CN114271920B - Preparation method of 3D printing combined guide plate suitable for femoral neck system - Google Patents
Preparation method of 3D printing combined guide plate suitable for femoral neck system Download PDFInfo
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Abstract
The invention relates to a preparation method of a 3D printing combined guide plate suitable for a femoral neck system, which comprises two parts of fracture three-dimensional CT data acquisition and guide plate design, wherein the guide plate design comprises a central guide pin guide hole design, an anti-rotation guide pin guide hole design, a small tuberosity positioning and fixing guide hole design and a detachable fixing base design.
Description
Technical Field
The invention relates to a preparation method of a 3D printing combined guide plate, in particular to a preparation method of a 3D printing combined guide plate suitable for a femoral neck system.
Background
Femoral neck fractures are common in elderly patients, accounting for 3.6% of fractures in the whole body. With the rapid development of traffic, the occurrence rate of fracture of femur neck of young people is increased due to high-energy injury, and complications such as poor hip joint movement, ischemic necrosis of femoral head, nonunion of fracture and the like are still the difficulty of current treatment. The internal fixture comprises a hollow nail, a dynamic hip screw, a locking steel plate, an intramedullary nail and the like. However, the failure rate after the internal fixation operation is up to 37% reported in the literature, the fixation of 3 hollow nails is a 'gold standard' for treating the fracture of the femoral neck, but the screw withdrawal, cutting and loosening are quite common, the fixation strength of the hollow nails is low, and the patient still needs to lie in bed for a long time after the operation; the dynamic hip screw is suitable for shear fracture, but has the defects of larger trauma, more bone loss in the neck of femur, weak anti-rotation force of a single screw and the like.
The Swiss hip joint research group develops a new weapon for fixing the fracture of the femoral neck, namely a femoral neck power rotation-resistant cross nail system (Femoral Neck System, FNS), through 10 years, the unique nail-in-nail design of the novel weapon can be used for minimally invasive implantation, stable rotation resistance can be provided, the phenomena of screw cutting, nail withdrawal and the like are less, the early postoperative load of a patient is reduced, the life quality is improved, a series of complications caused by lying in bed are reduced, and a novel treatment means is provided for internal fixation treatment of the fracture of the femoral neck. However, because the femur neck is special in anatomy, the front dip angle, the neck dip angle and the neck stem angle exist, and the FNS new technology has a certain learning curve, a user needs to have abundant experience and a skilled operation technology, and meanwhile, the proper position of the central positioning guide pin in the femur neck needs to be adjusted through multiple perspectives, and the repeated adjustment of the guide pin in the femur neck can influence the quality of bones, so that the internal fixation stability is influenced; meanwhile, multiple perspectives in the operation increase the operation time and increase the radiation exposure risk of patients and medical staff. Therefore, a safer and more efficient method is needed to ensure accurate and safe placement of the FNS center guide pin.
In recent years, along with the continuous maturation and development of 3D printing technology, the combination with clinical practice is also more and more intimate, and the personalized navigation template designed and manufactured by combining the three-dimensional reconstruction technology, the reverse engineering technology and the 3D printing technology is also more and more used for the clinical auxiliary orthopaedics internal fixation technology. The 3D printing technology is a technology which is developed and matured in recent years, and is called a rapid prototyping technology, a patient needing 3D printing is subjected to CT scanning and three-dimensional reconstruction before operation, scanning data are imported into Mimics software, the 3D model and a navigation template are printed through special materials, a clinician can know the fracture degree more accurately according to a physical model, an accurate and detailed operation scheme can be formulated before operation, the operation is assisted by the navigation template through facilitating 3D printing, the accuracy and safety of operation nail placement are improved, and X-ray perspective exposure time of patients and medical staff is shortened.
Therefore, it is necessary to develop a navigation template device which is convenient to mount and dismount in operation and is safe and effective in assisting in setting nails and a preparation method thereof.
