个体化导航模板辅助半肩置换的基础研究和临床应用
发布时间：2019-03-20 10:10
【摘要】：[目的]1.对国人肱骨近端进行三维解剖学研究,为假体设计和外科技术提供理论依据。2.探讨个体化导航模板在尸体实验中确定假体高度和后倾角度的准确性。3.探讨个体化导航模板辅助半肩置换的临床疗效。[方法]1.选择肩关节无畸形和骨质损坏的门诊病人30例(60肩),进行CT扫描,扫描厚度0.625mm,用Mimics和Imageware以1.25mmm层厚、0.6mm层间隔重建出肱骨的三维模型并进行三维测量。2.选择9具(18肩)肩关节无明显畸形和骨质损坏的成人尸体标本,所有尸体标本行双侧肩关节断层CT扫描,将.DICOM格式的原始数据导入Mimics和Imageware等逆向工程软件,构建三维模型并进行重要参数的测量,根据三维测量结果确定肱骨头后倾角和高度,以结节间沟和假体柄为反模设计出个体化导航模板,利用RP技术制作出肱骨头导航模板实物。尸体实验中,所有标本均利用个体化导航模板指导假体置入的方位。术后所有标本行CT断层扫描,测量置入假体的高度和后倾角度并与术前测量对比,客观评价个体化肱骨头导航模板辅助肩关节假体定位的准确性和有效性。3.选取来我院就诊的肱骨近端粉碎性骨折患者12例,男5例,女7例。所有患者术前进行双侧肩关节CT扫描,设计出个体化半肩置换导航模板。通过快速成型机制作模板实物并辅助半肩置换术中假体高度和后倾角度的确定。术后行患肢X线片检查,动态观察大小结节愈合及假体位置变化情况,采用肩关节Neer评分标准评定术后肩关节功能。[结果]1.国人肱骨头冠状面直径和矢状面直径分别为(41.8±3.6)mm和(39.1±4.1)mm,冠状面与矢状面直径之比为(1.07±0.08),肱骨头高度和肱骨头表面曲率直径分别为(17.2±1.8)mm和(44.9±4.6)mm,肱骨头高度与曲率半径之比为(0.77±0.09)。肱骨头后倾角和颈干角分别为(16.9±8.9)。和(128.4±4.2)。,内、后侧偏心距分别为(5.1±1.6)mm和(3.8±1.7)mm。各数据性别间差异不明显,但数据与目前肩关节假体和外科技术常用参数有显著差异。2.半肩置换术前后肱骨头高度误差平均在(1.44±0.96)mm,后倾角度误差平均在(0.25±0.15)。,左右两侧无统计学差异。导航模板能够在术中指导假体的置入,且精确度较高。3.12例患者术后获得10-34个月(平均16.8个月)随访,12例患者(12肩)大小结节均获骨性愈合,愈合时间为3-4个月,平均为3.4个月。末次随访肩关节Neer评分标准评定疗效：优8例,良3例,可1例,优良率为91.67%。[结论]1.肱骨近端形状不规则,个体差异较大,重建肩关节个体化解剖结构对提高半肩置换术后关节功能具有非常重要的作用。2.使用新型个体化导航模板辅助半肩置换可以获得精确的假体高度和后倾角度,具有可靠的稳定性和导航性。3.通过将3D打印技术和计算机辅助设计相结合设计个体化导航模板,可大大提高半肩置换中假体高度及后倾角度的精确性,使患者获得更好的活动功能,为半肩置换术提供了一种新的简单、有效的方法。
[Abstract]:[purpose] 1. A three-dimensional anatomical study of the proximal humerus in Chinese was carried out to provide the theoretical basis for the design and surgical techniques of the prosthesis. 2. To explore the accuracy of individual navigation templates in determining the height and angle of prosthesis in cadaveric experiments. 3. Objective: to investigate the clinical effect of individualized navigation template assisted hemishoulder replacement. [method] 1. Thirty outpatients (60 shoulders) with no deformity and bone damage of shoulder joint were selected. The thickness of CT scan was 0.625 mm. The humeral bone model was reconstructed by Mimics and Imageware with 1.25mmm layer thickness and 0.6mm interval and measured in 3 D. Nine adult cadavers (18 shoulders) with no obvious deformities and bone damage were selected. All cadaveric specimens were scanned by bilateral shoulder CT, and the original data in .DICOM format were imported into reverse engineering software such as Mimics and Imageware. The three-dimensional model is constructed and the important parameters are measured. According to the results of the three-dimensional measurement, the posterior obliquity and height of the humeral head are determined, and the individual navigation template is designed by taking the intertubercular sulcus and the prosthetic handle as the inverse models. The humeral head navigation template was made by RP technology. In cadaveric experiments, individual navigation templates were used to guide the placement of prosthesis. CT tomography was performed on all specimens after operation to measure the height and retrenchment angle of the implanted prosthesis and to evaluate objectively the accuracy and effectiveness of individual humeral head navigation templates to assist the localization of shoulder prosthesis. 3. The accuracy and effectiveness of individual humeral head navigation templates in the localization of shoulder prosthesis were objectively evaluated. Twelve patients (5 males and 7 females) with comminuted proximal humeral fractures were selected. All patients underwent CT scan of bilateral shoulder joint before operation to design individual semi-shoulder replacement navigation template. The height and backtilt angle of the prosthesis were determined by rapid prototyping (RP) and assisted by semi-shoulder replacement. X-ray examination of the affected limbs was performed after operation to dynamically observe the healing of small and large nodules and the change of prosthesis