CN106137305B - 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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- CN106137305B CN106137305B CN201510724643.5A CN201510724643A CN106137305B CN 106137305 B CN106137305 B CN 106137305B CN 201510724643 A CN201510724643 A CN 201510724643A CN 106137305 B CN106137305 B CN 106137305B
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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
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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, the threedimensional model of full backbone and pelvis is rebuild；Simulation operation is carried out on threedimensional model；Osteotomy is simulated, recovers normal backbone physiological camber.Position and big little makings osteotomy template according to simulation operation osteotomy；And manufactured using 3D printing.The osteotomy template is individuation；The subjectivity of osteotomy position and the selection of osteotomy size, repeated multiple times operation perspective etc. are eliminated in art；Suitable for the orthopedic, tumor of spine orthopedic of Thoracolumbar disk old fracture kyphosis deformity, ankylosing spondylitis osteotomy is orthopedic etc.；It is easy to operate, relatively low is required to doctor, reduces operation risk, improves procedure efficiency, and then reduces operation cost.
Description
Technical field
The present invention relates to computer aided technique and medical instruments field, more particularly to a kind of Thoracolumbar disk kyphosis deformity is 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 are generally required after
Road osteotomy is orthopedic, and the purpose of operation is correction deformity, pain of alleviation, stable backbone and protection nerve, and is neurological functional recovery
Create conditions.
Osteotomy orthopaedy through the way of escape is the preferred measure operation plan of above-mentioned disease, but has in implementation process of performing the operation and cut
The position of bone is put recovers poor, patients symptomatic relief's unobvious etc. with more difficult determination in osteotomy size art, postoperative sagittal curvature.
The previously such operation of tradition, patient is preoperative simply to be measured from X-ray film, is estimated general osteotomy angle, is relied on art in art
Person's experience carries out osteotomy, and random big, subjectivity is strong.It is postoperative undesirable, the preoperative disease of patient's Thoracolumbar disk sagittal curvature recovery occur
Shape alleviates unobvious etc..
The content of the invention
In order to solve the above technical problems, Thoracolumbar disk sagittal curvature mould rod of the present invention by preoperative analysis personalized designs
Mechanical characteristic under states of physiologic function, there is provided a kind of a kind of convenient, efficient Thoracolumbar disk kyphosis deformity is through way of escape individuation
Osteotomy navigation template preparation method, preparation method simple operations are convenient to work, and accurately, the osteotomy template is individuation；Art
In eliminate osteotomy area selection subjectivity, it is repeated multiple times operation perspective etc.；Suitable for Thoracolumbar disk old fracture kyphosis deformity
It is orthopedic, tumor of spine orthopedic, mandatory rachitis it is orthopedic etc.；It is easy to operate, relatively low is required to doctor, reduces operation wind
Danger, procedure efficiency is improved, and then reduce operation cost.
A kind of Thoracolumbar disk kyphosis deformity in the present invention of above technical problem is solved through way of escape individuation osteotomy navigation mould
Plate and preparation method thereof, it is characterised in that：Comprise the following steps：
（1）64 row's CT scans are carried out to the full backbone of patient and pelvis, obtain DICOM data：
（2）3 d modeling software-Mimics is imported data to, rebuilds the threedimensional model of full backbone and pelvis；
（3）Simulate osteotomy：
Patient-side is convex and rear convex Cobb angles by being measured in computer software, it is determined that intend osteotomy centrum, it is expected that
Osteotomy angle, using the leading edge midpoint of osteotomy centrum as fulcrum, measure the scope of excision needed for centrum trailing edge and vertebral plate；
Computer simulation osteotomy determines osteotomy centrum and osteotomy area.
Osteotomy is simulated in computer software, recovers patient's Sagittal balance, i.e., the plumb line through C7 centrums midpoint approaches
Soleplate trailing edge on S1 centrums.Record the size of osteotomy position and osteotomy area.
（4）Osteotomy guide plate is designed in computer software：
With step（3）Middle data are that foundation designs osteotomy guide plate in software Geomagic, and osteotomy guide plate includes following knot
Structure：Bilateral type individuation osteotomy navigation masterplate articular process and vertebral plate detent mechanism, bilateral type individuation osteotomy navigation masterplate spinous process
Root detent mechanism, navigation masterplate base portion bi-lateral support mechanism, navigation masterplate Heng Lian finger pressures mechanism；So as to make the auxiliary of personalization
Help osteotomy guiding tool.
（5）Incoming 3D printer carries out printing in kind.Material object is brought into operation after can sterilizing, assisted surgery directly perceived.
The step（1）Middle CT scan thickness is 0.625mm, and matrix is 512 × 512.
