本文選題：三維重建 + 逆向工程��； 參考：《南方醫(yī)科大學(xué)》2013年博士論文

【摘要】：第一部分三維重建與逆向工程技術(shù)設(shè)計兒童先天性髖關(guān)節(jié)脫位Steel三相截骨術(shù)截骨模板 研究背景 先天性髖關(guān)節(jié)脫位又稱為發(fā)育性髖關(guān)節(jié)脫位,是一種對兒童健康影響大的病變,估計我國的發(fā)生率大概為1%。髖是下肢重要的活動關(guān)節(jié),如能做到早診斷、早治療,臨床效果是滿意的。但是如果得不到及時有效的治療,髖關(guān)節(jié)將早期退行性骨關(guān)節(jié)炎,最終威脅髖關(guān)節(jié)的遠(yuǎn)期功能,嚴(yán)重影響人類的健康和生活質(zhì)量。因此在早期通過合理的手術(shù)不僅可使髖關(guān)節(jié)復(fù)位穩(wěn)定,還可以避免許多手術(shù)并發(fā)癥。然而在過去其治療原則或手術(shù)方案的制定通常以患兒年齡和X線為依據(jù)。由于X線檢查的局限性,難以使臨床醫(yī)師對髖關(guān)節(jié)發(fā)育不良有全面準(zhǔn)確的認(rèn)識。近年來隨著計算機(jī)技術(shù)在影像學(xué)中的應(yīng)用,三維重建技術(shù)及三維可視化分析技術(shù)獲得了長足的進(jìn)步,尤其在小兒先天性髖關(guān)節(jié)脫位的手術(shù)治療中顯示了它的優(yōu)越性。本文主要探討三維重建與逆向工程技術(shù)重建患兒髖關(guān)節(jié)可能性及模擬截骨的臨床應(yīng)用價值。 目的 先天性髖關(guān)節(jié)脫位在早期通過合理的手術(shù)不僅可使髖關(guān)節(jié)復(fù)位穩(wěn)定,還可以避免許多手術(shù)并發(fā)癥。然而在過去其治療原則或手術(shù)方案的制定通常以患兒年齡和X線為依據(jù)。由于X線檢查的局限性,難以使臨床醫(yī)師對髖關(guān)節(jié)發(fā)育不良有一個全面準(zhǔn)確的認(rèn)識。近年來隨著計算機(jī)技術(shù)在影像學(xué)中的應(yīng)用,三維重建技術(shù)及三維可視化分析技術(shù)獲得了長足的進(jìn)步,尤其在小兒先天性髖關(guān)節(jié)脫位的手術(shù)治療中顯示了它的優(yōu)越性。本文主要探討三維重建與逆向工程技術(shù)重建患兒髖關(guān)節(jié)可能性及模擬截骨的臨床應(yīng)用價值。本研究旨在利用三維重建與逆向工程技術(shù)為兒童先天性髖關(guān)節(jié)脫位Steel三相截骨矯正術(shù)提供一種相對精確的截骨方案。 方法 采用連續(xù)螺旋CT對一例兒童先天性髖關(guān)節(jié)脫位患者行骨盆連續(xù)斷層掃描,掃描條件：電壓120kv,層厚0.625mm,矩陣512x512。 髖關(guān)節(jié)的三維重建：將掃描Dicom格式圖像導(dǎo)入Materialise Mimics14.1軟件,采用表面遮蓋顯示法(shaded surface display,SSD)進(jìn)行三維表面重建,然后將重建的髖關(guān)節(jié)以.stl格式保存,導(dǎo)入Imageware12.0軟件進(jìn)行進(jìn)一步分析及設(shè)計。 先天性髖關(guān)節(jié)脫位的模擬截骨與復(fù)位：通過Imageware12.0軟件,利用軟件中的鏡像功能,在患側(cè)生成健側(cè)的髖關(guān)節(jié)的三維模型,根據(jù)steel三相截骨方案在髖關(guān)節(jié)模型上進(jìn)行截骨,以健側(cè)髖關(guān)節(jié)的模型為指導(dǎo)將截斷的骨塊進(jìn)行旋轉(zhuǎn),重建正常的髖關(guān)節(jié)解剖,使患臼覆蓋達(dá)到預(yù)設(shè)的髖臼位置。 截骨模板的生成：通過截骨旋轉(zhuǎn)重建后的髖關(guān)節(jié)與鏡像生成的髖關(guān)節(jié)模型進(jìn)行對比,以截骨兩端區(qū)域為基準(zhǔn)進(jìn)行反求,設(shè)計模板(包括開口角度和旋轉(zhuǎn)角度)。 結(jié)果 通過三維重建得到了較好的顯示結(jié)果,重建的髖關(guān)節(jié)三維模型,可以直觀顯示患髖解剖形態(tài)。 通過三維可視化髖臼模型,模擬Steel三相截骨術(shù)可精確設(shè)計小兒髖關(guān)節(jié)。 通過三維重建與逆向工程技術(shù)構(gòu)建的截骨模板,為Steel三相截骨矯正術(shù)提供一種相對精確的截骨方案。 結(jié)論 基于CT影像下先天性髖關(guān)節(jié)脫位的患兒髖關(guān)節(jié)三維重建效果直觀：本課題通過目前較成熟的三維軟件成像技術(shù),利用先天性髖關(guān)節(jié)脫位的患兒薄層掃描后的CT影像,不僅可以清晰、直觀地觀察患兒髖關(guān)節(jié)的三維形態(tài),而且可以將我們關(guān)心的部位分離或透視,并能以任一角度旋轉(zhuǎn),排除臨近結(jié)構(gòu)的遮擋。 第二部分Steel三相截骨模板在兒童先天性髖關(guān)節(jié)脫位治療中的應(yīng)用 目的 本研究主要探討三維重建與逆向工程技術(shù)重建患兒髖關(guān)節(jié)可能性及模擬截骨的臨床應(yīng)用價值。利用三維重建與逆向工程技術(shù)為兒童先天性髖關(guān)節(jié)脫位Steel三相截骨矯正術(shù)提供一種相對精確的截骨方案,并觀察13例使用此類方法設(shè)計的模板的臨床療效。 