CN107157580A - A kind of Digital location minimally invasive spine surgical 3D printing guide plate and preparation method - Google Patents
A kind of Digital location minimally invasive spine surgical 3D printing guide plate and preparation method Download PDFInfo
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- CN107157580A CN107157580A CN201710511326.4A CN201710511326A CN107157580A CN 107157580 A CN107157580 A CN 107157580A CN 201710511326 A CN201710511326 A CN 201710511326A CN 107157580 A CN107157580 A CN 107157580A
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- guide plate
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- skin
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Classifications
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
- A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
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- A61B90/37—Surgical systems with images on a monitor during operation
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B33—ADDITIVE MANUFACTURING TECHNOLOGY
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- B33—ADDITIVE MANUFACTURING TECHNOLOGY
- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
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- B—PERFORMING OPERATIONS; TRANSPORTING
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- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
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- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
- A61B2090/3762—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy using computed tomography systems [CT]
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Abstract
Digital location minimally invasive spine surgical 3D printing guide plate disclosed by the invention, centre sets locating piece cavity and spinous process position line, both sides are provided with pilot hole, locating piece is provided with locating piece in cavity, the side bottom of locating piece axis one is provided with T-shaped groove, guide plate bottom surface, which is provided with T-shaped fixed groove, T-shaped fixed groove, is provided with Position Scale, and Position Scale surface is provided with scale.Guide plate of the present invention, positioning flow is optimized with reference to digitized measurement, easy, and secondary positioning can be directly carried out according to the mark done in tested object epidermis, it is to avoid can not be to the inconvenience such as sterilization completely of tester's art area in art；Also make fast and accurately to determine point of puncture in doctor's art, and ensure to puncture direction in coronal-plane and sagittal plane while reaching accurately, compared with traditional operation mode, operating time can be shortened, reduce the exit dose of doctor and patient in art, the security and accuracy of operation are improved, there is wide applicability in vertebra Minimally Invasive Surgery field.
Description
Technical field
The invention mainly relates to technical field of medical instruments, specifically, plate technique neck is oriented to the present invention relates to 3D printing
Domain.
Background technology
With medical domain fast development, modern medicine is intended to the therapeutic strategy of individuation, computer information technology and
The combination extensively and profoundly of life science, generates emerging cross discipline-digital medical, greatly promotes modern clinic
The development of the Clinics of individuation.And 3D printing technique be directly from computer model material successively or pointwise accumulates three
Object is tieed up, as one kind in computer-aided manufacturing (CAM) technology, many of medical domain has been successfully applied in recent years
Aspect.Medical Imaging Technology is combined with 3D printing technique, makes medical image not only from two dimensional surface Image Development to 3 D stereo,
And develop into the mock-up of current organ.Further combined with CAD (CAD), can not only manufacture people from place
Body anatomical structure models, and can produce to come with the individual operation guide plate that human anatomic structure surface is matched completely.
At present, people are by computer digital correlation technique, and ambits multiple for medical science are carried out at view data
After reason, dissection modeling and three-dimensional reconstruction, display and the cruel anatomical structure of positioning human body bone are formed, also, carry out in a computer
Simulated surgical operation, designs optimal operation pathway, and rational individualized surgical planning, improves the levels of precision of operation,
Surgical operation step is simplified, the learning curve of junior doctor is shortened, is that the innovation of digital osteology and method battle array have established heavily fortified point
Real basis, while the incomparable broad space also created for 3D printing in the application of biomedical sector.
Current minimally invasive spine surgical development is increasingly extensive, including percutaneous vertbroplasty (PVP) or balloon kyphoplasty
(PKP) or percutaneous cervical arc root ligamentopexis, foramen intervertebrale lens, MED, tumor of spine focus biopsy etc., advantage is operation wound
Small, recovery is fast, suffers from acceptance good.And Minimally Invasive Surgery is percutaneous operation, by vertebra skin of back, it is only capable of substantially determining vertebra
Body position, therefore simple by centrum dorsal skin is difficult the definite operation centrum position of identification, now in order to determine vertebra of performing the operation
Body, it is ensured that put accurate needle angle and depth during nail, the accurate entry point for determining pedicle and enters to follow closely direction, need more into
The a large amount of x-ray bombardments of row are determined.This not only causes very big actual bodily harm and financial burden to patient, and such as heavy dose of penetrates
Line, which is projected, often easily triggers postoperative nausea, the adverse reaction such as vomiting.The ray shadow that can not be estimated also is caused to doctor simultaneously
Ring.Even trigger tumour.Though CT adds the lower pedicle screw of navigation to insert technology in oneself the current art more advanced through having, it can reach
Higher screw inserts accuracy rate, but equipment is expensive, and the hospital that state's interior energy is equipped with this kind equipment is very rare.