Matrix refers to the pixel that image is 512*512, thickness is thinner, and that brings is accurate higher, and CT is swept equivalent to pixel
The time retouched is longer.But thickness can not be too thin.
The step（6）Middle material therefor is photosensitive resin material.It can also use other materials, such as nylon, and
The biological nature of nylon is more preferable, can be with the of short duration contact of human body.
Method in the present invention is based on medical image, rebuilds the threedimensional model for intending fixed-segment backbone；On threedimensional model
Carry out simulation operation；Osteotomy is simulated, recovers normal sagittal curvature.According to the simulation operation big little makings osteotomy template of osteotomy；And profit
Manufactured with 3D printing or other processing methods.The osteotomy template is individuation；The selection of osteotomy area is eliminated in art
Subjectivity, repeated multiple times operation perspective etc.；Suitable for the orthopedic, tumor of spine orthopedic of Thoracolumbar disk old fracture kyphosis deformity,
Mandatory rachitis it is orthopedic etc.；It is easy to operate, relatively low is required to doctor, reduces operation risk, improves procedure efficiency, and then subtract
Perform the operation less cost.
In Geomagic, extraction intends the anatomic morphological of osteotomy centrum spinous process root and lamina portion and established to solve therewith
It is the reverse templates of 3mm to cut open shape thickness, and the osteotomy orientation of articular process, vertebral plate and spinous process, design are determined in above-mentioned template
Osteotomy guide plate, save as STL formatted files and be passed to 3D printer progress 3D printings in kind.
Osteotomy navigation template form customized have followed primary skeleton anatomical features, maintain function, have personalized, customization
Change advantage, while operation wound is small.
Preoperative simulation operation obtains patient through the most suitable osteotomy position of the way of escape and osteotomy area in the present invention, with this parameter system
Make osteotomy guide plate, implement to perform the operation with this guide plate in art, the sclerotin cut off in art is consistent with Design.It can in real time understand and cut
Bone exact position, avoids neural blood vessel from damaging, and increases operation safety, reduces postoperative complication.
Embodiment：
In order to illustrate more clearly about the embodiment of the present invention or technical scheme of the prior art, letter will be made to embodiment below
Singly introduce, patent of the present invention includes but is 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：Bag
Include following steps：
（1）64 row's CT scans are carried out to the full backbone of patient and pelvis, obtain DICOM data：CT scan thickness
For 0.625mm, matrix is 512 × 512.
Matrix refers to the pixel that image is 512*512, thickness is thinner, and that brings is accurate higher, and CT is swept equivalent to pixel
The time retouched is longer.But thickness can not be too thin.
（2）3 d modeling software-Mimics is imported data to, rebuilds the threedimensional model of full backbone and pelvis；
（3）Simulate osteotomy：
Patient-side is convex and rear convex Cobb angles by being measured in computer software, it is determined that intend osteotomy centrum, it is expected that
Osteotomy angle, using the leading edge midpoint of osteotomy centrum as fulcrum, measure the scope of excision needed for centrum trailing edge and vertebral plate；
Osteotomy is simulated in computer software, recovers patient's Sagittal balance, i.e., the plumb line through C7 centrums midpoint approaches
Soleplate trailing edge on S1 centrums.Record the size of osteotomy position and osteotomy area.
（4）Osteotomy guide plate is designed in computer software：
With step（3）Middle data are that foundation designs osteotomy guide plate in software Geomagic, and osteotomy guide plate includes following knot
Structure：Bilateral type individuation osteotomy navigation masterplate articular process and vertebral plate detent mechanism, bilateral type individuation osteotomy navigation masterplate spinous process
Root detent mechanism, navigation masterplate base portion bi-lateral support mechanism, navigation masterplate Heng Lian finger pressures mechanism；
In Geomagic design osteotomy navigation masterplates：
The anatomic morphological of osteotomy centrum spinous process root and lamina portion is intended in extraction and to establish anatomical shape therewith consistent thick
Spend for the reverse templates of 3mm, the osteotomy orientation of determination articular process, vertebral plate and spinous process in above-mentioned template, design osteotomy navigation template,
Save as STL formatted files and be passed to 3D printer progress 3D printings in kind.
（5）Incoming 3D printer carries out printing in kind.Material object is brought into operation after can sterilizing, assisted surgery directly perceived.
It can use other materials, such as nylon, and the biological nature of nylon is more preferable, and can be with the of short duration contact of human body.
