計(jì)算機(jī)輔助個(gè)體化導(dǎo)航模板在Bernese髖臼周圍截骨術(shù)中的研究與應(yīng)用
發(fā)布時(shí)間：2019-04-02 01:13
【摘要】：[目的]1.對(duì)髖臼發(fā)育不良患者的髖關(guān)節(jié)進(jìn)行三維解剖學(xué)測(cè)量,為制定術(shù)前規(guī)劃提供依據(jù)。2.在尸體實(shí)驗(yàn)中應(yīng)用導(dǎo)航模板輔助Bernese髖臼周圍截骨術(shù),探討導(dǎo)航模板輔助Bernese髖臼周圍截骨術(shù)的可行性。3.探討個(gè)體化導(dǎo)航模板輔助髖臼發(fā)育不良患者Bernese髖臼周圍截骨術(shù)的效果。[方法]1.回顧性分析髖臼發(fā)育不良的患者共34例,三維重建其骨盆與股骨；確定股骨頭中心、髖臼中心、股骨頸軸線、標(biāo)準(zhǔn)矢狀面等,確定測(cè)量外側(cè)中心邊緣角、臼頂傾斜角、髖臼外展角、股骨頭超出指數(shù)、股骨頭前后側(cè)覆蓋率、臼頂覆蓋率、髖臼前傾角及股骨頸前傾角等相關(guān)參數(shù)的方法,并對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。2.對(duì)5具(10髖)尸體標(biāo)本進(jìn)行CT掃描和三維重建,計(jì)算機(jī)模擬Bernese髖臼周圍截骨術(shù)并設(shè)計(jì)臼頂和髖臼后方髂骨截骨導(dǎo)航模板及髖臼旋轉(zhuǎn)模板,應(yīng)用快速成型技術(shù)制作模板實(shí)物；術(shù)中應(yīng)用導(dǎo)航模板完成臼頂和髖臼后方截骨及游離髖臼的旋轉(zhuǎn)移位；術(shù)后完成骨盆平片和CT掃描,比較計(jì)算機(jī)模擬術(shù)后與尸體術(shù)后兩者的差別,評(píng)價(jià)個(gè)體化導(dǎo)航模板輔助Bernese髖臼周圍截骨術(shù)的可行性。3.對(duì)26例髓臼發(fā)育不良的患者完成骨盆和雙側(cè)股骨的CT掃描和三維重建,測(cè)量患者髖關(guān)節(jié)各個(gè)相關(guān)參數(shù)；根據(jù)個(gè)體化的病理解剖異常,進(jìn)行手術(shù)模擬,制定最佳的術(shù)前規(guī)劃；根據(jù)術(shù)前規(guī)劃設(shè)計(jì)坐骨截骨導(dǎo)航模板、臼項(xiàng)和髖臼后方髂骨截骨導(dǎo)航模板及髖臼旋轉(zhuǎn)模板；應(yīng)用快速成型技術(shù)將設(shè)計(jì)的導(dǎo)航模板打印出實(shí)物；術(shù)中應(yīng)用個(gè)體化導(dǎo)航模板輔助完成Bernese髖臼周圍截骨術(shù)；對(duì)計(jì)算機(jī)模擬術(shù)后與實(shí)際術(shù)后的相關(guān)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。[結(jié)果]1.建立了三維模型上確定股骨頭中心、髖臼中心、股骨頸軸線、正中矢狀面等測(cè)量基準(zhǔn)點(diǎn)、線、面的方法,建立了三維測(cè)量各個(gè)解剖學(xué)參數(shù)的方法；測(cè)量的外側(cè)邊緣中心角(4.28±9.43)。、臼頂傾斜角(28.84±9.99)。、股骨頭超出指數(shù)(44.03±9.27)%、髖臼外展角(36.45±4.08)。、前側(cè)覆蓋率(9.24±7.09)%、后側(cè)覆蓋率(42.14±14.54)%,并與骨盆平片測(cè)量結(jié)果比較,差異無(wú)統(tǒng)計(jì)學(xué)意義；三維測(cè)量正常側(cè)股骨臼頂覆蓋率(79.36±4.46)%、髖臼前傾角(17.37±4.32)。測(cè)量異常側(cè)的股骨臼頂覆蓋率(55.25±10.99)%、髖臼前傾角(25.02±8.21)。,經(jīng)統(tǒng)計(jì)學(xué)分析,差異有統(tǒng)計(jì)學(xué)差異；三維測(cè)量股骨頸前傾角(26.18±15.21)。與斷層CT測(cè)量股骨頸前傾角(27.83±11.69)。,經(jīng)統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)差異。2.尸體實(shí)驗(yàn)中,快速成型制作的模板實(shí)物與骨盆貼合良好;可以按照模板所帶有的截骨方向和靛臼旋轉(zhuǎn)方向精確完成髖臼周圍截骨和游離髖臼的旋轉(zhuǎn)；手術(shù)后測(cè)量的相關(guān)指標(biāo)與計(jì)算機(jī)模擬術(shù)后的相關(guān)指標(biāo)經(jīng)統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)意義。3.26例(26髖)髖臼發(fā)育不良患者的臨床應(yīng)用中,根據(jù)患者的病理解剖異常設(shè)計(jì)制作了26組個(gè)體化導(dǎo)航模板,術(shù)中導(dǎo)航模板與相應(yīng)骨性結(jié)構(gòu)貼敷良好,精確輔助完成了髖臼周圍截骨與游離髖臼的旋轉(zhuǎn)；手術(shù)后測(cè)量的相關(guān)指標(biāo)與計(jì)算機(jī)模擬術(shù)后的相關(guān)指標(biāo)經(jīng)統(tǒng)計(jì)學(xué)分析,差異無(wú)統(tǒng)計(jì)學(xué)意義。所有手術(shù)均未出現(xiàn)截骨進(jìn)入髖臼內(nèi),無(wú)坐骨神經(jīng)及股神經(jīng)損傷等嚴(yán)重并發(fā)癥；所有的截骨步驟,都不需要在透視下完成。[結(jié)論]1.髖臼發(fā)育不良患者髖關(guān)節(jié)形態(tài)個(gè)體差異大,計(jì)算機(jī)三維重建技術(shù)可以良好的顯示髖關(guān)節(jié)的病理解剖的形態(tài),可以進(jìn)行精確解剖學(xué)測(cè)量,為手術(shù)規(guī)劃提供了依據(jù)；2.導(dǎo)航模板的使用能夠精確的完成髖臼周圍截骨和游離髖臼的旋轉(zhuǎn),達(dá)到了精確指導(dǎo)實(shí)際手術(shù)的目的；3.計(jì)算機(jī)輔助個(gè)體化導(dǎo)航模板輔助Bernese髖臼周圍截骨術(shù),提高了該手術(shù)的精確性,簡(jiǎn)化了手術(shù)操作難度,減少了手術(shù)的主要并發(fā)癥,減少了醫(yī)患的輻射傷害,具有一定的應(yīng)用價(jià)值。