3D printing vertebra Minimally Invasive Surgery is oriented to plate technique can provide a good solution for this.Patent CN
204863422 U patents disclose a kind of vertebra guide plate of 3D printing, but need to set polylith spacer, root when in use
Confirm to select that piece spacer to use as final positioning according to CT scan data, and spacer used needs to paste always
Until operation terminates on patient skin, this prevents the position below spacer from sterilizing, to add operation risk, and also causing should
Technology is using being restricted in operation, and the A of patent CN 104287815 use metal sleeve, increase error, is finally determining
Any block centrum performed the operation and during guide plate placement location before two patented methods still need X-ray and be repeatedly scanned with,
The accurate placement to guide plate can be realized, causes prior art guide plate not to be avoided that still percutaneous cervical arc root when performing the operation to X in art
The dependence of ray scanning.
The content of the invention
For in the prior art it is preoperative because position factor cause guide plate poor accuracy, be not avoided that vertebra Minimally Invasive Surgery when
Dependence to CT scan in art, and guide plate position fixing process is cumbersome and is unable to reach the state of the art of operation sterility requirements, this hair
It is bright that a kind of Digital location minimally invasive spine surgical 3D printing guide plate and preparation method are provided, used when CT extracts data in the preoperative
Special prone position gesture rack (gesture rack is separately applied for a patent), using in any edge of survey tool measurement and positioning block and backbone
The distance of the intersection point of axis to operation centrum central point is recorded as a values；Operation centrum central point hanging down to skin surface is measured again
Straight distance is recorded as b values；By a values and b values can guide plate is placed in logistic exact position, i.e., needed on backbone center line
The distance for wanting upper and lower translation to finely tune is recorded as c values.According to the mark line and a values of tested object locating piece surrounding, b values and c values
The position of guide plate placement in art can be marked again using locating piece in tested object backbone skin region, this thoroughly solves hand
To the dependence of CT scan in art, and break away from preoperative the drawbacks of can not remove positioner into art, surgery area is not influenceed
Sterilization, through in vertebra Minimally Invasive Surgery have wide applicability.
The technical scheme that the present invention is provided is as follows：
A kind of Digital location minimally invasive spine surgical 3D printing guide plate preparation method that the present invention is provided, including following step
Suddenly：
(1) position support：Tested object prostrate on the gesture rack of 3D printing spinal operation prone position, CT scan position with
Position during operation is consistent, on the skin that locating piece is placed to patient spine center line Jin Shu areas, and makes marks.
(2) CT scan：Tested object trunk is scanned using Multi-section CT machine, the tested object related data of storage
Information.
(2) data are split in medical image software：CT scan data is imported into medical image software processing, threshold value point is utilized
Method and the Boolean calculation summation cut, show that outer layer is skin in same masking-out, while both can be kept by centrum and skin
Relative position and actual consistent, last export.
(3) established using locating piece and be oriented to Board position：Appointed in medical image software using survey tool measurement and positioning block
The distance of intersection point to centrum central point of performing the operation of an edge and backbone axis of anticipating is recorded as a values；Operation centrum center is measured again
The vertical range of point to skin surface is recorded as b values；By a values and b values can guide plate is placed in logistic exact position, i.e.,
The distance for needing upper and lower translation to finely tune on backbone center line is recorded as c values.Positioning is utilized in tested object backbone skin region
Block marks the position that guide plate is placed in art again.
(4) data are encapsulated in reverse engineering software：By data processing, it is last that final fitting surface imports area of computer aided
Qualified file is obtained, and is exported.
(5) CAD：Step (4) file is imported into design vertebra in CASE(Computer Aided Software Engineering) and is oriented to template die
Type, completes the design of guide plate main part and is oriented to bore portion design, reserved in design can placement positioning block cavity, to guide plate
Chamfering is carried out, in the middle part of guide plate and both sides design cavity.
(6) 3D printing is oriented to Slab：Guiding Slab is produced by 3D printing technique, being oriented to plate surface has vertebra at two
Nut squeezes into hole, and guide plate center sets positioning cavity, and 3D printing rapid shaping prints guider entity.
