不稳定骨盆骨折复位架的研发与应用

发布时间：2018-03-10 20:54

本文选题：不稳定骨盆骨折　切入点：三维重建　出处：《中国人民解放军医学院》2015年博士论文　论文类型：学位论文

【摘要】：研究背景不稳定骨盆骨折是骨盆环损伤导致一侧或双侧骨盆部分或完全移位的骨盆骨折类型,其外科处置主要有切开复位内固定和闭合复位外固定架固定两种方式。传统的治疗方式,即切开复位内固定,可以直视损伤区域,利于骨折解剖复位；但由于骨盆位置深在,手术过程容易损伤盆腔内的重要血管神经。闭合复位的优势在于减少软组织暴露引起的血管神经损伤风险,但传统的闭合复位方式很难达到解剖复位。计算机辅助骨科手术(computer assisted orthopaedic surgery, CAOS)能为我们解决这一难题。它将计算机图像处理技术、机器人技术与骨科手术相结合,对人体解剖结构进行显示和定位,术中利用计算机导航和软件虚拟操作进行手术,提高了手术操作精度、减少手术损伤。本课题旨在研发出一种基于骨盆三维影像和CAOS技术可精确复位不稳定骨盆骨折的骨盆复位架,使不稳定骨盆骨折的复位过程精确、自动和可程序化。目的(1)根据不稳定骨盆骨折在三维空间中的移位特点,建立骨折的复位路径。(2)基于计算机模拟的骨盆骨折的复位路径,设计出可以精确复位骨盆骨折的骨盆复位架,并进行模型骨和初步临床试验验证。方法(1)利用Mimics、3-Matic等CAD (Computer aided design,计算机辅助设计)软件三维重建骨盆,分析规划不稳定骨盆骨折解剖复位所需的复位路径。骨盆骨折后的骨块或半骨盆在空间上有不同方向的移位。各种方向移位的骨盆,通过怎样的复位顺序可以得到最佳的复位效果,即解剖复位。这些都需要通过详细的临床路径规划和计算机和模拟骨来完成,这部分实验含有两方面的实验：第一、通过骨盆三维重建模型,研究出一套可定量计算骨盆移位距离和旋转角度的影像学测量方法。第二、基于已完成的影像学测量方法,利用Mimics、3-Matic软件,模拟不同类型骨盆骨折达到解剖复位所需的复位路径。(2)基于计算机模拟的骨盆骨折的复位路径,设计出可以精确复位骨盆骨折的骨盆复位架。基于计算机软件模拟出的不稳定骨盆骨折的复位路径。在Starr骨盆复位架的基础上,将骨盆骨折在不同平面的复位路径刻度化和精确化,制作骨盆复位架。(3)骨盆复位架复位效果的实验验证。第一、模型骨实验。在模型骨上制作不稳定骨盆骨折模型.通过骨盆复位架进行骨折复位。第二、初步临床实验。基于模型骨实验的结果,选择合适的骨盆骨折病例,利用骨盆复位架进行复位手术并评价效果。结果(1)本研究所建立的测量方法能精确计算不稳定骨盆骨折在三维空间中的旋转和平移复位量.并将旋转移位分解至两个正交轴和一个任意轴。(2)根据远程运动中心(简称“远心”,Remote center of motion, RCM)机构基本构型,设计并制作基于圆弧形导轨型RCM机构的不稳定骨盆复位架,结合半骨盆在三维空间中的移位计算,建立出基于骨盆复位架的不稳定骨盆骨折复位路径。(3)经模型骨实验验证,不稳定骨盆骨折复位架的平移和旋转精度分别小于5毫米和4度：经初步临床试验验证,复位架可实现不稳定骨盆骨折解剖复位。结论本研究设计的骨盆复位架可以用于对不稳定骨盆骨折的复位操作,使不稳定骨盆骨折的复位过程按刻度和特定路径精确实施,达到传统闭合复位无法轻易完成的不稳定骨盆骨折解剖复位。
[Abstract]:The research background of unstable pelvic fractures is pelvic ring injuries cause type unilateral or bilateral pelvic partially or completely displaced fractures of the pelvis, the surgical procedures are open reduction and internal fixation and external fixation in two ways. The traditional treatment methods, namely open reduction and internal fixation, can look into the damaged area, conducive to the anatomical reduction of fracture but because deep in the pelvis position; and the operation process is easy to damage the important blood vessels and nerves in the pelvic cavity. The advantage of closed reduction and reduce exposure risk caused by vascular injury of soft tissue, but the traditional way of closed reduction is difficult to achieve anatomical reduction. Computer aided surgical department of orthopedics (computer assisted orthopaedic surgery, CAOS) can we solve this it will be a problem. Computer image processing technology, robot technology and the combination of the Department of orthopedics operation, display and set of human anatomy A surgery using computer navigation and virtual software operation, improve operation accuracy, reduce surgical injury. The purpose of this study is to develop a three-dimensional image frame pelvic pelvic reduction and CAOS technique can accurate reduction of unstable pelvic fractures based on the reduction of unstable pelvic fracture accurately, automatic and programmable purpose. (1) according to the characteristics of unstable pelvic shift in the 3D fracture, fracture reduction and path establishment. (2) the reset path of computer simulation based on the design of pelvic fracture, can pelvic reduction frame accurate reduction of pelvic fracture, and bone model and