Disclosure of Invention
Aiming at the problems in the prior art, the invention provides a preparation method of a 3D printing combined guide plate suitable for a novel femoral neck internal fixation system, which effectively improves the accuracy of nail placement, improves the safety of nail placement, shortens the operation time, and reduces the exposure times and time of patients and medical staff under X rays.
In order to achieve the above purpose, the present invention is realized by the following technical scheme: the preparation method of the 3D printing combined guide plate suitable for the femoral neck system comprises two parts of fracture three-dimensional CT data acquisition and guide plate design, and the preparation method specifically comprises the following steps:
three-dimensional CT data acquisition for fracture
(1) Scanning bones of affected parts of patients by using three-dimensional CT scanning equipment;
(2) The three-dimensional CT scanning data of the affected part of the patient scanned in the step (1) is imported into three-dimensional reconstruction software (chemicals 21.0);
(3) Optimizing the CT scanning original data extracted in the step (2), dividing bones of a hip joint part layer by layer, firstly selecting gray scales of all bones to divide, respectively extracting bone information of thighbone, hip bone and the like, and then cleaning messy information among all bones in a region growing mode;
(4) And (3) calculating the information among the bones after the cleaning in the step (3) by adopting a default (optimal) command of the system according to the previously selected threshold value.
(5) Measuring three-dimensional data of the femoral neck by using the Mimics 21.0 software, and implementing pre-resetting in the software 3-Matic according to the measurement result;
(6) Drawing the relative position relation of the bone nail, the central positioning guide pin and the simulated bone drill cylinder by using NX10.0 software according to the three-dimensional data of the femoral neck after the reduction in the step (5) to obtain a stl format for standby, and then introducing the model and the femur into magics 21.0;
(7) The included angle between the cylinder and the femoral shaft is designed to be 130 degrees, the cylinder in the three-dimensional structure is rotated, the roller is slowly dragged, the position relation of the cylinder passing through the femoral neck is observed on the 3D interface, the cross section, the sagittal plane and the coronal plane respectively, and then the design of the simulated safety nail path of the lower FNS is completed;
(8) Observing whether the simulation safety nail channel and the bone nail penetrate through the femoral neck and the femoral head, and performing proper fine adjustment on the simulation safety nail channel and the bone nail according to an observation result so as to ensure the safety and the accuracy of the FNS simulation safety nail channel;
the guide plate design consists of a central guide pin guide hole design, an anti-rotation guide pin guide hole design, a small tuberosity positioning and fixing guide hole design and a detachable fixing base design,
(9) Setting the diameter of a nail path according to the track axis line of a simulated safety nail path in magics21.0 software, designing the inner diameter of a guide hole of a central guide pin to be 3.2 mm, the outer diameter to be 7.5 mm, and enabling the tip of the guide pin to be 5mm away from subchondral bone;
anti-rotation guide pin guide hole design
(10) Setting an axial lead parallel to the central guide pin according to the axial lead of the track of the simulated safety nail track in magics21.0 software, wherein the distance between the two axial leads is 8 mm, the inner diameter of the guide hole of the anti-rotation guide pin is designed to be 3.2 mm, the outer diameter is 7.5 mm, and the distance between the tip of the guide pin and the subchondral bone is 5 mm;
positioning and fixing guide hole design for small tuberosity
(11) A positioning and fixing guide hole perpendicular to the femur shaft and parallel to the lower edge of the small tuberosity is designed in the magics21.0 software, the inner diameter of the guide hole is designed to be 2.1 mm, and the outer diameter of the guide hole is designed to be 7.5 mm;
