儿童先天性髋关节脱位Steel三相截骨模板的设计与应用

发布时间：2018-06-11 20:14

本文选题：三维重建 + 逆向工程　；参考：《南方医科大学》2013年博士论文

【摘要】：第一部分三维重建与逆向工程技术设计儿童先天性髋关节脱位Steel三相截骨术截骨模板研究背景先天性髋关节脱位又称为发育性髋关节脱位,是一种对儿童健康影响大的病变,估计我国的发生率大概为1%。髋是下肢重要的活动关节,如能做到早诊断、早治疗,临床效果是满意的。但是如果得不到及时有效的治疗,髋关节将早期退行性骨关节炎,最终威胁髋关节的远期功能,严重影响人类的健康和生活质量。因此在早期通过合理的手术不仅可使髋关节复位稳定,还可以避免许多手术并发症。然而在过去其治疗原则或手术方案的制定通常以患儿年龄和X线为依据。由于X线检查的局限性,难以使临床医师对髋关节发育不良有全面准确的认识。近年来随着计算机技术在影像学中的应用,三维重建技术及三维可视化分析技术获得了长足的进步,尤其在小儿先天性髋关节脱位的手术治疗中显示了它的优越性。本文主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。目的先天性髋关节脱位在早期通过合理的手术不仅可使髋关节复位稳定,还可以避免许多手术并发症。然而在过去其治疗原则或手术方案的制定通常以患儿年龄和X线为依据。由于X线检查的局限性,难以使临床医师对髋关节发育不良有一个全面准确的认识。近年来随着计算机技术在影像学中的应用,三维重建技术及三维可视化分析技术获得了长足的进步,尤其在小儿先天性髋关节脱位的手术治疗中显示了它的优越性。本文主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。本研究旨在利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术提供一种相对精确的截骨方案。方法采用连续螺旋CT对一例儿童先天性髋关节脱位患者行骨盆连续断层扫描,扫描条件：电压120kv,层厚0.625mm,矩阵512x512。髋关节的三维重建：将扫描Dicom格式图像导入Materialise Mimics14.1软件,采用表面遮盖显示法(shaded surface display,SSD)进行三维表面重建,然后将重建的髋关节以.stl格式保存,导入Imageware12.0软件进行进一步分析及设计。先天性髋关节脱位的模拟截骨与复位：通过Imageware12.0软件,利用软件中的镜像功能,在患侧生成健侧的髋关节的三维模型,根据steel三相截骨方案在髋关节模型上进行截骨,以健侧髋关节的模型为指导将截断的骨块进行旋转,重建正常的髋关节解剖,使患臼覆盖达到预设的髋臼位置。截骨模板的生成：通过截骨旋转重建后的髋关节与镜像生成的髋关节模型进行对比,以截骨两端区域为基准进行反求,设计模板(包括开口角度和旋转角度)。结果通过三维重建得到了较好的显示结果,重建的髋关节三维模型,可以直观显示患髋解剖形态。通过三维可视化髋臼模型,模拟Steel三相截骨术可精确设计小儿髋关节。通过三维重建与逆向工程技术构建的截骨模板,为Steel三相截骨矫正术提供一种相对精确的截骨方案。结论基于CT影像下先天性髋关节脱位的患儿髋关节三维重建效果直观：本课题通过目前较成熟的三维软件成像技术,利用先天性髋关节脱位的患儿薄层扫描后的CT影像,不仅可以清晰、直观地观察患儿髋关节的三维形态,而且可以将我们关心的部位分离或透视,并能以任一角度旋转,排除临近结构的遮挡。第二部分Steel三相截骨模板在儿童先天性髋关节脱位治疗中的应用目的本研究主要探讨三维重建与逆向工程技术重建患儿髋关节可能性及模拟截骨的临床应用价值。利用三维重建与逆向工程技术为儿童先天性髋关节脱位Steel三相截骨矫正术提供一种相对精确的截骨方案,并观察13例使用此类方法设计的模板的临床疗效。方法临床资料：本组13例,男8例,女5例,平均年龄7.2±1.1(6-9)岁。右侧8例,左侧5例。髋臼指数44.0°±1.9°(40°-46°)。13例患者术前诊断无股骨头坏死。根据患者的X线及临床表现,拟按照Steel截骨术进行截骨矫形。截骨模板在Steel截骨术中应用：按照Steel截骨的手术进行髋臼截骨后,将计算机辅助生成的截骨模板植入,克氏针固定。结果 13例Steel截骨术的患儿通过三维重建与逆向工程技术构建的截骨模板重建的髋关节初期临床疗效满意。结论基于CT扫描后的三维重建影像可以应用于临床解剖研究：利用CT扫描数据三维重建的患儿髋关节可视化图像,不仅立体直观,而且由计算机软件对其解剖参数的测量也减小了人为因素的误差,能够在三维空间中准确的定位并获得各种三维数据,为临床解剖的研究提供一种新的研究途径。通过三维重建与逆向工程分析构建的Steel三相截骨模板可以提供良好的匹配性,同时减少了手术的时间,提高了手术的安全性。三维重建和逆向工程技术的出现以及不断的发展为现代骨科手术提供了新的辅助手段,根据CT数据重建的三维模型可以直接、深入观察手术部位结构特点,可以对手术区的结构进行三维可视化分析,维持充分的髋臼覆盖,而且可提高手术的安全性。因此,针对先天性髋关节脱位患者采用Steel截骨的问题,我们按照临床手术要求进行设计,根据截骨位置以及截骨后骨块的三维可视化分析还原正常的髋关节,生成植入骨块模型,随着逆向工程技术及激光快速成型技术在医学的应用,我们可以将截骨模板通过快速成型技术生成实体,这样就保证了植入骨块的准确匹配,保证了充分的髋臼覆盖以及重建后髋臼的稳定性。螺旋CT以及三维可视化分析可精确重建小儿髋关节,为临床医师的手术方案、手术入路、植入骨块模型提供可靠的依据,达到针对不同病人手术个体化的最终目标,不但使手术实施的可行性、安全性增加,而且能够降低手术的风险性,减少手术的并发症。
[Abstract]:Part three: three dimensional reconstruction and reverse engineering to design Steel osteotomy template for congenital dislocation of the hip in children.
Research background