方法 臨床資料：本組13例,男8例,女5例,平均年齡7.2±1.1(6-9)歲。右側(cè)8例,左側(cè)5例。髖臼指數(shù)44.0°±1.9°(40°-46°)。13例患者術(shù)前診斷無股骨頭壞死。根據(jù)患者的X線及臨床表現(xiàn),擬按照Steel截骨術(shù)進(jìn)行截骨矯形。 截骨模板在Steel截骨術(shù)中應(yīng)用：按照Steel截骨的手術(shù)進(jìn)行髖臼截骨后,將計算機(jī)輔助生成的截骨模板植入,克氏針固定。 結(jié)果 13例Steel截骨術(shù)的患兒通過三維重建與逆向工程技術(shù)構(gòu)建的截骨模板重建的髖關(guān)節(jié)初期臨床療效滿意。 結(jié)論 基于CT掃描后的三維重建影像可以應(yīng)用于臨床解剖研究：利用CT掃描數(shù)據(jù)三維重建的患兒髖關(guān)節(jié)可視化圖像,不僅立體直觀,而且由計算機(jī)軟件對其解剖參數(shù)的測量也減小了人為因素的誤差,能夠在三維空間中準(zhǔn)確的定位并獲得各種三維數(shù)據(jù),為臨床解剖的研究提供一種新的研究途徑。通過三維重建與逆向工程分析構(gòu)建的Steel三相截骨模板可以提供良好的匹配性,同時減少了手術(shù)的時間,提高了手術(shù)的安全性。 三維重建和逆向工程技術(shù)的出現(xiàn)以及不斷的發(fā)展為現(xiàn)代骨科手術(shù)提供了新的輔助手段,根據(jù)CT數(shù)據(jù)重建的三維模型可以直接、深入觀察手術(shù)部位結(jié)構(gòu)特點,可以對手術(shù)區(qū)的結(jié)構(gòu)進(jìn)行三維可視化分析,維持充分的髖臼覆蓋,而且可提高手術(shù)的安全性。因此,針對先天性髖關(guān)節(jié)脫位患者采用Steel截骨的問題,我們按照臨床手術(shù)要求進(jìn)行設(shè)計,根據(jù)截骨位置以及截骨后骨塊的三維可視化分析還原正常的髖關(guān)節(jié),生成植入骨塊模型,隨著逆向工程技術(shù)及激光快速成型技術(shù)在醫(yī)學(xué)的應(yīng)用,我們可以將截骨模板通過快速成型技術(shù)生成實體,這樣就保證了植入骨塊的準(zhǔn)確匹配,保證了充分的髖臼覆蓋以及重建后髖臼的穩(wěn)定性。螺旋CT以及三維可視化分析可精確重建小兒髖關(guān)節(jié),為臨床醫(yī)師的手術(shù)方案、手術(shù)入路、植入骨塊模型提供可靠的依據(jù),達(dá)到針對不同病人手術(shù)個體化的最終目標(biāo),不但使手術(shù)實施的可行性、安全性增加,而且能夠降低手術(shù)的風(fēng)險性,減少手術(shù)的并發(fā)癥。
[Abstract]:Part three: three dimensional reconstruction and reverse engineering to design Steel osteotomy template for congenital dislocation of the hip in children.
Research background
Congenital dislocation of the hip, also known as developmental dislocation of the hip, is a disease affecting the health of children. It is estimated that the incidence of 1%. is probably an important active joint of the lower extremities, such as early diagnosis, early treatment, and satisfactory clinical effects. However, the hip joint will be early degenerative if no timely and effective treatment is available. Osteoarthritis, which eventually threatens the long-term function of the hip joint, seriously affects human health and quality of life. Therefore, the early adoption of a reasonable operation can not only stabilize the reduction of the hip joint, but also avoid many surgical complications. However, in the past, the principles of treatment and the formulation of the operation plan were usually based on the age and X-ray of the children. Because of X The limitation of line examination makes it difficult for clinicians to have a comprehensive and accurate understanding of the dysplasia of the hip. In recent years, with the application of computer technology in imaging, three-dimensional reconstruction