position. The shoulder joint function was evaluated by the shoulder joint Neer scoring standard. [result] 1. The coronal and sagittal diameter of humeral head in Chinese were (41.8 卤3.6) mm and (39.1 卤4.1) mm, respectively, and the ratio of coronal to sagittal diameter was (1.07 卤0.08) mm,. The humeral head height and surface curvature diameter of humeral head were (17.2 卤1.8) mm and (44.9 卤4.6) mm, respectively. The ratio of humeral head height to radius of curvature was (0.77 卤0.09). The posterior obliquity of humeral head and the neck stem angle were (16.9 卤8.9) and (16.9 卤8.9), respectively. Within (128.4 卤4.2)., the posterior eccentricity was (5.1 卤1.6) mm and (3.8 卤1.7) mm., respectively. There is no significant gender difference among the data, but there is a significant difference between the data and the commonly used parameters of shoulder prosthesis and surgical techniques. 2. The mean error of humeral head height before and after half shoulder replacement was (1.44 卤0.96) mm, the mean error of backdip angle was (0.25 卤0.15)., and there was no significant difference between the two sides. 3. 12 patients were followed up for 10 months 34 months (average 16.8 months), 12 patients (12 shoulders) got bony healing, the size nodules of 12 patients (12 shoulders) all got bony healing, and all the 12 patients (12 shoulders) got bony healing, while the navigation template was able to guide the implantation of prosthesis during the operation, and the accuracy was high. The healing time was 3 months and 4 months, with an average of 3.4 months. The results of the last follow-up were as follows: excellent in 8 cases, good in 3 cases, fair in 1 case, the excellent and good rate was 91.67%. [conclusion] 1. The shape of proximal humerus is irregular and individual difference is great. It is very important to reconstruct individual anatomical structure of shoulder joint to improve joint function after half shoulder replacement. 2. Precise prosthetic height and backtilt angle can be obtained by using a new individualized navigation template assisted by semi-shoulder replacement, with reliable stability and navigation. 3. By combining 3D printing technology and computer-aided design to design individual navigation template, the accuracy of prosthesis height and backdip angle in half shoulder replacement can be greatly improved, and the patient can get better movement function. It provides a new simple and effective method for half shoulder replacement.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2444117
[Abstract]:[purpose] 1. A three-dimensional anatomical study of the proximal humerus in Chinese was carried out to provide the theoretical basis for the design and surgical techniques of the prosthesis. 2. To explore the accuracy of individual navigation templates in determining the height and angle of prosthesis in cadaveric experiments. 3. Objective: to investigate the clinical effect of individualized navigation template assisted hemishoulder replacement. [method] 1. Thirty outpatients (60 shoulders) with no deformity and bone damage of shoulder joint were selected. The thickness of CT scan was 0.625 mm. The humeral bone model was reconstructed by Mimics and Imageware with 1.25mmm layer thickness and 0.6mm interval and measured in 3 D. Nine adult cadavers (18 shoulders) with no obvious deformities and bone damage were selected. All cadaveric specimens were scanned by bilateral shoulder CT, and the original data in .DICOM format were imported into reverse engineering software such as Mimics and Imageware. The three-dimensional model is constructed and the important parameters are measured. According to the results of the three-dimensional measurement, the posterior obliquity and height of the humeral head are determined, and the individual navigation template is designed by taking the intertubercular sulcus and the prosthetic handle as the inverse models. The humeral head navigation template was made by RP technology. In cadaveric experiments, individual navigation templates were used to guide the placement of prosthesis. CT tomography was performed on all specimens after operation to measure the height and retrenchment angle of the implanted prosthesis and to evaluate objectively the accuracy and effectiveness of individual humeral head navigation templates to assist the localization of shoulder prosthesis. 