In the present invention, the position for being tested object row CT is consistent with the final position for using guide plate, by tested object
Prone position is on gesture rack, it is ensured that the centrum of tested object and skin molds relative constancy, prevents because Body Position Change causes
Soft tissue deformation is oriented to plate surface to fitting and causes gross error, its relative position and it is final using guide plate when it is highly consistent,
When tested object's position is determined, using ilium, rib lower edge as body surface standard point, on the backbone center line of tested object
One piece of locating piece is placed, and marks on skin the engagement edge of locating piece and skin.
In the present invention, step (1) and step (4) are preferentially made marks using waterproof marking pen.
In the present invention, the skin attachement face data of guide plate main part hold up tester by gesture rack and obtained, it can be ensured that
It is accurately reliable according to the guide plate that tester's skin data is prepared；The bat CT if tester lies low, then skin of back is certain
It is flat, the binding face for the guide plate made is exactly flat, and skin curved surface occurs after prone position when when performing the operation, the back of a bow
Deformation；Guide plate remainder is obtained by skin periphery row stretching order with trimming order, it can be ensured that guide plate is tried one's best with skin
Laminating, it is ensured that the height of stretching is parallel with the upper lower edge for squeezing into lesion centrum, being reserved in design can placement positioning block cavity；It is described
Pilot hole be designed as on centrum pedicle of vertebral arch lower edge be according to seek and pedicle of vertebral arch tangent plane, design two positions in pedicle of vertebral arch tangent plane
The suitable straight line for squeezing into pedicle of vertebral arch is put, linear position is adjusted, using this straight line as its center, the pipe of pedicle of vertebral arch is squeezed into design one
Road；Then pipeline and guide plate agent structure and pilot hole are summed, obtains guide plate, finally, it is appropriate that guide plate is carried out
Chamfering, in the middle part of guide plate and both sides design cavity.
Locating piece cavity is provided with the present invention, in the middle of guide plate, locating piece cavity both sides are provided with pilot hole, guide plate
Centre is provided with spinous process position line, and guide plate both sides are provided with cavity, and locating piece is provided with locating piece in cavity.
In the present invention, the side bottom of locating piece axis one is provided with T-shaped groove, T-shaped groove insertion locating piece bottom surface,
Guide plate bottom surface is provided with T-shaped fixed groove, T-shaped fixed groove and is provided with Position Scale, and Position Scale is in T shape,
It is adapted and sets with the T-shaped fixed groove of guide plate and the T-shaped groove of locating piece, Position Scale surface is provided with scale, zero quarter
The length spent to termination is consistent with T-shaped fixed groove length.
In the present invention, the condition of scanning described in step (2) is voltage 120kV, electric current 166mAs, thickness 0.8mm, matrix
512x512。
In the present invention, 3D printing spinal operation prone position gesture rack is provided with breast standing groove and belly standing groove, a pair of breasts
Lattice gear is provided between room standing groove, belly standing groove both sides are provided with fixation wall, between breast standing groove and belly standing groove
Provided with chest groove, cavity is arranged on below breast standing groove and chest groove, and the gesture rack back side is provided with cavity, belly standing groove
Bottom is provided with perforate.
In the present invention, 3D printing spinal operation prone position gesture rack is using the environmentally friendly printed material system of PLA polylactic acid degradables
It is standby.
In the present invention, 3D printing spinal operation prone position gesture rack uses 3d printing shapings.
Beneficial effects of the present invention:
The design process for the Digital location minimally invasive spine surgical 3D printing guide plate that the present invention is provided uses digital medical
3D reconstruction techniques, its data is entirely derived from patient, and accurate Three-dimensional objectsization can be designed according to patient individual difference and are oriented to
Plate；The design and use of guide plate take into account inspection position and art in position to the soft tissue movement such as skin to location accuracy
Influence, matching degree when can significantly improve design and apply, influence of the reduction error to operation improve medical safety.
Locating piece combination digitized measurement optimizes positioning flow in the present invention, easy, according to measurement a values, b values and c values
Secondary positioning can be directly carried out with reference to the mark done in tested object epidermis, without detent mechanism is fixed on for a long time
With tested object, it is to avoid can not be to the inconvenience such as sterilization completely of tester's art area in art；Also make in doctor's art fast and accurately
Point of puncture is determined, and ensures to puncture direction in coronal-plane and sagittal plane while reaching accurately, compared with traditional operation mode, hand can be shortened
The art time, the exit dose of doctor and patient in art is reduced, improve the security and accuracy of operation.