removable fixed base design
(12) Extracting the outer side wall surface anatomical data of the femur greater tuberosity by using geomatic 2019 software, importing the surface data into magics21.0, performing reverse offset 2.0 mm treatment, merging, filling and optimizing the offset surface and the original surface, establishing a directional base consistent with the outer side wall anatomical form of the femur greater tuberosity, wherein the upper edge of the base is parallel to the thigh lateral muscle ridge (upper edge width 2 cm), and the lower edge of the base is parallel to the lower edge of the lesser greater tuberosity (lower edge width 3 cm);
(13) Simultaneously importing the base of the step (12) into three guide hole data, combining the three guide hole data with each other to reconstruct a guide template prototype, forming a navigation template for positioning the FNS of the guide hole, dividing the guide plate into two parts according to the position of the guide hole, enabling the dividing lines of the guide plate to be basically at the position where the guide holes are maximally separated, and generating upper and lower 2 combined guide plates;
(14) After the upper and lower 2 combined guide plates generated in the step (13) are subjected to Boolean operation, the guide template nail channel is penetrated, and the boundary is trimmed, so that the design of the combined guide plates is completed;
(15) Designing 3 circular rings with inner diameter of 7.6 mm, outer diameter of 8.5mm and height of 5mm in NX10.0 software on the basis of the guide plate in the step (14);
(16) Inputting the guide plate designed in the step (15) into a SL450 three-dimensional printing mode forming machine for printing and manufacturing;
(17) And (3) sterilizing the guide plate printed in the step (16) by adopting low-temperature plasma.
By means of the scheme, the invention has at least the following advantages: the clinician can know the degree of fracture according to the practicality model more accurately, can formulate accurate, detailed operation scheme before the art, does not need the art to have abundant experience and skilled operation technique, does not need the multiple perspective to adjust the suitable position of central location guide pin in the femur neck, does not need to adjust repeatedly in the femur neck for the guide pin, stops appearing influencing the emergence of bone quality condition, improves the accuracy and the security of operation nail placement, does not need multiple perspective to increase operation time in the art, greatly reduces patient and medical personnel ray exposure risk, and the invention cost of manufacture is low, is fit for extensive popularization and use.
Detailed Description
The present invention will be further described below.
The preparation method of the 3D printing combined guide plate suitable for the femoral neck system comprises two parts of three-dimensional CT data acquisition and guide plate design, and the preparation method is as follows:
three-dimensional CT data acquisition for fracture
(1) Scanning bones of affected parts of patients by using a three-dimensional CT scanning device;
(2) The three-dimensional CT scanning data of the affected part of the patient scanned in the step (1) is imported into three-dimensional reconstruction software (chemicals 21.0);
(3) Optimizing the CT scanning original data extracted in the step (2), dividing bones of a hip joint part layer by layer, firstly selecting gray scales of all bones to divide, respectively extracting bone information of thighbone, hip bone and the like, and then cleaning messy information among all bones in a region growing mode;
(4) Calculating the information among the bones after the cleaning in the step (3) by adopting a default (optimal) command of the system according to the selected threshold value; so as to obtain the complete bone, then repairing the surface of the bone, and finally storing in STL format for standby;
(5) Measuring three-dimensional data of the femoral neck by using the Mimics 21.0 software, and implementing pre-resetting in the software 3-Matic according to the measurement result;
