CN106137305A - A kind of Thoracolumbar disk deformity is through way of escape individuation osteotomy navigation template preparation method - Google Patents
A kind of Thoracolumbar disk deformity is through way of escape individuation osteotomy navigation template preparation method Download PDFInfo
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- CN106137305A CN106137305A CN201510724643.5A CN201510724643A CN106137305A CN 106137305 A CN106137305 A CN 106137305A CN 201510724643 A CN201510724643 A CN 201510724643A CN 106137305 A CN106137305 A CN 106137305A
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- osteotomy
- individuation
- escape
- thoracolumbar disk
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/14—Surgical saws ; Accessories therefor
- A61B17/15—Guides therefor
Abstract
The present invention relates to a kind of Thoracolumbar disk deformity through way of escape individuation osteotomy navigation template preparation method, it is characterised in that: based on medical image, rebuild the threedimensional model of full backbone and pelvis；Threedimensional model carries out sham operated；Simulation osteotomy, recovers normal backbone physiological camber.Position and big little makings osteotomy template according to sham operated osteotomy；And utilize 3D printing to manufacture.Described osteotomy template is individuation；Art eliminates osteotomy position and the subjectivity of osteotomy size selection, repeated multiple times operation perspective etc.；Being applicable to orthopedic, tumor of spine orthopedic of Thoracolumbar disk old fracture kyphosis deformity, ankylosing spondylitis osteotomy is orthopedic；Easy and simple to handle, doctor is required relatively low, reduce operation risk, improve procedure efficiency, and then reduce operation cost.
Description
Technical field
The present invention relates to computer aided technique and medical instruments field, particularly relate to a kind of Thoracolumbar disk kyphosis deformity through after
Road individuation osteotomy navigation template and preparation method thereof.
Background technology
Thoracolumbar disk old fracture kyphosis deformity, the deformity of tumor of spine, the deformity of mandatory rachitis generally require through after
Road osteotomy is orthopedic, and the purpose of operation is correction deformity, alleviates pain, stablizes backbone and protection nerve, and is neurological functional recovery
Create conditions.
It is the first-selected measure operation plan of above-mentioned disease through the osteotomy orthopaedy of the way of escape, but have osteotomy position in operation implementation process
Putting and more difficult determination in osteotomy size art, postoperative sagittal curvature recovers poor, patients symptomatic relief is inconspicuous.
Previously this type of operation of tradition, patient is preoperative simply to measure from X-ray film, estimates general osteotomy angle, relies on art in art
Person's experience carries out osteotomy, and random big, subjectivity is strong.Postoperative occur that patient chest lumbar vertebrae sagittal curvature recovers undesirable, preoperative disease
Shape alleviation is inconspicuous.
Content of the invention
In order to solve above technical problem, the present invention is by the Thoracolumbar disk sagittal curvature mould rod of preoperative analysis personalized designs
Mechanical characteristic under states of physiologic function, provides a kind of a kind of Thoracolumbar disk kyphosis deformity convenient, efficient through way of escape individuation
Osteotomy navigation template preparation method, preparation method simple operations is convenient to work, and accurately, described osteotomy template is individuation；Art
In eliminate osteotomy area select subjectivity, repeated multiple times operation perspective etc.；It is applicable to Thoracolumbar disk old fracture kyphosis deformity
Orthopedic, tumor of spine orthopedic, mandatory rachitis orthopedic etc.；Easy and simple to handle, doctor is required relatively low, reduce operation wind
Danger, improves procedure efficiency, and then reduces operation cost.
Solve a kind of Thoracolumbar disk kyphosis deformity in the present invention of above technical problem through way of escape individuation osteotomy navigation mould
Plate and preparation method thereof, it is characterised in that: comprise the following steps:
(1) to patient, full backbone and pelvis carry out 64 row's CT scan, acquisition DICOM data:
(2) import data to 3 d modeling software-Mimics, rebuild the threedimensional model of full backbone and pelvis；
(3) osteotomy is simulated:
By measurement patient-side in computer software, convex and rear convex Cobb angle, determines and intends osteotomy centrum, obtains expected osteotomy
Angle, with the leading edge midpoint of osteotomy centrum as fulcrum, the scope of measurement centrum trailing edge and the required excision of vertebral plate；
Computer simulation osteotomy determines osteotomy centrum and osteotomy area.