Brief description of the drawings
Fig. 1 is shown as medical image software processing result figure of the present invention.
Fig. 2 is shown as reverse engineering software result figure of the present invention.
Fig. 3 is shown as CAD result of the present invention, guide plate and the close schematic diagram of skin attachement.
Fig. 4 is shown as guide plate schematic diagram of the present invention.
Fig. 5 is shown as guide plate side view of the present invention.
Fig. 6 is shown as guide plate upward view of the present invention.
Fig. 7 is shown as guide plate pictorial diagram one of the present invention.
Fig. 8 is shown as guide plate pictorial diagram two of the present invention.
Fig. 9 is shown as positioning block structure schematic diagram of the present invention.
Figure 10 is shown as Position Scale structural representation of the present invention.
Figure 11 is shown as gesture rack structural representation of the present invention.
Figure 12 is shown as gesture rack support board structure schematic diagram of the present invention.
Figure 13 is shown as 2 support frame attachment structure schematic diagrams of gesture rack of the present invention.
In Fig. 1-13,1- guide plates, 2- pilot holes, 3- locating pieces cavity, 4- cavities, 5- spinous process position line, 6-T fonts are consolidated
Determine groove, 7- locating pieces, 8-T font grooves, 9- Position Scales, 10- scales, 11- breast standing groove, 12- bellies standing groove,
13- fixation walls, 14- chests groove, 15- lattice gear, 16- perforates, 17- cavitys, 20- centrums.
Embodiment
The embodiment to the present invention is described in further detail below, but the method for the present invention is not limited to following realities
Apply example.
Embodiment one：Digital location minimally invasive spine surgical 3D printing guide plate preparation method
A kind of Digital location minimally invasive spine surgical 3D printing guide plate preparation method that the present invention is provided, including following step
Suddenly：
(1) position support：Tested object prostrate on the gesture rack of 3D printing spinal operation prone position, CT scan position with
Position during operation is consistent, on the skin that locating piece (7) is placed to patient spine center line Jin Shu areas, and makes marks.
(2) CT scan：Tested object trunk is scanned using Multi-section CT machine, the tested object related data of storage
Information.
(2) data are split in medical image software：CT scan data is imported into medical image software processing, threshold value point is utilized
Method and the Boolean calculation summation cut, show that outer layer is skin in same masking-out, while both can be kept by centrum and skin
Relative position and actual consistent, last export, such as illustrate shown in accompanying drawing 1.
(3) established using locating piece (7) and be oriented to Board position：Survey tool measurement and positioning block is used in medical image software
(7) distance at any one edge and intersection point to operation centrum (20) central point of backbone axis is recorded as a values；Operation is measured again
The vertical range of centrum (20) central point to skin surface is recorded as b values；Guide plate (1) it can be put in logistic by a values and b values
The exact position put, i.e., the distance for needing upper and lower translation to finely tune on backbone center line is recorded as c values.In tested object backbone
Skin region marks the position of guide plate in art (1) placement using locating piece again.
(4) data are encapsulated in reverse engineering software：By data processing, it is last that final fitting surface imports area of computer aided
Qualified file is obtained, and is exported, as shown in explanation accompanying drawing 2.
(5) CAD：Step (4) file is imported into design vertebra in CASE(Computer Aided Software Engineering) and is oriented to template die
Type, completes the design of guide plate (1) main part and pilot hole (2) part is designed, and being reserved in design can placement positioning block cavity
(3) chamfering, is carried out to guide plate (1), in the middle part of guide plate (1) and both sides design cavity.
(6) 3D printing is oriented to Slab：Guiding Slab is produced by 3D printing technique, guide plate (1) surface has two
Place's pedicle of vertebral arch squeezes into hole, and guide plate center sets positioning empty (4), and 3D printing rapid shaping prints guider entity.
In the present invention, the condition of scanning described in step (2) is voltage 120kV, electric current 166mAs, thickness 0.8mm, matrix
512x512。
In the present invention, should be disrobed during scanning, belt, it is to avoid CT data three-dimensionals rebuild after influence skin data place
Reason.
