個(gè)體化導(dǎo)航模板輔助半肩置換的基礎(chǔ)研究和臨床應(yīng)用
發(fā)布時(shí)間：2019-03-20 10:10
【摘要】：[目的]1.對(duì)國(guó)人肱骨近端進(jìn)行三維解剖學(xué)研究,為假體設(shè)計(jì)和外科技術(shù)提供理論依據(jù)。2.探討個(gè)體化導(dǎo)航模板在尸體實(shí)驗(yàn)中確定假體高度和后傾角度的準(zhǔn)確性。3.探討個(gè)體化導(dǎo)航模板輔助半肩置換的臨床療效。[方法]1.選擇肩關(guān)節(jié)無畸形和骨質(zhì)損壞的門診病人30例(60肩),進(jìn)行CT掃描,掃描厚度0.625mm,用Mimics和Imageware以1.25mmm層厚、0.6mm層間隔重建出肱骨的三維模型并進(jìn)行三維測(cè)量。2.選擇9具(18肩)肩關(guān)節(jié)無明顯畸形和骨質(zhì)損壞的成人尸體標(biāo)本,所有尸體標(biāo)本行雙側(cè)肩關(guān)節(jié)斷層CT掃描,將.DICOM格式的原始數(shù)據(jù)導(dǎo)入Mimics和Imageware等逆向工程軟件,構(gòu)建三維模型并進(jìn)行重要參數(shù)的測(cè)量,根據(jù)三維測(cè)量結(jié)果確定肱骨頭后傾角和高度,以結(jié)節(jié)間溝和假體柄為反模設(shè)計(jì)出個(gè)體化導(dǎo)航模板,利用RP技術(shù)制作出肱骨頭導(dǎo)航模板實(shí)物。尸體實(shí)驗(yàn)中,所有標(biāo)本均利用個(gè)體化導(dǎo)航模板指導(dǎo)假體置入的方位。術(shù)后所有標(biāo)本行CT斷層掃描,測(cè)量置入假體的高度和后傾角度并與術(shù)前測(cè)量對(duì)比,客觀評(píng)價(jià)個(gè)體化肱骨頭導(dǎo)航模板輔助肩關(guān)節(jié)假體定位的準(zhǔn)確性和有效性。3.選取來我院就診的肱骨近端粉碎性骨折患者12例,男5例,女7例。所有患者術(shù)前進(jìn)行雙側(cè)肩關(guān)節(jié)CT掃描,設(shè)計(jì)出個(gè)體化半肩置換導(dǎo)航模板。通過快速成型機(jī)制作模板實(shí)物并輔助半肩置換術(shù)中假體高度和后傾角度的確定。術(shù)后行患肢X線片檢查,動(dòng)態(tài)觀察大小結(jié)節(jié)愈合及假體位置變化情況,采用肩關(guān)節(jié)Neer評(píng)分標(biāo)準(zhǔn)評(píng)定術(shù)后肩關(guān)節(jié)功能。[結(jié)果]1.國(guó)人肱骨頭冠狀面直徑和矢狀面直徑分別為(41.8±3.6)mm和(39.1±4.1)mm,冠狀面與矢狀面直徑之比為(1.07±0.08),肱骨頭高度和肱骨頭表面曲率直徑分別為(17.2±1.8)mm和(44.9±4.6)mm,肱骨頭高度與曲率半徑之比為(0.77±0.09)。肱骨頭后傾角和頸干角分別為(16.9±8.9)。和(128.4±4.2)。,內(nèi)、后側(cè)偏心距分別為(5.1±1.6)mm和(3.8±1.7)mm。各數(shù)據(jù)性別間差異不明顯,但數(shù)據(jù)與目前肩關(guān)節(jié)假體和外科技術(shù)常用參數(shù)有顯著差異。2.半肩置換術(shù)前后肱骨頭高度誤差平均在(1.44±0.96)mm,后傾角度誤差平均在(0.25±0.15)。,左右兩側(cè)無統(tǒng)計(jì)學(xué)差異。導(dǎo)航模板能夠在術(shù)中指導(dǎo)假體的置入,且精確度較高。3.12例患者術(shù)后獲得10-34個(gè)月(平均16.8個(gè)月)隨訪,12例患者(12肩)大小結(jié)節(jié)均獲骨性愈合,愈合時(shí)間為3-4個(gè)月,平均為3.4個(gè)月。末次隨訪肩關(guān)節(jié)Neer評(píng)分標(biāo)準(zhǔn)評(píng)定療效：優(yōu)8例,良3例,可1例,優(yōu)良率為91.67%。[結(jié)論]1.肱骨近端形狀不規(guī)則,個(gè)體差異較大,重建肩關(guān)節(jié)個(gè)體化解剖結(jié)構(gòu)對(duì)提高半肩置換術(shù)后關(guān)節(jié)功能具有非常重要的作用。2.使用新型個(gè)體化導(dǎo)航模板輔助半肩置換可以獲得精確的假體高度和后傾角度,具有可靠的穩(wěn)定性和導(dǎo)航性。3.通過將3D打印技術(shù)和計(jì)算機(jī)輔助設(shè)計(jì)相結(jié)合設(shè)計(jì)個(gè)體化導(dǎo)航模板,可大大提高半肩置換中假體高度及后傾角度的精確性,使患者獲得更好的活動(dòng)功能,為半肩置換術(shù)提供了一種新的簡(jiǎn)單、有效的方法。
[Abstract]:[purpose] 1. A three-dimensional anatomical study of the proximal humerus in Chinese was carried out to provide the theoretical basis for the design and surgical techniques of the prosthesis. 2. To explore the accuracy of individual navigation templates in determining the height and angle of prosthesis in cadaveric experiments. 3. Objective: to investigate the clinical effect of individualized navigation template assisted hemishoulder replacement. [method] 1. Thirty outpatients (60 shoulders) with no deformity and bone damage of shoulder joint were selected. The thickness of CT scan was 0.625 mm. The humeral bone model was reconstructed by Mimics and Imageware with 1.25mmm layer thickness and 0.6mm interval and measured in 3 D. Nine adult cadavers (18 shoulders) with no obvious deformities and bone damage were selected. All cadaveric specimens were scanned by bilateral shoulder CT, and the original data in .DICOM format were imported into reverse engineering software such as Mimics and Imageware. The three-dimensional model is constructed and the important parameters are measured. According to the results of the three-dimensional measurement, the posterior obliquity and height of the humeral head are determined, and the individual navigation template is designed by taking the intertubercular sulcus and the prosthetic handle as the inverse models. The humeral head navigation template was made by RP technology. In cadaveric experiments, individual navigation templates were used to guide the placement of prosthesis. CT tomography was performed on all specimens after operation to measure the height and retrenchment angle of the implanted prosthesis and to evaluate objectively the accuracy and effectiveness of individual humeral head navigation templates to assist the localization of shoulder prosthesis. 