technology and three-dimensional visualization analysis technology have made great progress, especially in the surgical treatment of congenital dislocation of the hip in children. This article mainly discusses the clinical application value of three-dimensional reconstruction and reverse engineering in the reconstruction of hip joint and Simulation of osteotomy in children.
objective
Congenital dislocation of the hip can not only stabilize the reduction of the hip joint, but also avoid many surgical complications. However, in the past, the principles of treatment and the formulation of the operation plan were usually based on the age and X-ray of the children. In recent years, with the application of computer technology in imaging, three dimensional reconstruction technology and three-dimensional visualization analysis technology have made great progress, especially in the surgical treatment of congenital dislocation of the hip in children. This paper mainly discusses the reconstruction of three dimensional reconstruction and reverse engineering technology to reconstruct children. The possibility of hip joint and the clinical value of simulated osteotomy. The purpose of this study is to provide a relatively precise osteotomy scheme for Steel three phase osteotomy for congenital dislocation of the hip in children.
Method
A continuous spiral CT scan was performed on a case of congenital dislocation of the hip in children. The scanning conditions were: voltage 120kv, layer thickness 0.625mm, matrix 512x512..
Three-dimensional reconstruction of the hip joint: the scanned Dicom format image is introduced into the Materialise Mimics14.1 software, the surface covering display (shaded surface display, SSD) is used to reconstruct the three-dimensional surface. Then the reconstructed hip joint is saved in.Stl format, and the software of Imageware12.0 is introduced into the one step analysis and design.
The simulated osteotomy and reduction of congenital dislocation of the hip: using the Imageware12.0 software, using the image function of the software, the three-dimensional model of the hip joint is generated on the affected side, the osteotomy of the hip joint is carried out on the hip joint model according to the steel three phase osteotomy scheme, and the truncated bone block is rotated and reconstructed with the model of the healthy side of the hip joint. The anatomy of the hip joint enables the coverage of the acetabulum to reach the preset acetabular position.