Simulate osteotomy in computer software, recover patient's Sagittal balance, i.e. the plumb line through C7 centrum midpoint is close
Soleplate trailing edge on S1 centrum.Record osteotomy position and the size of osteotomy area.
(4) in computer software, osteotomy guide plate is designed:
In step (3), data are for according to designing osteotomy guide plate in software Geomagic, and osteotomy guide plate comprises following structure: double
Side type individuation osteotomy navigation masterplate articular process and vertebral plate detent mechanism, bilateral type individuation osteotomy navigation masterplate spinous process root are calmly
Position mechanism, navigation masterplate base portion bi-lateral support mechanism, navigation masterplate Heng Lian finger pressure mechanism；Thus make the auxiliary osteotomy of personalization
Guiding tool.
(5) incoming 3D printer carries out printing in kind.Material object can be brought into after sterilizing in operation, assisted surgery directly perceived.
In described step (1), CT scan thickness is 0.625mm, and matrix is 512??512.
Matrix is equivalent to pixel, refers to the pixel that image is 512*512, and thickness is thinner, and that brings is accurately higher, and CT sweeps
The time retouched is longer.But thickness can not be too thin.
In described step (6), material therefor is photosensitive resin material.Also other materials can be used, such as nylon, and
The biological nature of nylon is more preferable, can the of short duration contact with human body.
Method in the present invention, based on medical image, rebuilds the threedimensional model intending fixed-segment backbone；On threedimensional model
It is simulated operation；Simulation osteotomy, recovers normal sagittal curvature.According to sham operated osteotomy big little makings osteotomy template；And profit
Print with 3D or other processing methods manufacture.Described osteotomy template is individuation；Art eliminates what osteotomy area selected
Subjectivity, repeated multiple times operation perspective etc.；It is applicable to orthopedic, tumor of spine orthopedic of Thoracolumbar disk old fracture kyphosis deformity,
Mandatory rachitis orthopedic etc.；Easy and simple to handle, doctor is required relatively low, reduce operation risk, improve procedure efficiency, and then subtract
Operation cost less.
In Geomagic, extract the anatomic morphological intending osteotomy centrum spinous process root and lamina portion and foundation solves therewith
Cuing open shape thickness is the reverse template of 3mm, determines the osteotomy orientation of articular process, vertebral plate and spinous process, design in above-mentioned template
Osteotomy guide plate, saves as STL formatted file incoming 3D printer and carries out 3D printing in kind.
Osteotomy navigation template form customized have followed primary skeleton anatomical features, maintains function, has personalization, customization
Change advantage, operation wound is little simultaneously.
In the present invention, preoperative sham operated acquisition patient is through the way of escape most suitable osteotomy position and osteotomy area, with this parameter system
Making osteotomy guide plate, implementing operation with this guide plate in art, in art, the sclerotin of excision is consistent with Design.Can understand in real time and cut
Bone exact position, it is to avoid neural blood vessel damages, increases operation safety, reduces postoperative complication.
Detailed description of the invention:
In order to be illustrated more clearly that the embodiment of the present invention or technical scheme of the prior art, embodiment will be made simply below
Introduce, but patent of the present invention includes being not limited only to the embodiments described below.
Embodiment 1
A kind of Thoracolumbar disk kyphosis deformity is through way of escape individuation osteotomy navigation template and preparation method thereof, it is characterised in that: include with
Lower step:
(1) to patient, full backbone and pelvis carry out 64 row's CT scan, obtain DICOM data: CT scan thickness is
0.625mm, matrix is 512??512.
Matrix is equivalent to pixel, refers to the pixel that image is 512*512, and thickness is thinner, and that brings is accurately higher, and CT sweeps
The time retouched is longer.But thickness can not be too thin.
(2) import data to 3 d modeling software-Mimics, rebuild the threedimensional model of full backbone and pelvis；
(3) osteotomy is simulated:
By measurement patient-side in computer software, convex and rear convex Cobb angle, determines and intends osteotomy centrum, obtains expected osteotomy
Angle, with the leading edge midpoint of osteotomy centrum as fulcrum, the scope of measurement centrum trailing edge and the required excision of vertebral plate；
Simulate osteotomy in computer software, recover patient's Sagittal balance, i.e. through the plumb line at C7 centrum midpoint close to S1 vertebra
Soleplate trailing edge on body.Record osteotomy position and the size of osteotomy area.