Embodiment two：The collection of CT data and mark
In the present invention, the position for being tested object row CT is consistent with the final position using guide plate (1), by tested pair
As prone position is on gesture rack, it is ensured that the centrum (20) of tested object and skin molds relative constancy, prevent because position changes
Become and cause soft tissue deformation to cause gross error to fitting guiding plate surface, when its relative position is with finally guide plate (1) is used
It is highly consistent, when tested object's position is determined, using ilium, rib lower edge as body surface standard point, in the ridge of tested object
One piece of locating piece (7) is placed on post center line, and is made in waterproof marking pen on skin and marks contact of the locating piece (7) with skin
Edge.
Tested object trunk is scanned using Multi-section CT machine, the tested object-related information of storage.
Embodiment three：CAD
In the present invention, the skin attachement face data of guide plate (1) main part hold up tester by gesture rack and obtained, can be true
Protect the guide plate (1) prepared according to tester's skin data accurate reliable；The bat CT if tester lies low, then skin of back
Must be flat, the binding face of the guide plate made is exactly flat, and skin curved surface after prone position when when performing the operation, the back of a bow
Deform upon；Guide plate (1) remainder is obtained by skin periphery row stretching order with trimming order, it can be ensured that guide plate (1)
Try one's best and fit with skin, it is ensured that the height of stretching is parallel with the upper lower edge for squeezing into lesion centrum (20), being reserved in design to place
Locating piece cavity (3)；The pilot hole (2) be designed as on centrum pedicle of vertebral arch lower edge be according to seek and pedicle of vertebral arch tangent plane,
Design two position suitables in pedicle of vertebral arch tangent plane and squeeze into the straight line of pedicle of vertebral arch, adjust linear position, using this straight line as cylinder in
The pipeline of pedicle of vertebral arch is squeezed into the heart, design one；Then pipeline and guide plate (1) agent structure and pilot hole are summed, are oriented to
Plate (1), finally, appropriate chamfering is carried out to guide plate (1), in the middle part of guide plate (1) and both sides design cavity, such as accompanying drawing 3
It is shown.
Example IV：3D printing is oriented to Slab
In the present invention, as shown in accompanying drawing 4, accompanying drawing 5, accompanying drawing 6, accompanying drawing 7, accompanying drawing 8, positioning is provided with the middle of guide plate (1)
Block cavity (3), locating piece cavity (3) both sides, which are provided with the middle of pilot hole (2), guide plate (1), is provided with spinous process position line (5),
Guide plate (1) both sides are provided with empty (4), and locating piece (7), locating piece (7) axis side are provided with locating piece cavity (3)
Bottom is provided with T-shaped groove (8), T-shaped groove (8) insertion locating piece (7) bottom surface, and guide plate bottom surface is provided with T-shaped solid
Determine to be provided with Position Scale (9) in groove (6), T-shaped fixed groove (6), Position Scale (9) is in T shape, with guide plate (1) T
Font fixed groove (6) and the T-shaped groove of locating piece (8), which are adapted, to be set, and Position Scale (9) surface is provided with scale (10),
The length of zero graduation to termination is consistent with T-shaped fixed groove (6) length, and the four of spinous process position line (5) and locating piece empty (3)
Side mark is accurately positioned guider putting position, pilot hole (2) venipuncture positioning pedicle of vertebral arch.
Embodiment five：3D printing spinal operation prone position gesture rack
The invention provides a kind of 3D printing spinal operation prone position gesture rack, put provided with breast standing groove (11) and belly
Put and lattice gear (15) is provided between groove (12), a pair of breast standing grooves (11), belly standing groove (12) both sides are provided with fixation wall
(13) chest groove (14), belly standing groove (12), are provided between gesture rack breast standing groove (11) and belly standing groove (12)
Bottom is provided with perforate (6)
In the present invention, the gesture rack back side is provided with cavity (17).
In the present invention, all corner angle in gesture rack upper surface are all arc chord angle.
In the present invention, breast standing groove (11) horizontal cross-section is trapezoidal.
In the present invention, the arc chord angle radian of belly standing groove (12) both sides is more than breast standing groove (11) surrounding arc chord angle arc
Degree.
In the present invention, 3D printing spinal operation prone position gesture rack is using the environmentally friendly printed material system of PLA polylactic acid degradables
It is standby.
In the present invention, 3D printing spinal operation prone position gesture rack uses 3d printing shapings.