3. The accuracy and effectiveness of individual humeral head navigation templates in the localization of shoulder prosthesis were objectively evaluated. Twelve patients (5 males and 7 females) with comminuted proximal humeral fractures were selected. All patients underwent CT scan of bilateral shoulder joint before operation to design individual semi-shoulder replacement navigation template. The height and backtilt angle of the prosthesis were determined by rapid prototyping (RP) and assisted by semi-shoulder replacement. X-ray examination of the affected limbs was performed after operation to dynamically observe the healing of small and large nodules and the change of prosthesis position. The shoulder joint function was evaluated by the shoulder joint Neer scoring standard. [result] 1. The coronal and sagittal diameter of humeral head in Chinese were (41.8 鹵3.6) mm and (39.1 鹵4.1) mm, respectively, and the ratio of coronal to sagittal diameter was (1.07 鹵0.08) mm,. The humeral head height and surface curvature diameter of humeral head were (17.2 鹵1.8) mm and (44.9 鹵4.6) mm, respectively. The ratio of humeral head height to radius of curvature was (0.77 鹵0.09). The posterior obliquity of humeral head and the neck stem angle were (16.9 鹵8.9) and (16.9 鹵8.9), respectively. Within (128.4 鹵4.2)., the posterior eccentricity was (5.1 鹵1.6) mm and (3.8 鹵1.7) mm., respectively. There is no significant gender difference among the data, but there is a significant difference between the data and the commonly used parameters of shoulder prosthesis and surgical techniques. 2. The mean error of humeral head height before and after half shoulder replacement was (1.44 鹵0.96) mm, the mean error of backdip angle was (0.25 鹵0.15)., and there was no significant difference between the two sides. 3. 12 patients were followed up for 10 months 34 months (average 16.8 months), 12 patients (12 shoulders) got bony healing, the size nodules of 12 patients (12 shoulders) all got bony healing, and all the 12 patients (12 shoulders) got bony healing, while the navigation template was able to guide the implantation of prosthesis during the operation, and the accuracy was high. The healing time was 3 months and 4 months, with an average of 3.4 months. The results of the last follow-up were as follows: excellent in 8 cases, good in 3 cases, fair in 1 case, the excellent and good rate was 91.67%. [conclusion] 1. The shape of proximal humerus is irregular and individual difference is great. It is very important to reconstruct individual anatomical structure of shoulder joint to improve joint function after half shoulder replacement. 2. Precise prosthetic height and backtilt angle can be obtained by using a new individualized navigation template assisted by semi-shoulder replacement, with reliable stability and navigation. 3. By combining 3D printing technology and computer-aided design to design individual navigation template, the accuracy of prosthesis height and backdip angle in half shoulder replacement can be greatly improved, and the patient can get better movement function. It provides a new simple and effective method for half shoulder replacement.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2444117
[Abstract]:[purpose] 1. A three-dimensional anatomical study of the proximal humerus in Chinese was carried out to provide the theoretical basis for the design and surgical techniques of the prosthesis. 2. To explore the accuracy of individual navigation templates in determining the height and angle of prosthesis in cadaveric experiments. 3. Objective: to investigate the clinical effect of individualized navigation template assisted hemishoulder replacement. [method] 1. Thirty outpatients (60 shoulders) with no deformity and bone damage of shoulder joint were selected. The thickness of CT scan was 0.625 mm. The humeral bone model was reconstructed by Mimics and Imageware with 1.25mmm layer thickness and 0.6mm interval and measured in 3 D. Nine adult cadavers (18 shoulders) with no obvious deformities and bone damage were selected. All cadaveric specimens were scanned by bilateral shoulder CT, and the original data in .DICOM format were imported into reverse engineering software such as Mimics and Imageware. The three-dimensional model is constructed and