Method in the present invention is based on medical image, rebuilds the threedimensional model for intending fixed-segment backbone；On threedimensional model
Carry out simulation operation；Osteotomy is simulated, recovers normal sagittal curvature.According to the simulation operation big little makings osteotomy template of osteotomy；And profit
Manufactured with 3D printing or other processing methods.The osteotomy template is individuation；The selection of osteotomy area is eliminated in art
Subjectivity, repeated multiple times operation perspective etc.；Suitable for the orthopedic, tumor of spine orthopedic of Thoracolumbar disk old fracture kyphosis deformity,
Mandatory rachitis it is orthopedic etc.；It is easy to operate, relatively low is required to doctor, reduces operation risk, improves procedure efficiency, and then subtract
Perform the operation less cost.
Individuation is printed into navigation osteotomy template to be applied in operation：Patient lies prone is conventional on spinal surgery frame
Appear osteotomy vertebra and up and down each 3-4 vertebras spinous process, vertebral plate and articular process.By individuation osteotomy guide plate it is sterilized after enter operating room, put
Osteotomy guide plate is put in the region of anatomy, it is desirable to which osteotomy guide plate can be bonded completely with spinal posterior structure, as osteotomy position.Osteotomy
Vertebra is respectively implanted into 2~3 pairs of pedicle screws up and down.According to the size of osteotomy guide plate, the vertebral plate, spinous process and joint of respective range are cut off
It is prominent, V-arrangement osteotomy is carried out using osteotome by both sides pedicle of vertebral arch, the cortex of bone in front of centrum, while move under water to upper hypocentrum
Vertebral plate is fully depressurized, and spinal cord is oppressed after preventing closure.Osteotomy surface is alternately closed by gimmick bilateral, pre-bending pitman is fixed
Pedicle screw, pressurization close osteotomy surface after tightening, and perspective osteotomy surface closure is good, between vertebral plate and Minor articulus bone grafting, complete
Operation.
The accurate validity for model of geometry is extremely important.Personalized osteotomy guide plate form customized have followed
Primary skeleton anatomical features, bone function is maintained, there is personalized, customization advantage, while operation wound is small.
In art patient lies prone on spinal surgery frame, routinely appear osteotomy vertebra and up and down each 3-4 vertebras spinous process, vertebral plate and
Articular process.By individuation osteotomy guide plate it is sterilized after enter operating room, place osteotomy guide plate in the region of anatomy, it is desirable to osteotomy guide plate energy
It is bonded completely with spinal posterior structure, as osteotomy position.Osteotomy vertebra is respectively implanted into 2~3 pairs of pedicle screws up and down.According to cut
The size of bone conduction plate, the vertebral plate, spinous process and articular process of respective range are cut off, carrying out V-arrangement using osteotome by both sides pedicle of vertebral arch cuts
Bone, the cortex of bone in front of centrum, while move under water and the vertebral plate of upper hypocentrum is fully depressurized, oppress ridge after preventing closure
Marrow.Osteotomy surface is alternately closed by gimmick bilateral, pre-bending pitman fixes pedicle screw, and pressurization closes osteotomy surface after tightening,
It is good to have an X-rayed osteotomy surface closure, between vertebral plate and Minor articulus bone grafting, completion are performed the operation.
Follow-up After：Two groups of patient's intraoperative blood losses, operating time, fluoroscopy during operation time compared with being contrasted with traditional operation group
Number, Cobb corrections situation, fusion situation etc..
The template of personalized designs is better than the osteotomy guide plate biomechanical property simply by virtue of Experience Design, so far
Using about more than 20 example patients, to observe 2 years, amount of bleeding is few when in art, and speed is fast, and fluoroscopy during operation number 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%.
The foregoing description of the disclosed embodiments, those skilled in the art are enable to realize or using the present invention.To this
A variety of modifications of a little embodiments will be apparent for those skilled in the art, as defined herein general
Principle can be realized in other embodiments without departing from the spirit or scope of the present invention.Therefore, the present invention will not
It 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
Most wide scope.