3. The accuracy and effectiveness of individual humeral head navigation templates in the localization of shoulder prosthesis were objectively evaluated. Twelve patients (5 males and 7 females) with comminuted proximal humeral fractures were selected. All patients underwent CT scan of bilateral shoulder joint before operation to design individual semi-shoulder replacement navigation template. The height and backtilt angle of the prosthesis were determined by rapid prototyping (RP) and assisted by semi-shoulder replacement. X-ray examination of the affected limbs was performed after operation to dynamically observe the healing of small and large nodules and the change of prosthesis position. The shoulder joint function was evaluated by the shoulder joint Neer scoring standard. [result] 1. The coronal and sagittal diameter of humeral head in Chinese were (41.8 卤3.6) mm and (39.1 卤4.1) mm, respectively, and the ratio of coronal to sagittal diameter was (1.07 卤0.08) mm,. The humeral head height and surface curvature diameter of humeral head were (17.2 卤1.8) mm and (44.9 卤4.6) mm, respectively. The ratio of humeral head height to radius of curvature was (0.77 卤0.09). The posterior obliquity of humeral head and the neck stem angle were (16.9 卤8.9) and (16.9 卤8.9), respectively. Within (128.4 卤4.2)., the posterior eccentricity was (5.1 卤1.6) mm and (3.8 卤1.7) mm., respectively. There is no significant gender difference among the data, but there is a significant difference between the data and the commonly used parameters of shoulder prosthesis and surgical techniques. 2. The mean error of humeral head height before and after half shoulder replacement was (1.44 卤0.96) mm, the mean error of backdip angle was (0.25 卤0.15)., and there was no significant difference between the two sides. 3. 12 patients were followed up for 10 months 34 months (average 16.8 months), 12 patients (12 shoulders) got bony healing, the size nodules of 12 patients (12 shoulders) all got bony healing, and all the 12 patients (12 shoulders) got bony healing, while the navigation template was able to guide the implantation of prosthesis during the operation, and the accuracy was high. The healing time was 3 months and 4 months, with an average of 3.4 months. The results of the last follow-up were as follows: excellent in 8 cases, good in 3 cases, fair in 1 case, the excellent and good rate was 91.67%. [conclusion] 1. The shape of proximal humerus is irregular and individual difference is great. It is very important to reconstruct individual anatomical structure of shoulder joint to improve joint function after half shoulder replacement. 2. Precise prosthetic height and backtilt angle can be obtained by using a new individualized navigation template assisted by semi-shoulder replacement, with reliable stability and navigation. 3. By combining 3D printing technology and computer-aided design to design individual navigation template, the accuracy of prosthesis height and backdip angle in half shoulder replacement can be greatly improved, and the patient can get better movement function. It provides a new simple and effective method for half shoulder replacement.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前1条
1 鲁宁;Edward V Craig;;人工肩关节表面置换术的应用[J];中华关节外科杂志(电子版);2010年05期
，本文编号：2444117
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