Using 3D printing integrated molding, using ergonomics curved surface radian, meet body biomechanicses, aim at women special
Different design breast places groove so that test and when performing the operation it is more comfortable, using the environmentally friendly printed material of PLA polylactic acid degradables without
Integrated 3D printing shaping that metal structure is nonmagnetic, when CT extracts data in the preoperative, can be used so that patient CT on CT
When prone body position with operation when it is consistent, improve operation precision, can be used on MRI machine, thoroughly solve perform the operation in it is right
The dependence of CT scan, and broken away from preoperative positioner and the traditional operation gesture rack of can not being removed into art can not be common in nuclear-magnetism
The drawbacks of operation position under shaking is scanned, the sterilization in surgery area is not influenceed, and the cavity design of bottom accelerates 3D printing speed
Waste of material is reduced, there is wide applicability in vertebra Minimally Invasive Surgery.
Embodiment six：Clinical test
6.1 test sample
Following experiment is completed using the present invention shown in accompanying drawing 7 of the present invention and accompanying drawing 8 is in kind.
5 chests for selecting in August, 2014 to be gone to a doctor in December, 2015 in the section of the 5th affiliated hospital's bone of Xinjiang Medicine University two
The patient of fracture of lumbar vertebra, wherein 4 patients use vertebroplasty, 1 patient uses percutaneous screw fixation, age 31~66
Year, average age 52.6 years old, wherein man 0, female 5, totally 6 groups of centrum of puncture, 2 groups of thoracic vertebrae, 4 groups of lumbar vertebrae, wherein：
Patient 1：Female, 60 years old, whole body many places soft tissue injury is caused with wound, low-back pain Ban Yu main suit is admitted to hospital, entered
Institute diagnoses：1st, the compression fracture of vertabral body of waist 1,2, whole body many places soft tissue injury, 3, the protrasion of the lumbar intervertebral disci.
Patient 2：Female, 49 years old, is chief complaint and is admitted to hospital, be admitted to hospital and examine for more than 4 hours with high falling to low-back pain limitation of activity
It is disconnected：1st, the compression fracture of vertabral body of chest 12,2, chest 10,12 fracture of spinous process of vertebra, the 3, the 12nd fracture of rib.
Patient 3：Female, 66 years old, is chief complaint and is admitted to hospital for 5 hours with tumble injury to low-back pain, admission diagnosis：1st, the centrum pressure of waist 1
Contracting is fractured, and 2, serious osteoporosis, 3,3 grades of hypertension-high danger.
Patient 4：Female, 57 years old, causes low-back pain to be chief complaint for 2 hours and is admitted to hospital with tumble injury, admission diagnosis：1st, the centrum pressure of waist 1
Contracting is fractured, 2. 3 grades of hypertension-high danger.
Patient 5：Female, 31 years old, causes low-back pain to be chief complaint for 4 hours and is admitted to hospital with wound, admission diagnosis：1st, the centrum pressure of chest 12
Contracting is fractured, 2, head injury, 3, right side fracture of scapula, 4, right side thoracic injury, 5, lumbar degenerative change, the 6, the 10th rib
Bone is fractured, and 7, right fracture of clavicle, 8, double lung blast injuries, 9, bilateral pleural effusion.
5 patients have a medical check-up equal impassivity symptom, and stool and urine is normal, the preoperative row x lines of all patients that are admitted to hospital, CT examination.Suffer from
Person 1,2,3,4 uses Nephrolithotomy Percutaneous, and patient 5 is included using method fixed in percutaneous screw, clinical trial object
Standard：It is the single segmental vertebral fracture of the damage of A types and impassivity symptom according to AO partings.
In June, 2013 is transferred to 2 months 15 in 2016 in the affiliated hospital's medical records system of Xinjiang Medicine University the 5th simultaneously
Example is using the case of minimally invasive spine surgical mode as simple control, wherein 13 patients use vertebroplasty, 2 patients adopt
Percutaneous screw fixation is used, 44~91 years old age, average age 66.2 years old, man 5, female 10 punctures centrum totally 16 groups, thoracic vertebrae
7 groups, 9 groups of lumbar vertebrae.
5 patients using 3D printing percutaneous cervical arc root guide plate by instructing puncturing operation process smoothly, and bone cement is without oozing
Leakage, pedicle screw position is good, and operation is completed according to plan.All case otch are first intention, do not occur otch sense
Dye, delayed union person, the complication such as postoperative amyelia neurotrosis symptom occur, and postoperative effect is good, seen in art with it is preoperative
The anomaly of Mimcs software Three-dimension Reconstruction Models is consistent, and fluoroscopy during operation and the check of postoperative X line show bone cement injection and vertebral arch
Root screw position is good.Postoperative patient reaches first intention, and Follow-up After 4-8 weeks is average 6 weeks.C-arm measures centrum perspective
Dosage is 1.13 ± 0.24mSv, small compared with 1.97 ± 1.20mSv that pertinent literature is reported.
