本文選題：不穩(wěn)定骨盆骨折　切入點(diǎn)：三維重建　出處：《中國人民解放軍醫(yī)學(xué)院》2015年博士論文　論文類型：學(xué)位論文

【摘要】：研究背景不穩(wěn)定骨盆骨折是骨盆環(huán)損傷導(dǎo)致一側(cè)或雙側(cè)骨盆部分或完全移位的骨盆骨折類型,其外科處置主要有切開復(fù)位內(nèi)固定和閉合復(fù)位外固定架固定兩種方式。傳統(tǒng)的治療方式,即切開復(fù)位內(nèi)固定,可以直視損傷區(qū)域,利于骨折解剖復(fù)位；但由于骨盆位置深在,手術(shù)過程容易損傷盆腔內(nèi)的重要血管神經(jīng)。閉合復(fù)位的優(yōu)勢在于減少軟組織暴露引起的血管神經(jīng)損傷風(fēng)險,但傳統(tǒng)的閉合復(fù)位方式很難達(dá)到解剖復(fù)位。計算機(jī)輔助骨科手術(shù)(computer assisted orthopaedic surgery, CAOS)能為我們解決這一難題。它將計算機(jī)圖像處理技術(shù)、機(jī)器人技術(shù)與骨科手術(shù)相結(jié)合,對人體解剖結(jié)構(gòu)進(jìn)行顯示和定位,術(shù)中利用計算機(jī)導(dǎo)航和軟件虛擬操作進(jìn)行手術(shù),提高了手術(shù)操作精度、減少手術(shù)損傷。本課題旨在研發(fā)出一種基于骨盆三維影像和CAOS技術(shù)可精確復(fù)位不穩(wěn)定骨盆骨折的骨盆復(fù)位架,使不穩(wěn)定骨盆骨折的復(fù)位過程精確、自動和可程序化。目的(1)根據(jù)不穩(wěn)定骨盆骨折在三維空間中的移位特點(diǎn),建立骨折的復(fù)位路徑。(2)基于計算機(jī)模擬的骨盆骨折的復(fù)位路徑,設(shè)計出可以精確復(fù)位骨盆骨折的骨盆復(fù)位架,并進(jìn)行模型骨和初步臨床試驗(yàn)驗(yàn)證。方法(1)利用Mimics、3-Matic等CAD (Computer aided design,計算機(jī)輔助設(shè)計)軟件三維重建骨盆,分析規(guī)劃不穩(wěn)定骨盆骨折解剖復(fù)位所需的復(fù)位路徑。骨盆骨折后的骨塊或半骨盆在空間上有不同方向的移位。各種方向移位的骨盆,通過怎樣的復(fù)位順序可以得到最佳的復(fù)位效果,即解剖復(fù)位。這些都需要通過詳細(xì)的臨床路徑規(guī)劃和計算機(jī)和模擬骨來完成,這部分實(shí)驗(yàn)含有兩方面的實(shí)驗(yàn)：第一、通過骨盆三維重建模型,研究出一套可定量計算骨盆移位距離和旋轉(zhuǎn)角度的影像學(xué)測量方法。第二、基于已完成的影像學(xué)測量方法,利用Mimics、3-Matic軟件,模擬不同類型骨盆骨折達(dá)到解剖復(fù)位所需的復(fù)位路徑。(2)基于計算機(jī)模擬的骨盆骨折的復(fù)位路徑,設(shè)計出可以精確復(fù)位骨盆骨折的骨盆復(fù)位架�；谟嬎銠C(jī)軟件模擬出的不穩(wěn)定骨盆骨折的復(fù)位路徑。在Starr骨盆復(fù)位架的基礎(chǔ)上,將骨盆骨折在不同平面的復(fù)位路徑刻度化和精確化,制作骨盆復(fù)位架。(3)骨盆復(fù)位架復(fù)位效果的實(shí)驗(yàn)驗(yàn)證。第一、模型骨實(shí)驗(yàn)。在模型骨上制作不穩(wěn)定骨盆骨折模型.通過骨盆復(fù)位架進(jìn)行骨折復(fù)位。第二、初步臨床實(shí)驗(yàn)。基于模型骨實(shí)驗(yàn)的結(jié)果,選擇合適的骨盆骨折病例,利用骨盆復(fù)位架進(jìn)行復(fù)位手術(shù)并評價效果。結(jié)果(1)本研究所建立的測量方法能精確計算不穩(wěn)定骨盆骨折在三維空間中的旋轉(zhuǎn)和平移復(fù)位量.并將旋轉(zhuǎn)移位分解至兩個正交軸和一個任意軸。(2)根據(jù)遠(yuǎn)程運(yùn)動中心(簡稱“遠(yuǎn)心”,Remote center of motion, RCM)機(jī)構(gòu)基本構(gòu)型,設(shè)計并制作基于圓弧形導(dǎo)軌型RCM機(jī)構(gòu)的不穩(wěn)定骨盆復(fù)位架,結(jié)合半骨盆在三維空間中的移位計算,建立出基于骨盆復(fù)位架的不穩(wěn)定骨盆骨折復(fù)位路徑。(3)經(jīng)模型骨實(shí)驗(yàn)驗(yàn)證,不穩(wěn)定骨盆骨折復(fù)位架的平移和旋轉(zhuǎn)精度分別小于5毫米和4度：經(jīng)初步臨床試驗(yàn)驗(yàn)證,復(fù)位架可實(shí)現(xiàn)不穩(wěn)定骨盆骨折解剖復(fù)位。結(jié)論本研究設(shè)計的骨盆復(fù)位架可以用于對不穩(wěn)定骨盆骨折的復(fù)位操作,使不穩(wěn)定骨盆骨折的復(fù)位過程按刻度和特定路徑精確實(shí)施,達(dá)到傳統(tǒng)閉合復(fù)位無法輕易完成的不穩(wěn)定骨盆骨折解剖復(fù)位。
[Abstract]:The research background of unstable pelvic fractures is pelvic ring injuries cause type unilateral or bilateral pelvic partially or completely displaced fractures of the pelvis, the surgical procedures are open reduction and internal fixation and external fixation in two ways. The traditional treatment methods, namely open reduction and internal fixation, can look into the damaged area, conducive to the anatomical reduction of fracture but because deep in the pelvis position; and the operation process is easy to damage the important blood vessels and nerves in the pelvic cavity. The advantage of closed reduction and reduce exposure risk caused by vascular injury of soft tissue, but the traditional way of closed reduction is difficult to achieve anatomical reduction. Computer aided surgical department of orthopedics (computer assisted orthopaedic surgery, CAOS) can we solve this it will be a problem. Computer image processing technology, robot technology and the combination of the Department of orthopedics operation, display and set of human anatomy A surgery using computer navigation and virtual software operation, improve operation accuracy, reduce surgical injury. The purpose of this study is to develop a three-dimensional image frame pelvic pelvic reduction and CAOS technique can accurate reduction of unstable pelvic fractures based on