计算机辅助个体化导航模板在Bernese髋臼周围截骨术中的研究与应用

发布时间：2019-04-02 01:13

【摘要】：[目的]1.对髋臼发育不良患者的髋关节进行三维解剖学测量,为制定术前规划提供依据。2.在尸体实验中应用导航模板辅助Bernese髋臼周围截骨术,探讨导航模板辅助Bernese髋臼周围截骨术的可行性。3.探讨个体化导航模板辅助髋臼发育不良患者Bernese髋臼周围截骨术的效果。[方法]1.回顾性分析髋臼发育不良的患者共34例,三维重建其骨盆与股骨；确定股骨头中心、髋臼中心、股骨颈轴线、标准矢状面等,确定测量外侧中心边缘角、臼顶倾斜角、髋臼外展角、股骨头超出指数、股骨头前后侧覆盖率、臼顶覆盖率、髋臼前倾角及股骨颈前倾角等相关参数的方法,并对结果进行统计学分析。2.对5具(10髋)尸体标本进行CT扫描和三维重建,计算机模拟Bernese髋臼周围截骨术并设计臼顶和髋臼后方髂骨截骨导航模板及髋臼旋转模板,应用快速成型技术制作模板实物；术中应用导航模板完成臼顶和髋臼后方截骨及游离髋臼的旋转移位；术后完成骨盆平片和CT扫描,比较计算机模拟术后与尸体术后两者的差别,评价个体化导航模板辅助Bernese髋臼周围截骨术的可行性。3.对26例髓臼发育不良的患者完成骨盆和双侧股骨的CT扫描和三维重建,测量患者髋关节各个相关参数；根据个体化的病理解剖异常,进行手术模拟,制定最佳的术前规划；根据术前规划设计坐骨截骨导航模板、臼项和髋臼后方髂骨截骨导航模板及髋臼旋转模板；应用快速成型技术将设计的导航模板打印出实物；术中应用个体化导航模板辅助完成Bernese髋臼周围截骨术；对计算机模拟术后与实际术后的相关指标进行统计学分析。[结果]1.建立了三维模型上确定股骨头中心、髋臼中心、股骨颈轴线、正中矢状面等测量基准点、线、面的方法,建立了三维测量各个解剖学参数的方法；测量的外侧边缘中心角(4.28±9.43)。、臼顶倾斜角(28.84±9.99)。、股骨头超出指数(44.03±9.27)%、髋臼外展角(36.45±4.08)。、前侧覆盖率(9.24±7.09)%、后侧覆盖率(42.14±14.54)%,并与骨盆平片测量结果比较,差异无统计学意义；三维测量正常侧股骨臼顶覆盖率(79.36±4.46)%、髋臼前倾角(17.37±4.32)。测量异常侧的股骨臼顶覆盖率(55.25±10.99)%、髋臼前倾角(25.02±8.21)。,经统计学分析,差异有统计学差异；三维测量股骨颈前倾角(26.18±15.21)。与断层CT测量股骨颈前倾角(27.83±11.69)。,经统计学分析,差异无统计学差异。2.尸体实验中,快速成型制作的模板实物与骨盆贴合良好;可以按照模板所带有的截骨方向和靛臼旋转方向精确完成髋臼周围截骨和游离髋臼的旋转；手术后测量的相关指标与计算机模拟术后的相关指标经统计学分析,差异无统计学意义。3.26例(26髋)髋臼发育不良患者的临床应用中,根据患者的病理解剖异常设计制作了26组个体化导航模板,术中导航模板与相应骨性结构贴敷良好,精确辅助完成了髋臼周围截骨与游离髋臼的旋转；手术后测量的相关指标与计算机模拟术后的相关指标经统计学分析,差异无统计学意义。所有手术均未出现截骨进入髋臼内,无坐骨神经及股神经损伤等严重并发症；所有的截骨步骤,都不需要在透视下完成。[结论]1.髋臼发育不良患者髋关节形态个体差异大,计算机三维重建技术可以良好的显示髋关节的病理解剖的形态,可以进行精确解剖学测量,为手术规划提供了依据；2.导航模板的使用能够精确的完成髋臼周围截骨和游离髋臼的旋转,达到了精确指导实际手术的目的；3.计算机辅助个体化导航模板辅助Bernese髋臼周围截骨术,提高了该手术的精确性,简化了手术操作难度,减少了手术的主要并发症,减少了医患的辐射伤害,具有一定的应用价值。
[Abstract]:[Objective] 1. The three-dimensional anatomical measurement of the hip joint of the acetabular dysplasia was performed to provide the basis for the development of preoperative planning. In the body experiment, the navigation template was used to assist the surrounding osteotomy of the Bernese acetabulum, and the feasibility of the navigation template to assist the periacetabular osteotomy was discussed. Objective To study the effect of individualized navigation template on the peripheral osteotomy of acetabular dysplasia in patients with acetabular dysplasia. [Method] 1. A retrospective analysis of 34 cases of acetabular dysplasia, three-dimensional reconstruction of the pelvis and femur, and the determination of the center of the femoral head, the center of the acetabulum, the axis of the femoral neck, the standard sagittal plane, etc., were used to determine the center of the femoral head, the center of the acetabulum, the axis of the femoral neck, the standard sagittal plane and so on. Methods of related parameters such as the front and back coverage of the femoral head, the coverage of the premolar, the anteversion of the acetabulum and the anteversion of the femoral neck were analyzed and the results were analyzed statistically. CT scanning and three-dimensional reconstruction of five (10 hips) cadavers were performed, and the computer was used to simulate the peripheral osteotomy of the Bernese acetabulum and to design the bone-cutting navigation template and the acetabular rotation template of the acetabular shell and the acetabulum. Intraoperative navigation template was used to complete the rotation and displacement of the posterior and free acetabulum of the posterior and posterior acetabulum of the acetabulum. The pelvic and CT scans were performed after the operation. The difference between the computer simulation and the post-operative procedure was compared to evaluate the feasibility of the individualized navigation template in the treatment of the peripheral osteotomy of the acetabulum. The CT scan and three-dimensional reconstruction of the pelvis and the bilateral femur were performed on 26 patients with the dysplasia of the bone, and the relevant parameters of the hip joint of the patient were measured, and the operation simulation was performed according to the individual pathological changes, and the optimal