preliminary clinical experiments. Methods (1 the use of Mimics, 3-Matic) CAD (Computer aided design, computer aided design) software for 3D reconstruction of the pelvis planning analysis of unstable pelvic fracture anatomical complex path reduction required. After pelvic fracture The displacement of the bone block or semi pelvis in different directions in space. All direction shift of the pelvis, through the reduction sequence of how can get the best reduction effect, namely the anatomical. All these need to be completed through the detailed clinical path planning and computer simulation and bone, this part contains two aspects: the first experiment through the pelvis, three-dimensional reconstruction model, developed a set of quantitative calculation of pelvic displacement distance and the rotation angle of the image measurement method. Second, learn the measurement method, has been completed based on the image by using Mimics, 3-Matic software, simulation of different types of pelvic fractures reached anatomical reduction path reduction required. (2) reset path computer simulation of pelvic fractures based on design can accurate reduction of pelvic fractures with pelvic reduction. The reset path of unstable pelvic fracture by computer simulation based on Starr. Based on the frame of the pelvic fracture, pelvic fracture reduction in path scale and precision of different planes, making the pelvic reduction frame. (3) experimental verification of pelvic reduction frame reduction effect. First, the experimental model of bone. In the model of bone on the unstable pelvic fracture model. The fracture reduction through the pelvic bone resetting frame second, preliminary clinical trials. Bone model based on the experimental results, select the appropriate cases of pelvic fracture, reduction surgery and evaluate the effect of using pelvic reduction frame. Results (1) measurement method established in this study can accurately calculate unstable pelvic fracture reduction amount of rotation and translation in the three-dimensional space and the rotation. The shift down to two orthogonal axes and an arbitrary axis. (2) according to the remote center of motion (referred to as "Remote center of from heart", motion, RCM) mechanism basic configuration, design and production based on circular arc guide mechanism RCM The unstable pelvic reduction, transposition and semi pelvis in three-dimensional space is calculated, a reset path of unstable pelvic fracture. Based on pelvic reduction frame (3) by bone model experiment, unstable pelvic fracture reduction and rotation precision translational frame are respectively less than 5 mm and 4 degrees: preliminary clinical trials verify, reset frame can be unstable pelvic fracture anatomical reduction. Conclusion pelvic reduction frame designed in this study can be used to reset operation of unstable pelvic fractures, the reduction of unstable pelvic fracture accurately according to the scale and the specific path, anatomic reduction of unstable pelvic to traditional closed reduction cannot easily complete fracture.

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.1

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