Claims (3)
1. a kind of Thoracolumbar disk kyphosis deformity is through way of escape individuation osteotomy navigation template preparation method, it is characterised in that：Including following
Step：
（1）64 row's CT scans are carried out to the full backbone of patient and pelvis, obtain DICOM data：CT scan thickness is
0.625mm, matrix 512*512；
（2）3 d modeling software-Mimics is imported data to, rebuilds the threedimensional model of full backbone and pelvis；Concrete operations are choosing
Threshold value select tool, obtain and intend the original illiteracy cover of fixed Thoracolumbar disk, then reduced with region tool for increasing and change above-mentioned illiteracy cover, produce
It is new to cover cover；Then, select this new three-dimensional modeling for covering cover and do smoothing processing, produce the Thoracolumbar disk three-dimensional mould of required fixed-segment
Type；
（3）Simulate osteotomy：
Computer simulation osteotomy determines osteotomy centrum and osteotomy area, convex and rear convex by measuring patient-side in computer software
Cobb angles, it is determined that intending osteotomy centrum, obtain being expected osteotomy angle, using the leading edge midpoint of osteotomy centrum as fulcrum, after measuring centrum
The scope of excision needed for edge and vertebral plate；
（4）Osteotomy guide plate is designed in computer software：
With step（3）Middle data are that foundation designs osteotomy guide plate in software Geomagic, and osteotomy guide plate includes following structure：It is double
Side type individuation osteotomy navigation masterplate articular process is fixed and vertebral plate position mechanism, bilateral type individuation osteotomy navigation masterplate spinous process root determine
Position mechanism, navigation masterplate base portion bi-lateral support mechanism, navigation masterplate Heng Lian finger pressures mechanism；
（5）Incoming 3D printer carries out printing in kind：The anatomic morphological of osteotomy centrum spinous process root and lamina portion is intended in extraction
And it is the reverse templates of 3mm to establish anatomical shape thickness therewith, and articular process, vertebral plate and spinous process are determined in above-mentioned template
Osteotomy orientation, osteotomy navigation template is designed, save as STL formatted files and be passed to 3D printer progress 3D printings in kind.
2. according to a kind of Thoracolumbar disk kyphosis deformity described in claim 1 through way of escape individuation osteotomy navigation template making side
Method, it is characterised in that：The step（4）It is middle to make personalized auxiliary osteotomy guiding tool.
3. according to a kind of Thoracolumbar disk kyphosis deformity described in claim 1 through way of escape individuation osteotomy navigation template making side
Method, it is characterised in that：The step（5）Middle material therefor is photosensitive resin material.
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| EP3568773A4 (en) | 2017-01-12 | 2020-11-04 | Mazor Robotics Ltd. | Image based pathology prediction using artificial intelligence |
| EP3568100A4 (en) * | 2017-01-12 | 2020-10-28 | Mazor Robotics Ltd. | Global balance using dynamic motion analysis |
| CN109830157A (en) * | 2019-01-23 | 2019-05-31 | 同济大学 | A kind of production method of 5 sacrum of waist, 1 anterior stabilization model |
| 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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| US4907577A (en) * | 1989-04-03 | 1990-03-13 | Wu Shing Sheng | Spinal transpedicle drill jig |
| DK2923664T3 (en) * | 2007-10-17 | 2019-04-23 | Aro Medical Aps | Torsion stabilization systems and apparatus |
| ITPI20110040A1 (en) * | 2011-04-08 | 2012-10-09 | Univ Pisa | DRILLING MASK FOR PLANTING A TRANSPEDUNCULAR SCREW |
| CN103099679B (en) * | 2013-03-06 | 2014-10-22 | 吴志宏 | Personalized lumbar internal fixation auxiliary device and manufacturing method thereof |
| CN103099669B (en) * | 2013-03-06 | 2014-12-24 | 吴志宏 | Single-side pedicle screw-driving auxiliary device and manufacturing method thereof |
| CN103932755B (en) * | 2014-05-09 | 2015-12-09 | 陆声 | A kind of osteotomy guider that can accurately locate and preparation method thereof |
| CN104287840B (en) * | 2014-10-28 | 2016-09-21 | 江苏舟可医疗器械科技有限公司 | A kind of navigation template for nervi trigeminus navigation puncture and navigation puncture method |
| CN104546060B (en) * | 2015-01-26 | 2017-02-01 | 北京大学第三医院 | Patella osteotomy navigation template for knee arthroplasty and manufacture method |
| CN204468186U (en) * | 2015-01-26 | 2015-07-15 | 北京大学第三医院 | A kind of patella osteotomy navigation template for knee prosthesis |
| CN104546111B (en) * | 2015-01-27 | 2017-02-22 | 南京医科大学第一附属医院 | Individualized guiding template assisting in setting pedicle screw into small incision and manufacturing method of individualized guiding template |
| CN204562290U (en) * | 2015-04-10 | 2015-08-19 | 北京大学第三医院 | The deep guide plate arrangement of a kind of Total knee arthroplasty distal femur |
| CN104825235A (en) * | 2015-05-22 | 2015-08-12 | 杭州六维齿科医疗技术有限公司 | Fibular flap repairing mandible defect operation guiding template and manufacturing method |
| CN104997562A (en) * | 2015-07-03 | 2015-10-28 | 陆声 | Navigation device capable of accurately locating hemiarthroplasty and manufacturing method of navigation device |
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