pre-operation planning was established. According to the pre-operation planning and design, the bone cutting navigation template, the mortar item and the posterior acetabular bone cut navigation template and the acetabular rotation template of the acetabulum are used; the designed navigation template is printed out of the physical object by using the rapid prototyping technology; and an individualized navigation template is used for assisting to complete the peripheral osteotomy of the Bernese acetabulum; The relevant indexes of the post-operative and actual post-operation of the computer were statistically analyzed. [Results] 1. A three-dimensional model was established to determine the reference point, line and surface of the femoral head, the center of the acetabulum, the axis of the femoral neck and the median sagittal plane. The method of three-dimensional measurement of various anatomical parameters was established. The central angle of the lateral edge was measured (4.28, 9.43). And the tilt angle of the molar top (28.84-9.99). The femoral head was beyond the index (44.03-9.27)% and the acetabular abduction angle (36.45-4.08). The front side coverage (9.24-7.09)%, the back-side coverage (42.14-14.54)%, and the measured results of the pelvic plain film were not statistically significant; the three-dimensional measurement of the normal-side femoral head coverage (79.36-4.46)%, and the acetabular anteversion (17.37-4.32). The femoral molar top coverage (55.25% 10.99)% and the acetabular anteversion angle (25.02-8.21) on the abnormal side were measured. According to the statistical analysis, the difference was statistically different; and the pretilt angle of the femoral neck (26.18-15.21) was measured in three dimensions. The pretilt angle of the femoral neck was measured with the fault CT (27.83-11.69). There was no statistical difference between the two groups. In the body experiment, the template object made of rapid prototyping is in good fit with the pelvis, and the rotation of the acetabular osteotomy and the free acetabulum can be accurately completed according to the cutting direction and the rotation direction of the indium in the template; In the clinical application of 3.26 (26 hips) acetabular dysplasia,26 groups of individual navigation templates were designed according to the pathological anatomy of the patient. During the operation, the navigation template and the corresponding bony structure were applied well, and the rotation of the acetabular osteotomy and the free acetabulum was completed accurately. The related indexes of the post-operative measurement and the relevant indexes after the computer simulation were analyzed statistically, and the difference was not statistically significant. None of the procedures had a serious complication of osteotomy into the acetabulum, no sciatic nerve and femoral nerve injury; all of the osteotomy steps did not need to be completed under fluoroscopy. [Conclusion] 1. The individual difference of the hip joint of the patient with acetabular dysplasia is large, the computer three-dimensional reconstruction technique can show the morphology of the pathological anatomy of the hip joint well, and the precise anatomical measurement can be performed to provide the basis for the operation planning; and 2. The use of the navigation template can accurately complete the rotation of the acetabulum and the free acetabulum, thus achieving the purpose of accurately guiding the actual operation; and 3. The computer-aided individualized navigation template is used for assisting the peripheral osteotomy of the Bernese acetabulum, the accuracy of the operation is improved, the operation difficulty is simplified, the main complication of the operation is reduced, the radiation injury of the patient and the patient is reduced, and the application value is certain.
【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】：R687.31

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