[Abstract]:[Objective] 1. The three-dimensional anatomical measurement of the hip joint of the acetabular dysplasia was performed to provide the basis for the development of preoperative planning. In the body experiment, the navigation template was used to assist the surrounding osteotomy of the Bernese acetabulum, and the feasibility of the navigation template to assist the periacetabular osteotomy was discussed. Objective To study the effect of individualized navigation template on the peripheral osteotomy of acetabular dysplasia in patients with acetabular dysplasia. [Method] 1. A retrospective analysis of 34 cases of acetabular dysplasia, three-dimensional reconstruction of the pelvis and femur, and the determination of the center of the femoral head, the center of the acetabulum, the axis of the femoral neck, the standard sagittal plane, etc., were used to determine the center of the femoral head, the center of the acetabulum, the axis of the femoral neck, the standard sagittal plane and so on. Methods of related parameters such as the front and back coverage of the femoral head, the coverage of the premolar, the anteversion of the acetabulum and the anteversion of the femoral neck were analyzed and the results were analyzed statistically. CT scanning and three-dimensional reconstruction of five (10 hips) cadavers were performed, and the computer was used to simulate the peripheral osteotomy of the Bernese acetabulum and to design the bone-cutting navigation template and the acetabular rotation template of the acetabular shell and the acetabulum. Intraoperative navigation template was used to complete the rotation and displacement of the posterior and free acetabulum of the posterior and posterior acetabulum of the acetabulum. The pelvic and CT scans were performed after the operation. The difference between the computer simulation and the post-operative procedure was compared to evaluate the feasibility of the individualized navigation template in the treatment of the peripheral osteotomy of the acetabulum. The CT scan and three-dimensional reconstruction of the pelvis and the bilateral femur were performed on 26 patients with the dysplasia of the bone, and the relevant parameters of the hip joint of the patient were measured, and the operation simulation was performed according to the individual pathological changes, and the optimal pre-operation planning was established. According to the pre-operation planning and design, the bone cutting navigation template, the mortar item and the posterior acetabular bone cut navigation template and the acetabular rotation template of the acetabulum are used; the designed navigation template is printed out of the physical object by using the rapid prototyping technology; and an individualized navigation template is used for assisting to complete the peripheral osteotomy of the Bernese acetabulum; The relevant indexes of the post-operative and actual post-operation of the computer were statistically analyzed. [Results] 1. A three-dimensional model was established to determine the reference point, line and surface of the femoral head, the center of the acetabulum, the axis of the femoral neck and