The formation of the osteotomy template: the hip joint reconstructed by the osteotomy was compared with the mirror generated hip model, and the reverse of the two ends of the osteotomy was taken as the baseline, and the template was designed (including the opening angle and the rotation angle).
Result
The 3D reconstruction results show that the reconstructed hip joint model can directly visualized the hips.
Three dimensional visualization of acetabular model and Simulation of Steel three-phase osteotomy can accurately design pediatric hip joint.
The osteotomy template constructed by three-dimensional reconstruction and reverse engineering technology provides a relatively accurate osteotomy for Steel three phase osteotomy.
conclusion
The results of three-dimensional reconstruction of hip joint in children with congenital dislocation of hip based on CT image are intuitionistic: this topic can not only clearly and intuitively observe the three-dimensional shape of the hip joint, but also be able to close us with the mature three-dimensional software imaging technology at present, using the CT images of the children with congenital dislocation of the hip after thin layer scanning. The part of the heart is separated or fluoroscopic and can be rotated at any angle to exclude the occlusion of the adjacent structure.
The second part is the application of Steel three phase osteotomy template in the treatment of congenital dislocation of the hip in children.
objective
This study mainly discusses the possibility of reconstruction of hip joint and the clinical value of simulated osteotomy in children with three-dimensional reconstruction and reverse engineering. Three-dimensional reconstruction and reverse engineering are used to provide a relatively precise case of osteotomy for Steel three phase osteotomy for congenital dislocation of the hip in children, and 13 cases are designed by this method. The clinical efficacy of the template.
Method
Clinical data: 13 cases in this group, 8 men and 5 women, the average age of 7.2 + 1.1 (6-9) years, the right 8 cases, the left 5 cases, the acetabular index 44 [.13] 1.9 degrees (40 -46 degrees) patients were diagnosed without osteonecrosis before operation. According to the X-ray and clinical manifestations of the patients, the osteotomy and orthopedics were made according to Steel osteotomy.
The osteotomy template was used in Steel osteotomy. After osteotomy of the acetabulum, a computer-assisted osteotomy template was implanted and Kirschner was fixed with the osteotomy of the Steel osteotomy.
Result
The initial clinical results of 13 cases of Steel osteotomy were satisfactory by three-dimensional reconstruction and reverse engineering.
conclusion
3D reconstruction images based on CT scan can be applied to clinical anatomy study: the visual images of hip joint in children reconstructed by CT scanning data are not only stereoscopic, but also the error of human factors can be reduced by the measurement of the anatomical parameters of computer software, and it can be accurately positioned and obtained in three-dimensional space. Three dimensional data provides a new approach for the study of clinical anatomy. The three phase osteotomy template constructed by three dimensional reconstruction and reverse engineering analysis can provide good matching, reduce the time of operation and improve the safety of the operation.
The appearance and continuous development of 3D reconstruction and reverse engineering technology provide a new auxiliary means for modern department of orthopedics operation. According to the three-dimensional model of the reconstruction of CT data, the structural features of the surgical site can be observed. The three-dimensional visualization of the structure of the operation area can be analyzed, the full acetabular cover can be maintained, and the high hand can be raised. Therefore, in view of the problem of Steel osteotomy for patients with congenital dislocation of the hip, we designed according to the requirements of the clinical operation. According to the position of the osteotomy and the three-dimensional visualization of the bone block after the osteotomy, the normal hip joint was reduced and the model of the implant was generated. With the reverse engineering and laser rapid prototyping, the medical treatment was used in the medical treatment. With the application of the study, we can generate the osteotomy template by rapid prototyping, which ensures the accurate matching of the implanted bone blocks, guarantees the full acetabular coverage and the stability of the acetabulum after the reconstruction. The spiral CT and three-dimensional visualization analysis can accurately reconstruct the child's hip joint, the surgical procedure of the clinician and the surgical approach. Implant bone block model provides a reliable basis to achieve the ultimate goal of individual operation for different patients. It not only makes the operation feasible, but also increases the safety, but also reduces the risk of operation and reduces the complications of operation.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R726.8

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本文編號：2006554