(4) in computer software, osteotomy guide plate is designed:
In step (3), data are for according to designing osteotomy guide plate in software Geomagic, and osteotomy guide plate comprises following structure: double
Side type individuation osteotomy navigation masterplate articular process and vertebral plate detent mechanism, bilateral type individuation osteotomy navigation masterplate spinous process root are calmly
Position mechanism, navigation masterplate base portion bi-lateral support mechanism, navigation masterplate Heng Lian finger pressure mechanism；
At Geomagic design osteotomy navigation masterplate:
Extract intend the anatomic morphological of osteotomy centrum spinous process root and lamina portion and set up anatomical shape thickness therewith be
The reverse template of 3mm, determines the osteotomy orientation of articular process, vertebral plate and spinous process in above-mentioned template, designs osteotomy navigation template, preserves
Carry out 3D printing in kind for STL formatted file incoming 3D printer.
(5) incoming 3D printer carries out printing in kind.Material object can be brought into after sterilizing in operation, assisted surgery directly perceived.Also
Can use other materials, such as nylon, and the biological nature of nylon is more preferable, and can the of short duration contact with human body.
Method in the present invention, based on medical image, rebuilds the threedimensional model intending fixed-segment backbone；On threedimensional model
It is simulated operation；Simulation osteotomy, recovers normal sagittal curvature.According to sham operated osteotomy big little makings osteotomy template；And profit
Print with 3D or other processing methods manufacture.Described osteotomy template is individuation；Art eliminates what osteotomy area selected
Subjectivity, repeated multiple times operation perspective etc.；It is applicable to orthopedic, tumor of spine orthopedic of Thoracolumbar disk old fracture kyphosis deformity,
Mandatory rachitis orthopedic etc.；Easy and simple to handle, doctor is required relatively low, reduce operation risk, improve procedure efficiency, and then subtract
Operation cost less.
Individuation is printed navigation osteotomy template be applied in operation: patient lies prone is on spinal surgery frame, conventional
Appear osteotomy vertebra and each 3-4 vertebra spinous process, vertebral plate and articular process up and down.Enter operating room after sterilized for individuation osteotomy guide plate, put
Put osteotomy guide plate in the region of anatomy, it is desirable to osteotomy guide plate can be fitted completely with spinal posterior structure, as osteotomy position.Osteotomy
2～3 pairs of pedicle screws respectively implanted up and down by vertebra.According to the size of osteotomy guide plate, excise vertebral plate, spinous process and the joint of respective range
Prominent, use osteotome to carry out V-arrangement osteotomy by both sides pedicle of vertebral arch, by centrum front cortex of bone, move under water to upper hypocentrum simultaneously
Vertebral plate fully reduces pressure, and prevents compressing spinal cord after Guan Bi.Being alternately closed osteotomy surface by gimmick bilateral, pre-bending pitman is fixed
Pedicle screw, pressurization tighten after Guan Bi osteotomy surface, perspective osteotomy surface Guan Bi is good, between vertebral plate and Minor articulus bone grafting, completes
Operation.
The accurate validity for model of geometry is extremely important.Personalized osteotomy guide plate form customized have followed
Primary skeleton anatomical features, maintains bone function, has personalization, customization advantage, and operation wound is little simultaneously.
In art, patient lies prone is on spinal surgery frame, routine appear osteotomy vertebra and up and down each 3-4 vertebra spinous process, vertebral plate and
Articular process.Enter operating room after sterilized for individuation osteotomy guide plate, place osteotomy guide plate in the region of anatomy, it is desirable to osteotomy guide plate energy
Fit completely with spinal posterior structure, as osteotomy position.2～3 pairs of pedicle screws respectively implanted up and down by osteotomy vertebra.According to cut
The size of bone conduction plate, excises vertebral plate, spinous process and the articular process of respective range, uses osteotome to carry out V-arrangement by both sides pedicle of vertebral arch and cuts
Bone, by centrum front cortex of bone, the vertebral plate to upper hypocentrum that simultaneously moves under water fully reduces pressure, and prevents compressing ridge after Guan Bi
Marrow.Being alternately closed osteotomy surface by gimmick bilateral, pre-bending pitman fixes pedicle screw, and pressurization closes osteotomy surface after tightening,
Perspective osteotomy surface Guan Bi is good, between vertebral plate and Minor articulus bone grafting, completes operation.