The collection of 6.2 data
The experimental group data statistics of table 1
6.3 statistical analysis
The percutaneous sacculus vertebroplasty patient perspective number of times 5 ± 0.82 times of experimental group 4,40 ± 8.16min of operating time,
The affiliated hospital's medical records system of retrospective analysis Xinjiang Medicine University the 5th is transferred in June, 2013 to 2 month 13 in 2016 and adopted
With the case perspective number of times 9.33 ± 1.37 times (wherein one loss of data) of percutaneous sacculus vertebroplasty mode, operating time
62.5±13.57min.The comparison of two sample averages is examined using t, and it is -5.899 to calculate perspective number of times t values, checks in and knows p<
0.05.It is -3.091 to calculate operating time t values, checks in and knows p<0.05, illustrate that guide plate group has an X-rayed number of times and time compared with contrast groups
Reduce.
The present invention can preferably be realized by as above serial experiment, the technical scheme that the present invention is provided is relative to existing skill
Art, the position that the U patents of patent CN 204863422 disclose below a kind of vertebra guide plate of 3D printing, spacer can not disappear
Poison, adds operation risk, and using being restricted in operation, the A of patent CN 104287815 use metal sleeve, increase
Error, finally determine any block centrum performed the operation and during guide plate placement location before two patented methods still need X-ray
It is repeatedly scanned with, the accurate placement to guide plate could be realized, cause prior art guide plate not to be avoided that percutaneous vertebral arch still
Dependence during root operation to X-ray scanning in art, the Digital location minimally invasive spine surgical 3D printing provided using the present invention is led
The 3D reconstruction techniques of digital medical are used to the design process of plate, its data is entirely derived from patient, can be poor according to individual patients
It is different to design accurate Three-dimensional objects guide plate；The design and use of guide plate, which take into account, checks that position is to skin in position and art
Influence of the soft tissue such as skin movement to location accuracy, matching degree when can significantly improve design and apply, reduces error pair
The influence of operation, improves medical safety, while locating piece combination digitized measurement optimizes positioning flow in the present invention, it is easy,
Secondary positioning can directly be carried out with reference to the mark done in tested object epidermis according to measurement a values, b values and c values, without inciting somebody to action
Detent mechanism is fixed on tested object for a long time, it is to avoid can not be to the inconvenience such as sterilization completely of tester's art area in art；
Make fast and accurately to determine point of puncture in doctor's art, and ensure puncture direction in coronal-plane and sagittal plane and meanwhile reach accurately, compared with
Traditional operation mode, can shorten operating time, reduce the exit dose of doctor and patient in art, improve the security of operation and accurate
Property, obtain significantly prominent technique effect.
The above embodiments are only that the preferred embodiment of the present invention is described, and not the scope of the present invention is entered
Row is limited, on the premise of design spirit of the present invention is not departed from, and those of ordinary skill in the art make to technical scheme
The various modifications gone out and improvement, all should fall into present invention determine that protection domain in.
Claims (10)
1. a kind of Digital location minimally invasive spine surgical 3D printing guide plate preparation method, it is characterised in that the preparation method
Comprise the following steps：
（1）Position support：Tested object prostrate is on the gesture rack of 3D printing spinal operation prone position, and CT scan position is with performing the operation
When position it is consistent, on the skin that locating piece is placed to patient spine center line Jin Shu areas, and make marks；
（2）CT scan：Tested object trunk is scanned using Multi-section CT machine, the tested object related data letter of storage
Breath；
（3）Data are split in medical image software：CT scan data is imported into medical image software processing, Threshold segmentation is utilized
Method and Boolean calculation summation, show that outer layer is skin in same masking-out, while both phases can be kept by centrum and skin
To position and actual consistent, last export；
（4）Established using locating piece and be oriented to Board position：It is any one using survey tool measurement and positioning block in medical image software
The distance at edge and intersection point to the operation centrum central point of backbone axis is recorded as a values；Operation centrum central point is measured again to arrive
The vertical range of skin surface is recorded as b values；By a values and b values can guide plate is placed in logistic exact position, i.e., in ridge
The distance for needing upper and lower translation to finely tune on post center line is recorded as c values, and locating piece weight is utilized in tested object backbone skin region
The position that guide plate is placed in new mark art；
（5）Data are encapsulated in reverse engineering software：By data processing, final fitting surface imports area of computer aided and finally obtained
Qualified file, and export；
（6）CAD：By step（4）File imports design vertebra in CASE(Computer Aided Software Engineering) and is oriented to Slab, complete
Into guide plate main part design and be oriented to bore portion design, in design reserve can placement positioning block cavity, to guide plate carry out
Chamfering, in the middle part of guide plate and both sides design cavity；
（7）3D printing is oriented to Slab：Guiding Slab is produced by 3D printing technique, being oriented to plate surface has pedicle of vertebral arch at two
Hole is squeezed into, guide plate center sets positioning cavity, and 3D printing rapid shaping prints guider entity.
