六轴并联机构在创伤长骨骨折移位复位中的研究与应用

发布时间：2018-04-05 03:03

  本文选题：Stewart平台　切入点：骨外固定器　出处：《天津医科大学》2017年硕士论文

【摘要】：目的:长骨骨折移位畸形是骨科最为常见的疾病,针对该类病例,骨外固定技术已在临床上获得大量成功的应用案例。然而目前主流的骨外固定复位技术均使用X线平片作为诊断测量依据,受点光源投影成像原理和手工测量操作的制约,这类方法在精度上存在一定的不足。针对此不足,本文对传统测量方法进行了改良,且提出一种基于三维重建的长骨骨折畸形复位新技术,并在临床中探讨其可操作性、精确性和有效性,验证其能否有效提升骨折复位的精度。方法:(1)收集从2016年2月至2016年8月就诊于我院并采用Stewart平台六轴并联机构(天津新中泰勒骨外固定器)进行治疗的胫腓骨骨折病人21例。其中,男性17例,女性4例,年龄14-76岁,平均42±15.2岁。获取所有患者术后患肢的正侧位X线片(GE XR656)及CT影像Dicom格式数据(GE 750三维螺旋CT);(2)运用Mimics 17.0、Coreldraw X7软件对传统测量方法进行改良,并应用于临床进行效果评价;(3)借助Mimics软件,处理CT影像数据并生成三维重建模型;(4)导入Stewart平台环精确三维模型并与Mimics的三维重建模型环配准;将骨段三维模型及环三维模型同步实施虚拟复位运动,记录多个运动关键点;(5)借助Solidworks 2017软件,提取各个关键点下Stewart平台近端环和远端环的相对位姿;(6)使用Matlab软件进行平台的运动学求解,计算平台各支链在调整运动中的目标长度,获得精确的调整方案;(7)拍摄调整后的患肢标准X线正侧位片,评价骨折畸形复位后的残留位移与角度,并进行统计学分析。结果:(1)本文所纳入的全部患者(21例)均得到了较好的骨折复位效果,对位对线良好,正位片中残余位移与成角畸形分别为2.9±2.5mm和1.3±1.1°,侧位片中残余位移与成角畸形分别为2.8±2.0mm和1.2±1.1°,均达到功能复位标准。(2)其中基于三维重建模型新算法进行二次复位的15例患者在理论上能进行更精准的复位,进行数据分析后显示:再次复位前后正位片中残余位移与成角畸形及改善度分别为3.3±2.7mm(52.17%)、1.3±1.2°(72.92%)和1.2±1.0mm(82.61%)、0.8±1.1°(83.33%),侧位片中残余位移与成角畸形及改善度分别为2.8±1.8mm(42.86%)、1.3±1.1°(53.57%)和0.9±1.1mm(81.63%)、0.5±0.9°(82.14%),且基于三维重建模型新算法的畸形改善度均大于改良测量法。进一步进行统计学分析后发现:在正位位移、侧位位移、侧位成角畸形残余方面,基于三维重建模型的新方法优于改良测量法,且具有明显统计学意义(P0.05);在正位成角方面尚不能在统计学上判断是否同样具有优势(未在统计学上得出显著性差异,P=0.159)。综合分析数据可得出基于三维重建模型的新算法优于二维平片测量法。结论:(1)本文提出的改良测量法相较传统测量法在理论上能够提高Stewart平台机构的复位精度;(2)本文提出的基于术后三维重建的长骨骨折复位方法相较于现有的二维平片测量法有效地降低了骨折参数辨识难度,具有更高的复位精确度;该方法可以用于骨折复位术后残余畸形的调整、对现有的主流骨折外固定调整技术遗留的偏差进行弥补,同时为术中骨折自动化复位技术研究提供一定的参考,在骨折复位领域具有广泛的临床用途。
[Abstract]:Objective: bone fracture displacement malformation is the most common disease in Department of orthopedics, in such cases, external fixation has been clinically obtained lots of successful cases. However, the current mainstream bone external fixation techniques were used as diagnostic X-ray measurement basis, restricted by the point projection light source and manual measurement principle operation, this method has some disadvantages in accuracy. To solve this problem, this paper improved the traditional measurement methods, and put forward a kind of 3D reconstruction based on long bone fracture deformity and reduction of new technology in the clinical study, the operability, accuracy and effectiveness, enhance the effectiveness of the verification fracture reduction accuracy. Methods: (1) collected from February 2016 to August 2016 in our hospital and the six axis parallel mechanism Stewart platform (Taylor Tianjin new bone external fixator for fracture of tibia and fibula) disease treatment One in 21 cases. Among them, 17 were male, 4 females, age 14-76 years, average 42 + 15.2 years. Positive side gets all patients postoperative limb radiographs (GE XR656) and CT image data in Dicom format (GE 750 3D spiral CT); (2) using Mimics 17 software, Coreldraw X7 to improve the traditional measurement methods, and evaluate the effect in clinical application; (3) with the help of Mimics software, CT image data and 3D reconstruction model; (4) into the Stewart platform ring precise three-dimensional model and three-dimensional reconstruction model of ring registration and Mimics; the 3D model of 3D bone model and loop synchronization implementation the virtual restoring movement record multiple motion key points; (5) with Solidworks 2017 software, the relative pose of each key point extraction Stewart platform of proximal and distal rings; (6) kinematics platform using Matlab software, computing platform in each branch in adjusting the movement of the eye 鏍囬暱搴，

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