the important parameters are measured. According to the results of the three-dimensional measurement, the posterior obliquity and height of the humeral head are determined, and the individual navigation template is designed by taking the intertubercular sulcus and the prosthetic handle as the inverse models. The humeral head navigation template was made by RP technology. In cadaveric experiments, individual navigation templates were used to guide the placement of prosthesis. CT tomography was performed on all specimens after operation to measure the height and retrenchment angle of the implanted prosthesis and to evaluate objectively the accuracy and effectiveness of individual humeral head navigation templates to assist the localization of shoulder prosthesis. 3. The accuracy and effectiveness of individual humeral head navigation templates in the localization of shoulder prosthesis were objectively evaluated. Twelve patients (5 males and 7 females) with comminuted proximal humeral fractures were selected. All patients underwent CT scan of bilateral shoulder joint before operation to design individual semi-shoulder replacement navigation template. The height and backtilt angle of the prosthesis were determined by rapid prototyping (RP) and assisted by semi-shoulder replacement. X-ray examination of the affected limbs was performed after operation to dynamically observe the healing of small and large nodules and the change of prosthesis position. The shoulder joint function was evaluated by the shoulder joint Neer scoring standard. [result] 1. The coronal and sagittal diameter of humeral head in Chinese were (41.8 鹵3.6) mm and (39.1 鹵4.1) mm, respectively, and the ratio of coronal to sagittal diameter was (1.07 鹵0.08) mm,. The humeral head height and surface curvature diameter of humeral head were (17.2 鹵1.8) mm and (44.9 鹵4.6) mm, respectively. The ratio of humeral head height to radius of curvature was (0.77 鹵0.09). The posterior obliquity of humeral head and the neck stem angle were (16.9 鹵8.9) and (16.9 鹵8.9), respectively. Within (128.4 鹵4.2)., the posterior eccentricity was (5.1 鹵1.6) mm and (3.8 鹵1.7) mm., respectively. There is no significant gender difference among the data, but there is a significant difference between the data and the commonly used parameters of shoulder prosthesis and surgical techniques. 2. The mean error of humeral head height before and after half shoulder replacement was (1.44 鹵0.96) mm, the mean error of backdip angle was (0.25 鹵0.15)., and there was no significant difference between the two sides. 3. 12 patients were followed up for 10 months 34 months (average 16.8 months), 12 patients (12 shoulders) got bony healing, the size nodules of 12 patients (12 shoulders) all got bony healing, and all the 12 patients (12 shoulders) got bony healing, while the navigation template was able to guide the implantation of prosthesis during the operation, and the accuracy was high. The healing time was 3 months and 4 months, with an average of 3.4 months. The results of the last follow-up were as follows: excellent in 8 cases, good in 3 cases, fair in 1 case, the excellent and good rate was 91.67%. [conclusion] 1. The shape of proximal humerus is irregular and individual difference is great. It is very important to reconstruct individual anatomical structure of shoulder joint to improve joint function after half shoulder replacement. 2. Precise prosthetic height and backtilt angle can be obtained by using a new individualized navigation template assisted by semi-shoulder replacement, with reliable stability and navigation. 3. By combining 3D printing technology and computer-aided design to design individual navigation template, the accuracy of prosthesis height and backdip angle in half shoulder replacement can be greatly improved, and the patient can get better movement function. It provides a new simple and effective method for half shoulder replacement.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 魯寧;Edward V Craig;;人工肩關(guān)節(jié)表面置換術(shù)的應(yīng)用[J];中華關(guān)節(jié)外科雜志(電子版);2010年05期
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