2. a kind of Digital location minimally invasive spine surgical 3D printing guide plate preparation method as claimed in claim 1, its feature
It is, the step（1）Tested object test CT position is consistent with the final position for using guide plate, and testee is relative
It is highly consistent when position and final use guide plate, when tested object's position is determined, using ilium, rib lower edge as body surface mark
On schedule, one piece of locating piece is placed on the backbone center line of tested object, and in locating piece and the engagement edge skin of skin
On make marks.
3. a kind of Digital location minimally invasive spine surgical 3D printing as described in claim 1 or claim 2 any one is led
To plate preparation method, it is characterised in that step（1）And step（4）Made marks using waterproof marking pen.
4. a kind of Digital location minimally invasive spine surgical 3D printing guide plate preparation method as claimed in claim 1, its feature
It is, the step（2）The condition of scanning is voltage 120kV, electric current 166mAs, thickness 0.8mm, matrix 512x512.
5. a kind of Digital location minimally invasive spine surgical 3D printing guide plate preparation method as claimed in claim 1, its feature
It is, the step（5）Tester is held up by the skin attachement face data of guide plate main part by gesture rack to obtain；Guide plate
Remainder is obtained by skin periphery row stretching order with trimming order, and placement positioning block cavity is reserved in design；It is described to be oriented to
Hole be designed as on centrum pedicle of vertebral arch lower edge be according to seek and pedicle of vertebral arch tangent plane, design two positions in pedicle of vertebral arch tangent plane and close
The suitable straight line for squeezing into pedicle of vertebral arch, adjusts linear position, using this straight line as its center, and the pipeline of pedicle of vertebral arch is squeezed into design one；
Then pipeline and guide plate agent structure and pilot hole are summed, obtains guide plate, chamfering is carried out to guide plate, in guide plate
Middle part and both sides design cavity.
6. a kind of Digital location minimally invasive spine surgical 3D printing guide plate as claimed in claim 1, it is characterised in that described
Be provided with the middle of guide plate locating piece cavity, locating piece cavity both sides be provided with the middle of pilot hole, guide plate be provided with spinous process determine
Bit line, guide plate both sides are provided with cavity, and locating piece is provided with locating piece in cavity.
7. a kind of Digital location minimally invasive spine surgical 3D printing guide plate as claimed in claim 6, it is characterised in that described
The side bottom of locating piece axis one be provided with T-shaped groove, T-shaped groove insertion locating piece bottom surface, guide plate bottom surface is set
Have in T-shaped fixed groove, T-shaped fixed groove and be provided with Position Scale, Position Scale is in T shape, it is T-shaped solid with guide plate
Determine groove and the T-shaped groove of locating piece and be adapted to set, Position Scale surface is provided with scale, the length of zero graduation to termination with
T-shaped fixed groove length is consistent.
8. a kind of 3D printing spinal operation prone position gesture rack as claimed in claim 1, it is characterised in that the position is set up
Have and lattice gear is provided between breast standing groove and belly standing groove, a pair of breast standing grooves, belly standing groove both sides are provided with solid
Determine wall, chest groove is provided between breast standing groove and belly standing groove, cavity is arranged under breast standing groove and chest groove
Side, the gesture rack back side is provided with cavity, and belly places trench bottom and is provided with perforate.
9. 3D printing spinal operation prone position gesture rack as claimed in claim 1, it is characterised in that described gesture rack is used
It is prepared by PLA polylactic acid degradables environmental protection printed material.
10. 3D printing spinal operation prone position gesture rack as claimed in claim 1, it is characterised in that the gesture rack is used
3d printing shapings.
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