the reduction of unstable pelvic fracture accurately, automatic and programmable purpose. (1) according to the characteristics of unstable pelvic shift in the 3D fracture, fracture reduction and path establishment. (2) the reset path of computer simulation based on the design of pelvic fracture, can pelvic reduction frame accurate reduction of pelvic fracture, and bone model and preliminary clinical experiments. Methods (1 the use of Mimics, 3-Matic) CAD (Computer aided design, computer aided design) software for 3D reconstruction of the pelvis planning analysis of unstable pelvic fracture anatomical complex path reduction required. After pelvic fracture The displacement of the bone block or semi pelvis in different directions in space. All direction shift of the pelvis, through the reduction sequence of how can get the best reduction effect, namely the anatomical. All these need to be completed through the detailed clinical path planning and computer simulation and bone, this part contains two aspects: the first experiment through the pelvis, three-dimensional reconstruction model, developed a set of quantitative calculation of pelvic displacement distance and the rotation angle of the image measurement method. Second, learn the measurement method, has been completed based on the image by using Mimics, 3-Matic software, simulation of different types of pelvic fractures reached anatomical reduction path reduction required. (2) reset path computer simulation of pelvic fractures based on design can accurate reduction of pelvic fractures with pelvic reduction. The reset path of unstable pelvic fracture by computer simulation based on Starr. Based on the frame of the pelvic fracture, pelvic fracture reduction in path scale and precision of different planes, making the pelvic reduction frame. (3) experimental verification of pelvic reduction frame reduction effect. First, the experimental model of bone. In the model of bone on the unstable pelvic fracture model. The fracture reduction through the pelvic bone resetting frame second, preliminary clinical trials. Bone model based on the experimental results, select the appropriate cases of pelvic fracture, reduction surgery and evaluate the effect of using pelvic reduction frame. Results (1) measurement method established in this study can accurately calculate unstable pelvic fracture reduction amount of rotation and translation in the three-dimensional space and the rotation. The shift down to two orthogonal axes and an arbitrary axis. (2) according to the remote center of motion (referred to as "Remote center of from heart", motion, RCM) mechanism basic configuration, design and production based on circular arc guide mechanism RCM The unstable pelvic reduction, transposition and semi pelvis in three-dimensional space is calculated, a reset path of unstable pelvic fracture. Based on pelvic reduction frame (3) by bone model experiment, unstable pelvic fracture reduction and rotation precision translational frame are respectively less than 5 mm and 4 degrees: preliminary clinical trials verify, reset frame can be unstable pelvic fracture anatomical reduction. Conclusion pelvic reduction frame designed in this study can be used to reset operation of unstable pelvic fractures, the reduction of unstable pelvic fracture accurately according to the scale and the specific path, anatomic reduction of unstable pelvic to traditional closed reduction cannot easily complete fracture.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R687.1

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