the median sagittal plane. The method of three-dimensional measurement of various anatomical parameters was established. The central angle of the lateral edge was measured (4.28, 9.43). And the tilt angle of the molar top (28.84-9.99). The femoral head was beyond the index (44.03-9.27)% and the acetabular abduction angle (36.45-4.08). The front side coverage (9.24-7.09)%, the back-side coverage (42.14-14.54)%, and the measured results of the pelvic plain film were not statistically significant; the three-dimensional measurement of the normal-side femoral head coverage (79.36-4.46)%, and the acetabular anteversion (17.37-4.32). The femoral molar top coverage (55.25% 10.99)% and the acetabular anteversion angle (25.02-8.21) on the abnormal side were measured. According to the statistical analysis, the difference was statistically different; and the pretilt angle of the femoral neck (26.18-15.21) was measured in three dimensions. The pretilt angle of the femoral neck was measured with the fault CT (27.83-11.69). There was no statistical difference between the two groups. In the body experiment, the template object made of rapid prototyping is in good fit with the pelvis, and the rotation of the acetabular osteotomy and the free acetabulum can be accurately completed according to the cutting direction and the rotation direction of the indium in the template; In the clinical application of 3.26 (26 hips) acetabular dysplasia,26 groups of individual navigation templates were designed according to the pathological anatomy of the patient. During the operation, the navigation template and the corresponding bony structure were applied well, and the rotation of the acetabular osteotomy and the free acetabulum was completed accurately. The related indexes of the post-operative measurement and the relevant indexes after the computer simulation were analyzed statistically, and the difference was not statistically significant. None of the procedures had a serious complication of osteotomy into the acetabulum, no sciatic nerve and femoral nerve injury; all of the osteotomy steps did not need to be completed under fluoroscopy. [Conclusion] 1. The individual difference of the hip joint of the patient with acetabular dysplasia is large, the computer three-dimensional reconstruction technique can show the morphology of the pathological anatomy of the hip joint well, and the precise anatomical measurement can be performed to provide the basis for the operation planning; and 2. The use of the navigation template can accurately complete the rotation of the acetabulum and the free acetabulum, thus achieving the purpose of accurately guiding the actual operation; and 3. The computer-aided individualized navigation template is used for assisting the peripheral osteotomy of the Bernese acetabulum, the accuracy of the operation is improved, the operation difficulty is simplified, the main complication of the operation is reduced, the radiation injury of the patient and the patient is reduced, and the application value is certain.