(6) Drawing the relative position relation of the bone nail, the central positioning guide pin and the simulated bone drill cylinder by using NX10.0 software according to the three-dimensional data of the femoral neck after the reduction in the step (5) to obtain a stl format for standby, and then introducing the model and the femur into magics 21.0;
(7) The included angle between the cylinder and the femoral shaft is designed to be 130 degrees, the cylinder in the three-dimensional structure is rotated, the roller is slowly dragged, the position relation of the cylinder passing through the femoral neck is observed on the 3D interface, the cross section, the sagittal plane and the coronal plane respectively, and then the design of the simulated safety nail path of the lower FNS is completed;
(8) Observing whether the simulation safety nail channel and the bone nail penetrate through the femoral neck and the femoral head, and performing proper fine adjustment on the simulation safety nail channel and the bone nail according to an observation result so as to ensure the safety and the accuracy of the FNS simulation safety nail channel;
the guide plate design consists of a central guide pin guide hole design, an anti-rotation guide pin guide hole design, a small tuberosity positioning and fixing guide hole design and a detachable fixing base design,
(9) Setting the diameter of a nail path according to the track axis line of a simulated safety nail path in magics21.0 software, designing the inner diameter of a guide hole of a central guide pin to be 3.2 mm, the outer diameter to be 7.5 mm, and enabling the tip of the guide pin to be 5mm away from subchondral bone;
anti-rotation guide pin guide hole design
(10) Setting an axial lead parallel to the central guide pin according to the axial lead of the track of the simulated safety nail track in magics21.0 software, wherein the distance between the two axial leads is 8 mm, the inner diameter of the guide hole of the anti-rotation guide pin is designed to be 3.2 mm, the outer diameter is 7.5 mm, and the distance between the tip of the guide pin and the subchondral bone is 5 mm;
positioning and fixing guide hole design for small tuberosity
(11) A positioning and fixing guide hole perpendicular to the femur shaft and parallel to the lower edge of the small tuberosity is designed in the magics21.0 software, the inner diameter of the guide hole is designed to be 2.1 mm, and the outer diameter of the guide hole is designed to be 7.5 mm;
removable fixed base design
(12) Extracting the outer side wall surface anatomical data of the femur greater tuberosity by using geomatic 2019 software, importing the surface data into magics21.0, performing reverse offset 2.0 mm treatment, merging, filling and optimizing the offset surface and the original surface, establishing a directional base consistent with the outer side wall anatomical form of the femur greater tuberosity, wherein the upper edge of the base is parallel to the thigh lateral muscle ridge (upper edge width 2 cm), and the lower edge of the base is parallel to the lower edge of the lesser greater tuberosity (lower edge width 3 cm);
(13) Simultaneously importing the base of the step (12) into three guide hole data, combining the three guide hole data with each other to reconstruct a guide template prototype, forming a navigation template for positioning the FNS of the guide hole, dividing the guide plate into two parts according to the position of the guide hole, enabling the dividing lines of the guide plate to be basically at the position where the guide holes are maximally separated, and generating upper and lower 2 combined guide plates;
(14) After the upper and lower 2 combined guide plates generated in the step (13) are subjected to Boolean operation, the guide template nail channel is penetrated, and the boundary is trimmed, so that the design of the combined guide plates is completed;
(15) Designing 3 circular rings with inner diameter of 7.6 mm, outer diameter of 8.5mm and height of 5mm in NX10.0 software on the basis of the guide plate in the step (14);
(16) Inputting the guide plate designed in the step (15) into a SL450 three-dimensional printing mode forming machine for printing and manufacturing;
(17) And (3) sterilizing the guide plate printed in the step (16) by adopting low-temperature plasma or ethylene oxide at low temperature.