Congenital dislocation of the hip, also known as developmental dislocation of the hip, is a disease affecting the health of children. It is estimated that the incidence of 1%. is probably an important active joint of the lower extremities, such as early diagnosis, early treatment, and satisfactory clinical effects. However, the hip joint will be early degenerative if no timely and effective treatment is available. Osteoarthritis, which eventually threatens the long-term function of the hip joint, seriously affects human health and quality of life. Therefore, the early adoption of a reasonable operation can not only stabilize the reduction of the hip joint, but also avoid many surgical complications. However, in the past, the principles of treatment and the formulation of the operation plan were usually based on the age and X-ray of the children. Because of X The limitation of line examination makes it difficult for clinicians to have a comprehensive and accurate understanding of the dysplasia of the hip. In recent years, with the application of computer technology in imaging, three-dimensional reconstruction technology and three-dimensional visualization analysis technology have made great progress, especially in the surgical treatment of congenital dislocation of the hip in children. This article mainly discusses the clinical application value of three-dimensional reconstruction and reverse engineering in the reconstruction of hip joint and Simulation of osteotomy in children.
objective
Congenital dislocation of the hip can not only stabilize the reduction of the hip joint, but also avoid many surgical complications. However, in the past, the principles of treatment and the formulation of the operation plan were usually based on the age and X-ray of the children. In recent years, with the application of computer technology in imaging, three dimensional reconstruction technology and three-dimensional visualization analysis technology have made great progress, especially in the surgical treatment of congenital dislocation of the hip in children. This paper mainly discusses the reconstruction of three dimensional reconstruction and reverse engineering technology to reconstruct children. The possibility of hip joint and the clinical value of simulated osteotomy. The purpose of this study is to provide a relatively precise osteotomy scheme for Steel three phase osteotomy for congenital dislocation of the hip in children.
Method
A continuous spiral CT scan was performed on a case of congenital dislocation of the hip in children. The scanning conditions were: voltage 120kv, layer thickness 0.625mm, matrix 512x512..
Three-dimensional reconstruction of the hip joint: the scanned Dicom format image is introduced into the Materialise Mimics14.1 software, the surface covering display (shaded surface display, SSD) is used to reconstruct the three-dimensional surface. Then the reconstructed hip joint is saved in.Stl format, and the software of Imageware12.0 is introduced into the one step analysis and design.
