本文選題：Stewart平臺　切入點：骨外固定器　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:長骨骨折移位畸形是骨科最為常見的疾病,針對該類病例,骨外固定技術(shù)已在臨床上獲得大量成功的應(yīng)用案例。然而目前主流的骨外固定復(fù)位技術(shù)均使用X線平片作為診斷測量依據(jù),受點光源投影成像原理和手工測量操作的制約,這類方法在精度上存在一定的不足。針對此不足,本文對傳統(tǒng)測量方法進行了改良,且提出一種基于三維重建的長骨骨折畸形復(fù)位新技術(shù),并在臨床中探討其可操作性、精確性和有效性,驗證其能否有效提升骨折復(fù)位的精度。方法:(1)收集從2016年2月至2016年8月就診于我院并采用Stewart平臺六軸并聯(lián)機構(gòu)(天津新中泰勒骨外固定器)進行治療的脛腓骨骨折病人21例。其中,男性17例,女性4例,年齡14-76歲,平均42±15.2歲。獲取所有患者術(shù)后患肢的正側(cè)位X線片(GE XR656)及CT影像Dicom格式數(shù)據(jù)(GE 750三維螺旋CT);(2)運用Mimics 17.0、Coreldraw X7軟件對傳統(tǒng)測量方法進行改良,并應(yīng)用于臨床進行效果評價;(3)借助Mimics軟件,處理CT影像數(shù)據(jù)并生成三維重建模型;(4)導(dǎo)入Stewart平臺環(huán)精確三維模型并與Mimics的三維重建模型環(huán)配準(zhǔn);將骨段三維模型及環(huán)三維模型同步實施虛擬復(fù)位運動,記錄多個運動關(guān)鍵點;(5)借助Solidworks 2017軟件,提取各個關(guān)鍵點下Stewart平臺近端環(huán)和遠(yuǎn)端環(huán)的相對位姿;(6)使用Matlab軟件進行平臺的運動學(xué)求解,計算平臺各支鏈在調(diào)整運動中的目標(biāo)長度,獲得精確的調(diào)整方案;(7)拍攝調(diào)整后的患肢標(biāo)準(zhǔn)X線正側(cè)位片,評價骨折畸形復(fù)位后的殘留位移與角度,并進行統(tǒng)計學(xué)分析。結(jié)果:(1)本文所納入的全部患者(21例)均得到了較好的骨折復(fù)位效果,對位對線良好,正位片中殘余位移與成角畸形分別為2.9±2.5mm和1.3±1.1°,側(cè)位片中殘余位移與成角畸形分別為2.8±2.0mm和1.2±1.1°,均達(dá)到功能復(fù)位標(biāo)準(zhǔn)。(2)其中基于三維重建模型新算法進行二次復(fù)位的15例患者在理論上能進行更精準(zhǔn)的復(fù)位,進行數(shù)據(jù)分析后顯示:再次復(fù)位前后正位片中殘余位移與成角畸形及改善度分別為3.3±2.7mm(52.17%)、1.3±1.2°(72.92%)和1.2±1.0mm(82.61%)、0.8±1.1°(83.33%),側(cè)位片中殘余位移與成角畸形及改善度分別為2.8±1.8mm(42.86%)、1.3±1.1°(53.57%)和0.9±1.1mm(81.63%)、0.5±0.9°(82.14%),且基于三維重建模型新算法的畸形改善度均大于改良測量法。進一步進行統(tǒng)計學(xué)分析后發(fā)現(xiàn):在正位位移、側(cè)位位移、側(cè)位成角畸形殘余方面,基于三維重建模型的新方法優(yōu)于改良測量法,且具有明顯統(tǒng)計學(xué)意義(P0.05);在正位成角方面尚不能在統(tǒng)計學(xué)上判斷是否同樣具有優(yōu)勢(未在統(tǒng)計學(xué)上得出顯著性差異,P=0.159)。綜合分析數(shù)據(jù)可得出基于三維重建模型的新算法優(yōu)于二維平片測量法。結(jié)論:(1)本文提出的改良測量法相較傳統(tǒng)測量法在理論上能夠提高Stewart平臺機構(gòu)的復(fù)位精度;(2)本文提出的基于術(shù)后三維重建的長骨骨折復(fù)位方法相較于現(xiàn)有的二維平片測量法有效地降低了骨折參數(shù)辨識難度,具有更高的復(fù)位精確度;該方法可以用于骨折復(fù)位術(shù)后殘余畸形的調(diào)整、對現(xiàn)有的主流骨折外固定調(diào)整技術(shù)遺留的偏差進行彌補,同時為術(shù)中骨折自動化復(fù)位技術(shù)研究提供一定的參考,在骨折復(fù)位領(lǐng)域具有廣泛的臨床用途。
[Abstract]:Objective: bone fracture displacement malformation is the most common disease in Department of orthopedics, in such cases, external fixation has been clinically obtained lots of successful cases. However, the current mainstream bone external fixation techniques were used as diagnostic X-ray measurement basis, restricted by the point projection light source and manual measurement principle operation, this method has some disadvantages in accuracy. To solve this problem, this paper improved the traditional measurement methods, and put forward a kind of 3D reconstruction based on long bone fracture deformity and reduction of new technology in the clinical study, the operability, accuracy and effectiveness, enhance the effectiveness of the verification fracture reduction accuracy. Methods: (1) collected from February 2016 to August 2016 in our hospital and the six axis parallel mechanism Stewart platform (Taylor Tianjin new bone external fixator for fracture of tibia and fibula) disease treatment One in 21 cases. Among them, 17 were male, 4 females, age 14-76 years, average 42 + 15.2 years. Positive side gets all patients postoperative limb radiographs (GE XR656) and CT image data in Dicom format (GE 750 3D spiral CT); (2) using Mimics 17 software, Coreldraw X7 to improve the traditional measurement methods, and evaluate the effect in clinical application; (3) with the help of Mimics software, CT image data and 3D reconstruction model; (4) into the Stewart platform ring precise three-dimensional model and three-dimensional reconstruction model of ring registration and Mimics; the 3D model of 3D bone model and loop synchronization implementation the virtual restoring movement record multiple motion key points; (5) with Solidworks 2017 software, the relative pose of each key point extraction Stewart platform of proximal and distal rings; (6) kinematics platform using Matlab software, computing platform in each branch in adjusting the movement of the eye 鏍囬暱搴，

本文編號：1712887