Follow-up After: compare two groups of patient's intraoperative blood losses, operating time, fluoroscopy during operation with traditional operation group
Number, Cobb correct situation, fusion situation etc..
The template of personalized designs is more better than the osteotomy guide plate biomechanical property simply by virtue of Experience Design, so far
Using about more than 20 example patients, observing 2 years, when in art, amount of bleeding is few, and speed is fast, and fluoroscopy during operation number of times is few, it is high to put nail accuracy rate,
Success rate is very；Post-operative corrective rate is high, basically reaches more than 95%.
Described above to the disclosed embodiments, makes those skilled in the art be capable of or uses the present invention.To this
Multiple modifications of a little embodiments will be apparent from for those skilled in the art, as defined herein typically
Principle can realize without departing from the spirit or scope of the present invention in other embodiments.Therefore, the present invention will not
Can be intended to be limited to the embodiments shown herein, and be to fit to consistent with principles disclosed herein and features of novelty
Scope the widest.
Claims (6)
1. a Thoracolumbar disk kyphosis deformity is through way of escape individuation osteotomy navigation template preparation method, it is characterised in that: include following
Step:
(1) to patient, full backbone and pelvis carry out 64 row's CT scan, acquisition DICOM data:
(2) import data to 3 d modeling software-Mimics, rebuild the threedimensional model of full backbone and pelvis；
(3) osteotomy is simulated:
By measurement patient-side in computer software, convex and rear convex Cobb angle, determines and intends osteotomy centrum, obtains expected osteotomy angle
Degree, with the leading edge midpoint of osteotomy centrum as fulcrum, the scope of measurement centrum trailing edge and the required excision of vertebral plate；
(4) in computer software, osteotomy guide plate is designed:
In step (3), data are for according to designing osteotomy guide plate in software Geomagic, and osteotomy guide plate comprises following structure: double
Type individuation osteotomy navigation masterplate articular process in side is fixed and vertebral plate position mechanism, bilateral type individuation osteotomy navigation masterplate spinous process root are fixed
Position mechanism, navigation masterplate base portion bi-lateral support mechanism, navigation masterplate Heng Lian finger pressure mechanism；
(5) incoming 3D printer carries out printing in kind.
2. a kind of Thoracolumbar disk kyphosis deformity according to claim 1 is through way of escape individuation osteotomy navigation template and making thereof
Method, it is characterised in that: in described step (1), CT scan thickness is 0.625mm, and matrix is 512??512.
3. a kind of Thoracolumbar disk kyphosis deformity according to claim 1 is through way of escape individuation osteotomy navigation template and making thereof
Method, it is characterised in that: in described step (2), concrete operations are for selecting threshold value select tool, it is thus achieved that intend the fixing original illiteracy of Thoracolumbar disk
Cover, then reduce and change above-mentioned illiteracy cover with region tool for increasing, produce new illiteracy and cover；Then, this new three-dimensional modeling covering cover is selected simultaneously
Do smoothing processing, obtain the Thoracolumbar disk threedimensional model of required fixed-segment.
4. a kind of Thoracolumbar disk kyphosis deformity according to claim 1 is through way of escape individuation osteotomy navigation template and making thereof
Method, it is characterised in that: described step (3) Computer Simulation osteotomy determines osteotomy centrum and osteotomy area.
5. a kind of Thoracolumbar disk kyphosis deformity according to claim 1 is through way of escape individuation osteotomy navigation template and making thereof
Method, it is characterised in that: described step (4) makes personalized auxiliary osteotomy guiding tool.
6. a kind of Thoracolumbar disk kyphosis deformity according to claim 1 is through way of escape individuation osteotomy navigation template and making thereof
Method, it is characterised in that: in described step (6), material therefor is photosensitive resin material.
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| CN201510724643.5A CN106137305B (en) | 2015-10-30 | 2015-10-30 | A kind of Thoracolumbar disk deformity is through way of escape individuation osteotomy navigation template preparation method |
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| CN111481259A (en) * | 2020-04-17 | 2020-08-04 | 广西医科大学 | Preparation method of bone cutting guide plate made of polyether-ether-ketone and bone cutting guide plate |
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| CN111481259A (en) * | 2020-04-17 | 2020-08-04 | 广西医科大学 | Preparation method of bone cutting guide plate made of polyether-ether-ketone and bone cutting guide plate |
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