The simulated osteotomy and reduction of congenital dislocation of the hip: using the Imageware12.0 software, using the image function of the software, the three-dimensional model of the hip joint is generated on the affected side, the osteotomy of the hip joint is carried out on the hip joint model according to the steel three phase osteotomy scheme, and the truncated bone block is rotated and reconstructed with the model of the healthy side of the hip joint. The anatomy of the hip joint enables the coverage of the acetabulum to reach the preset acetabular position.
The formation of the osteotomy template: the hip joint reconstructed by the osteotomy was compared with the mirror generated hip model, and the reverse of the two ends of the osteotomy was taken as the baseline, and the template was designed (including the opening angle and the rotation angle).
Result
The 3D reconstruction results show that the reconstructed hip joint model can directly visualized the hips.
Three dimensional visualization of acetabular model and Simulation of Steel three-phase osteotomy can accurately design pediatric hip joint.
The osteotomy template constructed by three-dimensional reconstruction and reverse engineering technology provides a relatively accurate osteotomy for Steel three phase osteotomy.
conclusion
The results of three-dimensional reconstruction of hip joint in children with congenital dislocation of hip based on CT image are intuitionistic: this topic can not only clearly and intuitively observe the three-dimensional shape of the hip joint, but also be able to close us with the mature three-dimensional software imaging technology at present, using the CT images of the children with congenital dislocation of the hip after thin layer scanning. The part of the heart is separated or fluoroscopic and can be rotated at any angle to exclude the occlusion of the adjacent structure.
The second part is the application of Steel three phase osteotomy template in the treatment of congenital dislocation of the hip in children.
objective
This study mainly discusses the possibility of reconstruction of hip joint and the clinical value of simulated osteotomy in children with three-dimensional reconstruction and reverse engineering. Three-dimensional reconstruction and reverse engineering are used to provide a relatively precise case of osteotomy for Steel three phase osteotomy for congenital dislocation of the hip in children, and 13 cases are designed by this method. The clinical efficacy of the template.
Method
Clinical data: 13 cases in this group, 8 men and 5 women, the average age of 7.2 + 1.1 (6-9) years, the right 8 cases, the left 5 cases, the acetabular index 44 [.13] 1.9 degrees (40 -46 degrees) patients were diagnosed without osteonecrosis before operation. According to the X-ray and clinical manifestations of the patients, the osteotomy and orthopedics were made according to Steel osteotomy.
The osteotomy template was used in Steel osteotomy. After osteotomy of the acetabulum, a computer-assisted osteotomy template was implanted and Kirschner was fixed with the osteotomy of the Steel osteotomy.
Result
The initial clinical results of 13 cases of Steel osteotomy were satisfactory by three-dimensional reconstruction and reverse engineering.
conclusion
3D reconstruction images based on CT scan can be applied to clinical anatomy study: the visual images of hip joint in children reconstructed by CT scanning data are not only stereoscopic, but also the error of human factors can be reduced by the measurement of the anatomical parameters of computer software, and it can be accurately positioned and obtained in three-dimensional space. Three dimensional data provides a new approach for the study of clinical anatomy. The three phase osteotomy template constructed by three dimensional reconstruction and reverse engineering analysis can provide good matching, reduce the time of operation and improve the safety of the operation.
The appearance and continuous development of 3D reconstruction and reverse engineering technology provide a new auxiliary means for modern department of orthopedics operation. According to the three-dimensional model of the reconstruction of CT data, the structural features of the surgical site can be observed. The three-dimensional visualization of the structure of the operation area can be analyzed, the full acetabular cover can be maintained, and the high hand can be raised. Therefore, in view of the problem of Steel osteotomy for patients with congenital dislocation of the hip, we designed according to the requirements of the clinical operation. According to the position of the osteotomy and the three-dimensional visualization of the bone block after the osteotomy, the normal hip joint was reduced and the model of the implant was generated. With the reverse engineering and laser rapid prototyping, the medical treatment was used in the medical treatment. With the application of the study, we can generate the osteotomy template by rapid prototyping, which ensures the accurate matching of the implanted bone blocks, guarantees the full acetabular coverage and the stability of the acetabulum after the reconstruction. The spiral CT and three-dimensional visualization analysis can accurately reconstruct the child's hip joint, the surgical procedure of the clinician and the surgical approach. Implant bone block model provides a reliable basis to achieve the ultimate goal of individual operation for different patients. It not only makes the operation feasible, but also increases the safety, but also reduces the risk of operation and reduces the complications of operation.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R726.8

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