Objective to study the value of three-dimensional reconstruction of the lesion site of ventricular septal defect (VSD) in children with ventricular septal defect (VSD) based on 256CT data and to make a solid model of VSD in children. To provide a new perspective for clinical repair of ventricular septal defect. Methods from September 2014 to July 2015, 30 children (17 males and 13 females) with subdry ventricular septal defect (VSD) confirmed by color ultrasound were selected from Zhengzhou Cardiovascular Disease Hospital. The average age was 2 years, 5 months and 3 years, with an average age of 2 years and 8 months. The body weight of 9.6 卤2.6kg.30 patients with ventricular septal defect (VSD) was examined by color ultrasound and enhanced 256CT cardiac imaging. The equipment was provided by Zhengzhou Cardiovascular Disease Hospital. The equipment model is 0.45mm Philips Brilliance iCT, layer thickness in the Netherlands. The image data of 256CT continuous tomography plain scan medical digital imaging and communication digital Imaging and Communications in medical image (DICOM) are obtained. The obtained DICOM image data is then imported into the medical Mimics19.0 software of Materialise Company in Belgium to optimize the image. To reduce 256CT factors and breathing movement, the heart beats to produce shadows and spots. Determine the threshold range of cardiac contrast agents, myocardium, and fat according to CT imaging principles, and label it. The target region is segmented by using the algorithm of region growth and dynamic region growth in medical Mimics software. Then Mimics software was used to edit the mask, and the editing command function was used for fine segmentation, separation of internal contrast agents, and preservation of normal tissue structure and lesion image. The 3D reconstruction data of 30 children were obtained and the 3D model was printed out by 3DP Unlimited X1000 industrial printer. Results 30 children underwent 3D reconstruction and rapid prototyping technique to guide the repair of ventricular septal defect (VSD). The original CT data were obtained, and then 3D printing was carried out according to the data processed by medical Mimics software. The intraoperative findings were consistent with the changes of lesion structure and the size of ventricular septal defect (VSD) in the pre-operative three-dimensional reconstruction model. The mean diameter of ventricular septal defect measured by 3D reconstruction model was 7.10 卤0.2mm, and the mean diameter of intraoperative ventricular septal defect was 7.20 卤0.2mm. There was no significant difference between the two methods. The repair of ventricular septal defect (VSD) was well sutured, the patching was good and the size of the patch was satisfactory. There were no complications such as atrioventricular block and tricuspid valve dysfunction in 30 cases of ventricular septal defect (VSD). The left and right outflow tract was normal and there was no change of outflow tract obstruction and residual leakage after ventricular septal repair. Conclusion 1. Through 3D reconstruction and rapid prototyping, the three-dimensional model of pathological organs can be obtained, including the internal structure of the heart chamber, the anatomic structure of the atrioventricular wall and the vascular structure of the heart. According to the 3D model, it can be used to observe and measure any angle of the lesion, to communicate conveniently before operation, to plan the operation path, to design the operation plan, to guide the operation of ventricular septal defect, and to compare the operation effect. Three-dimensional reconstruction and rapid prototyping can also provide a new perspective for the diagnosis of complex cardiovascular diseases such as tetralogy of Fallot, double outlet of right ventricle, aortic dissection and so on.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

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