【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)】：R687.31
本文編號(hào)：2452087
[Abstract]:[Objective] 1. The three-dimensional anatomical measurement of the hip joint of the acetabular dysplasia was performed to provide the basis for the development of preoperative planning. In the body experiment, the navigation template was used to assist the surrounding osteotomy of the Bernese acetabulum, and the feasibility of the navigation template to assist the periacetabular osteotomy was discussed. Objective To study the effect of individualized navigation template on the peripheral osteotomy of acetabular dysplasia in patients with acetabular dysplasia. [Method] 1. A retrospective analysis of 34 cases of acetabular dysplasia, three-dimensional reconstruction of the pelvis and femur, and the determination of the center of the femoral head, the center of the acetabulum, the axis of the femoral neck, the standard sagittal plane, etc., were used to determine the center of the femoral head, the center of the acetabulum, the axis of the femoral neck, the standard sagittal plane and so on. Methods of related parameters such as the front and back coverage of the femoral head, the coverage of the premolar, the anteversion of the acetabulum and the anteversion of the femoral neck were analyzed and the results were analyzed statistically. CT scanning and three-dimensional reconstruction of five (10 hips) cadavers were performed, and the computer was used to simulate the peripheral osteotomy of the Bernese acetabulum and to design the bone-cutting navigation template and the acetabular rotation template of the acetabular shell and the acetabulum. Intraoperative navigation template was used to complete the rotation and displacement of the posterior and free acetabulum of the posterior and posterior acetabulum of the acetabulum. The pelvic and CT scans were performed after the operation. The difference between the computer simulation and the post-operative procedure was compared to evaluate the feasibility of the individualized navigation template in the treatment of the peripheral osteotomy of the acetabulum. The CT scan and three-dimensional reconstruction of the pelvis and the bilateral femur were performed on 26 patients with the dysplasia of the bone, and the relevant parameters of the hip joint of the patient were measured, and the operation simulation was performed according to the individual pathological changes, and the optimal pre-operation planning was established. According to the pre-operation planning and design, the bone cutting navigation template, the mortar item and the posterior acetabular bone cut navigation template and the acetabular rotation template of the acetabulum are used; the designed navigation template is printed out of the physical object by using the rapid prototyping technology; and an individualized navigation template is used for assisting to complete the peripheral osteotomy of the Bernese acetabulum; The relevant indexes of the post-operative and actual post-operation of the computer were statistically analyzed. [Results] 1. A three-dimensional model was established to determine the reference point, line and surface of the femoral head, the center of the acetabulum, the axis of the femoral neck and the median sagittal plane. The method of three-dimensional measurement of various anatomical parameters was established. The central angle of the lateral edge was measured (4.28, 9.43). And the tilt angle of the molar top (28.84-9.99). The femoral head was beyond the index (44.03-9.27)% and the acetabular abduction angle (36.45-4.08). The front side coverage (9.24-7.09)%, the back-side coverage (42.14-14.54)%, and the measured results of the pelvic plain film were not statistically significant; the three-dimensional measurement of the normal-side femoral head coverage (79.36-4.46)%, and the acetabular anteversion (17.37-4.32). The femoral molar top coverage (55.25% 10.99)% and the acetabular anteversion angle (25.02-8.21) on the abnormal side were measured. According to the statistical analysis, the difference was statistically different; and the pretilt angle of the femoral neck (26.18-15.21) was measured in three dimensions. The pretilt angle of the femoral neck was measured with the fault CT (27.83-11.69). There was no statistical difference between the two groups. In the body experiment, the template object made of rapid prototyping is in good fit with the pelvis, and the rotation of the acetabular osteotomy and the free acetabulum can be accurately completed according to the cutting direction and the rotation direction of the indium in the template; In the clinical application of 3.26 (26 hips) acetabular dysplasia,26 groups of individual navigation templates were designed according to the pathological anatomy of the patient. During the operation, the navigation template and the corresponding bony structure were applied well, and the rotation of the acetabular osteotomy and the free acetabulum was completed accurately. The related indexes of the post-operative measurement and the relevant indexes after the computer simulation were analyzed statistically, and the difference was not statistically significant. None of the procedures had a serious complication of osteotomy into the acetabulum, no sciatic nerve and femoral nerve injury; all of the osteotomy steps did not need to be completed under fluoroscopy. [Conclusion] 1. The individual difference of the hip joint of the patient with acetabular dysplasia is large, the computer three-dimensional reconstruction technique can show the morphology of the pathological anatomy of the hip joint well, and the precise anatomical measurement can be performed to provide the basis for the operation planning; and 2. The use of the navigation template can accurately complete the rotation of the acetabulum and the free acetabulum, thus achieving the purpose of accurately guiding the actual operation; and 3. The computer-aided individualized navigation template is used for assisting the peripheral osteotomy of the Bernese acetabulum, the accuracy of the operation is improved, the operation difficulty is simplified, the main complication of the operation is reduced, the radiation injury of the patient and the patient is reduced, and the application value is certain.
【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)】：R687.31
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