Claims (1)
1. The preparation method of the 3D printing combined guide plate suitable for the femoral neck system comprises two parts of 3D bone data acquisition and guide plate design, and the preparation method specifically comprises the following steps:
the three-dimensional CT data of the fracture are acquired,
(1) Scanning bones of affected parts of patients by using a three-dimensional CT scanning device;
(2) The three-dimensional CT scanning data of the affected part of the patient scanned in the step (1) are imported into three-dimensional reconstruction software chemicals 21.0;
(3) Optimizing the CT scanning original data extracted in the step (2), dividing bones of a hip joint part layer by layer, firstly selecting gray scales of all bones for dividing, respectively extracting bone information of femur and hip bones, and then cleaning clutter information among all bones in a region growing mode;
(4) Calculating each bone according to the selected threshold value by adopting a default optimal command of the system according to the information among the bones after the cleaning in the step (3);
(5) Measuring three-dimensional data of the femoral neck by using the Mimics 21.0 software, and pre-resetting in the software 3-Matic according to the measurement result;
(6) Drawing the relative position relation of the bone nail, the central positioning guide pin and the simulated bone drill cylinder by using NX10.0 software according to the three-dimensional data of the femoral neck after the reset in the step (5) to obtain a stl format for standby, and then importing the model and the femoral information into magics 21.0;
(7) The included angle between the cylinder and the femoral shaft is designed to be 130 degrees, the cylinder in the three-dimensional structure is rotated, the roller is slowly dragged, the position relation of the cylinder passing through the femoral neck is observed on the 3D interface, the cross section, the sagittal plane and the coronal plane respectively, and then the design of a simulated safety nail path of the femoral neck dynamic rotation-resistant cross nail system is completed;
(8) Observing whether the simulation safety nail channel and the bone nail penetrate through the femoral neck and the femoral head, and performing proper fine adjustment on the simulation safety nail channel and the bone nail according to an observation result so as to ensure the safety and the accuracy of the simulation safety nail channel of the femoral neck power anti-rotation cross nail system;
the guide plate design consists of a central guide pin guide hole design, an anti-rotation guide pin guide hole design, a small tuberosity positioning and fixing guide hole design and a detachable fixing base design,
(9) Setting the diameter of a nail path according to the track axial lead of a simulated safety nail path by using magics21.0 software, designing the inner diameter of a guide hole of a central guide pin to be 3.2 mm, the outer diameter to be 7.5 mm, and enabling the tip of the guide pin to be 5mm away from subchondral bone;
anti-rotation guide pin guide hole design
(10) Setting an axial lead parallel to the central guide pin by using magics21.0 software according to the axial lead of the track of the simulated safety nail track, wherein the distance between the two axial leads is 8 mm, the inner diameter of the guide hole of the anti-rotation guide pin is designed to be 3.2 mm, the outer diameter is 7.5 mm, and the distance between the tip of the guide pin and the subchondral bone is 5 mm;
positioning and fixing guide hole design for small tuberosity
(11) The magics21.0 software is used for designing a positioning and fixing guide hole which is perpendicular to the femur shaft and parallel to the lower edge of the small tuberosity, the inner diameter of the guide hole is designed to be 2.1 mm, and the outer diameter of the guide hole is designed to be 7.5 mm;
removable fixed base design
(12) Extracting the outer side wall surface anatomical data of the femur greater tuberosity by using geomatic 2019 software, importing the surface data into magics21.0, performing reverse offset 2.0 mm treatment, merging, filling and optimizing the offset surface and the original surface, establishing a direction base consistent with the outer side wall anatomical form of the femur greater tuberosity, wherein the upper edge of the base is parallel to the thigh lateral muscle ridge, and the upper edge is 2 cm wide; the lower edge of the base is parallel to the lower edge of the small tuberosity, and the width of the lower edge is 3 cm;
(13) Simultaneously importing the base of the step (12) into three guide hole data, combining the three guide hole data with the base to reconstruct a guide template prototype to form a navigation template of a femur neck power anti-rotation cross-nailing system for positioning the guide holes, dividing a guide plate into two parts according to the positions of the guide holes, and enabling a dividing line of the guide plate to be at the position where the guide holes are maximally separated to generate upper and lower 2 combined guide plates;
(14) After the upper and lower 2 combined guide plates generated in the step (13) are subjected to Boolean operation, the guide template nail channel is penetrated, and the boundary is trimmed, so that the design of the combined guide plates is completed;
(15) Designing 3 circular rings with the inner diameter of 7.6 mm, the outer diameter of 8.5mm and the height of 5mm by using NX10.0 software on the basis of the guide plate in the step (14);
(16) Inputting the guide plate designed in the step (15) into a SL450 three-dimensional printing mode forming machine for printing and manufacturing;
(17) And (3) sterilizing the guide plate printed in the step (16) by adopting low-temperature plasma.
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