本文選題：拉力螺釘 + 數(shù)字模型�。� 參考：《南方醫(yī)科大學》2017年博士論文

【摘要】：目的設(shè)計帶順行前柱拉力螺釘導向裝置的髖臼后方解剖鋼板,并驗證其可行性及療效。方法隨機選取南方醫(yī)院2014年8月至2015年12月56例完成骨盆(排除解剖學異常和骨質(zhì)病變)CT掃描數(shù)據(jù)導入醫(yī)學影像處理軟件Mimics15.0,重建骨盆三維數(shù)字模型,將骨盆三維模型向?qū)?cè)旋轉(zhuǎn)90°,予半透明化處理,在髖臼前柱模擬順行置入三維圓柱體,調(diào)整其位置,逐步增大圓柱體的直徑,在虛擬三維圓柱體進入髖臼或穿出骨皮質(zhì)之前即為拉力螺釘?shù)淖畲笾睆健Ｍ瑫r向各個方向旋轉(zhuǎn)三維重建模型觀察圓柱體,確保圓柱體未穿出骨皮質(zhì)或者進入髖關(guān)節(jié)。測量出螺釘進釘點、進釘方向、可置入拉力螺釘?shù)淖畲笾睆胶烷L度。利用CT圖像三維重建和逆向工程技術(shù),探討個性化順行髖臼前柱拉力螺釘固定治療髖臼前柱骨折的最優(yōu)釘?shù)啦⒃跇吮具M行有限元驗證。獲取1位健康成年男性志愿者骨盆CT薄掃數(shù)據(jù)建立三維髖臼前柱拉力螺釘?shù)尼數(shù)滥Ｐ透鶕?jù)拉力螺釘?shù)膸缀纬叽缂傲W參數(shù),在Solidwoks 2012軟件中繪制出螺釘模型,用UG Imageware 12.0軟件將髖臼前柱和拉力螺釘進行裝配,設(shè)計出幾何算法釘?shù)馈?in-out-in"釘?shù)馈⒆杂舍數(shù)廊N固定方式,分別測定在重力負荷(600N、1200N、2400N)下髖骨和螺釘?shù)腣onMises應(yīng)力峰值和形變量等各項參數(shù),最后確定最優(yōu)釘?shù)�。根�?jù)測量出的進釘解剖學參數(shù),確定前柱拉力螺釘?shù)淖罴厌數(shù)�。提取髖臼后柱后方表面解剖學形態(tài)特征設(shè)計出帶前柱順行拉力螺釘導向裝置的髖臼后方解剖鋼板模板。利用3D打印技術(shù)打印出帶前柱順行拉力螺釘導向裝置的髖臼后方解剖鋼板模型,輸人數(shù)碼銑床獲得實體鋼板,并在骨盆干性標本和新鮮尸體標本進行驗證。結(jié)果(1)順行拉力螺釘?shù)倪M釘點至坐骨大切跡頂點的距離(OA)平均為(21.11±4.19)mm;至坐骨棘的距離(OB)平均為(56.18±2.01)mm;螺釘與直線OP之間的夾角∠φ平均為(68.51±4.52)°;螺釘與直線OT之間的夾角∠θ平均為(73.67±3.17)°。最大直徑平均為(7.31±2.42)mm;最大長度平均為(109.75±8.22)mm。(2)正常髖骨的位移明顯高于置入了螺釘?shù)捏y骨的位移,且螺釘在幾何算法釘?shù)乐畜y骨所受的應(yīng)力最小,位移最小。(3)成功設(shè)計制作出帶前柱順行拉力螺釘導向裝置的髖臼后方解剖鋼板,實驗組采用帶前柱順行拉力螺釘導向裝置的髖臼后方解剖鋼板置釘方法成功率可達到84.21%,對照組采用傳統(tǒng)的置釘方法成功率只有31.58%,實驗組置釘成功率明顯高于對照組。結(jié)論1.成功設(shè)計出可臨床應(yīng)用的帶前柱順行拉力螺釘導向裝置的髖臼后方解剖鋼板;2.利用該髖臼后方解剖鋼板的前柱順行拉力螺釘導向裝置能顯著提高拉力螺釘置釘?shù)某晒β屎蜏蚀_性。
[Abstract]:Objective to design the posterior acetabular anatomic plate with anterograde anterior column screw guide, and to verify its feasibility and curative effect. Methods from August 2014 to December 2015, 56 cases of pelvis (excluding anatomical abnormalities and bone lesions) were selected randomly and imported into medical image processing software Mimics 15.0 to reconstruct the three-dimensional digital model of pelvis. The three-dimensional model of pelvis was rotated 90 擄to the opposite side and treated with translucency. The anterior column of the acetabular was simulated and placed in a straight line. The position of the three-dimensional cylinder was adjusted, and the diameter of the cylinder was gradually increased. The maximum diameter of the pull screw is before the virtual three-dimensional cylinder enters the acetabulum or penetrates the bone cortex. At the same time, the three-dimensional reconstruction model is rotated in all directions to observe the cylinder to ensure that the cylinder does not penetrate the cortex of bone or enter the hip joint. The point and direction of screw entry are measured, and the maximum diameter and length of the screw can be inserted. Using 3D reconstruction of CT images and reverse engineering technique, the optimal nail path for the treatment of acetabular anterior column fractures with individualized anterograde anterior column screw fixation was investigated and verified by finite element method. The pelvic CT thin scan data of a healthy adult male volunteer were used to establish the screw model of 3D acetabular anterior column lag screw. According to the geometric dimensions and mechanical parameters of the screw, the screw model was drawn in Solidwoks 2012 software. Using UG Imageware 12.0 software, the acetabular anterior column and pull screw were assembled, and three fixing methods were designed, such as geometric algorithm, "in-out-in" nail channel and free nail channel. The parameters of Von Mises stress peak value and shape variable of hip and screw were measured under gravity load (600N ~ 1200Nm ~ 2400N) respectively. Finally, the optimal nail path is determined. According to the anatomical parameters of the screw, the optimal nail path of the anterior column lag screw was determined. The anatomical features of the posterior surface of the posterior column of the acetabulum were extracted. The model of acetabular posterior dissecting plate was printed by 3D printing technique, and the solid plate was obtained by digital milling machine, and verified in pelvis dry specimens and fresh cadavers. Results (1) the average distance from the point of forward pull screw to the point of great notch of ischium (OA) was (21.11 鹵4.19) mm, the distance to sciatic spine (OB) was (56.18 鹵2.01) mm, the angle of angle between screw and straight op was (68.51 鹵4.52) 擄, and the angle between screw and straight line OT was (73.67 鹵3.17) 擄. The average maximum diameter was (7.31 鹵2.42) mm, and the average maximum length was (109.75 鹵8.22) mm. (_ 2). The displacement of the normal hip bone was significantly higher than that of the screw placed in the hip bone, and the stress of the hip bone was the smallest in the geometric algorithm. (3) successful design and manufacture of the posterior dissecting plate with the guide device of the front column forward pull screw, The success rate of posterior acetabular anatomic plate nail placement was 84.21 in the experimental group and 31.58 in the control group. The success rate of the experimental group was significantly higher than that of the control group. Conclusion 1. The posterior acetabular anatomic plate with anterior column anterograde lag screw guide device was successfully designed for clinical use. The success rate and accuracy of screw placement can be significantly improved by using the anterior column anterograde lag screw guide device of the posterior acetabular anatomic plate.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R687.3

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