CN108720923A - Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool - Google Patents

Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool Download PDF

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Publication number
CN108720923A
CN108720923A CN201810281382.8A CN201810281382A CN108720923A CN 108720923 A CN108720923 A CN 108720923A CN 201810281382 A CN201810281382 A CN 201810281382A CN 108720923 A CN108720923 A CN 108720923A
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fracture
reduction
calcaneus
kirschner wire
reset
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CN108720923B (en
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王成功
钟达
刘华
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Xiangya Hospital of Central South University
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Xiangya Hospital of Central South University
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B33ADDITIVE MANUFACTURING TECHNOLOGY
    • B33YADDITIVE 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
    • B33Y10/00Processes of additive manufacturing
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B33ADDITIVE MANUFACTURING TECHNOLOGY
    • B33YADDITIVE 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
    • B33Y50/00Data acquisition or data processing for additive manufacturing
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B33ADDITIVE MANUFACTURING TECHNOLOGY
    • B33YADDITIVE 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
    • B33Y80/00Products made by additive manufacturing
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/108Computer aided selection or customisation of medical implants or cutting guides

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  • Engineering & Computer Science (AREA)
  • Chemical & Material Sciences (AREA)
  • Manufacturing & Machinery (AREA)
  • Materials Engineering (AREA)
  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Robotics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool, including;Modeling, analysing patient's condition;Simulate the reduction of the fracture;Determine the position of inner fixing device;After determining the reduction of the fracture, the position of Kirschner wire is resetted;Before determining the reduction of the fracture, the position of Kirschner wire is resetted;Steering tool before the design reduction of the fracture;It designs fracture inside-fixture and is placed in guide plate;All steering tools are prepared by 3D printing, and are tested.

Description

Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool
Technical field
The present invention relates to 3D printings and reduction of the fracture fixed network, more particularly to the calcaneum based on digitlization 3D printing tool Householder method is fixed in fracture closed reduction.
Background technology
Fracture closed reduction internal fixation:Refer to that fracture is first subjected to closed reduction, then carries out a kind of interior fixed hand Art mode is the combined process of closed reduction of fracture and internal fixation of fracture.
Closed reduction of fracture:Restore correctly to dissect between sclerite in the case where not cutting not exposed fracture area A kind of modus operandi of relationship.
Internal fixation of fracture:Each sclerite is linked to be one by inner fixing devices such as screw, steel plate, intramedullary needle, steel wires It is whole, help a kind of modus operandi for maintaining and healing in relatively fixed position of fracturing.
Digitizing technique design operation:Disease conditions in patients is analyzed on computers, by three-dimensional reconstruction, virtually The help of the technologies such as measuring and calculating, simulates surgical procedure, determines best operation plan on computers.
3D printing:It is one kind of increasing material manufacturing, a kind of rapid shaping technique, it is one kind using digital model file as base Plinth constructs the technology of object by layer-by-layer printing with adhesive materials such as powdery metal or plastics.
Fracture of calcaneus is a kind of very common frequently-occurring disease, and most common therapeutic modality is divided into two kinds, is to cut respectively Redution-in-fixed and closed reduction internal fixation.
Wherein, closed reduction internal fixation has many advantages, for example it can effectively evade internal fixation and lead The operative incision of cause is easy to generate the complication such as disunion, necrosis, infection, but closed reduction internal fixation needs exist for Exposure subtalar joint is cut using miniature incision, and needs X-ray examination in a large amount of progress art, it is more nerve-wracking to be, it closes It is high for the requirement of patient's technology to close reset, it is easy to cause reset dissatisfied, fixed to be unsatisfied with, operating time is long, and wound is big Etc. adverse consequences.
Currently, the basic step of fracture of calcaneus closed reduction internal fixation, corresponding feature and disadvantage are as follows:
These disadvantages are continuous with digitizing technique and 3D printing (increasing material manufacturing) technology at urgent problem to be solved Fixed operation thinking in a kind of completely new fracture of calcaneus closed reduction is invented by development, this team.
It solves:
1. it is preoperative, the details of fracture of calcaneus cannot be visually known;
2. it is preoperative, surgery planning, simulation operation intuitively cannot be repeatedly carried out, so that it is determined that in fracture of calcaneus closed reduction Fixed operation plan;
3. it is preoperative, it not can determine that type, the model for determining inner fixing device completely;
4. in art, it is still necessary to which row miniature incision exposes subtalar joint face;
5. in art, it is necessary to (such as by real time inspection:Subtalar joint miniature incision, repeatedly X-ray examination etc. in art) it could be bright True fracture of calcaneus situation;
6. in art, satisfied reset can just be obtained by needing to make repeated attempts;
7. in art, the installation site of inner fixing device is not accurate;
8. in art, need it is multiple be fixed temporarily, or need that inner fixing device is installed repeatedly;
9. in art, it is necessary to be guided by X-ray examination in art repeatedly or verification could install inner fixing device.The problems such as.
Invention content
To solve the above-mentioned problems of the prior art, the purpose of the present invention is to provide based on digitlization 3D printing tool Fracture of calcaneus closed reduction in fix householder method.Fracture operation scheme is designed by virtual technology, and 3D printing will be passed through The auxiliary of tool helps surgical procedure whole process to be carried out by Design scheme, to ensure personalized precisely medical treatment.
In order to achieve the above objectives, the technical scheme is that:
Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool.Including:Preoperative computer Design and steering tool make and two large divisions is implemented in operation, wherein preoperative Computer Design and steering tool make specific step Suddenly it is:
Step 1: modeling, analysing patient's condition:
The preoperative fracture of calcaneus CT data of patient are imported into computer, " 3 D stereo fracture is obtained after being rebuild by software Digital model ", and analysing patient's condition;
Step 2: the simulation reduction of the fracture:
By " 3 D stereo fracture of calcaneus digital model ", Magics software implementations " fracture block reset " are used on computers
Step 3: determining the position of inner fixing device:
By the installation of " the fracture of calcaneus digital model after reset " of computer inner simulation inner fixing device, test repeatedly Card, until completing Surgery simulation;
Step 4: after determining the reduction of the fracture, the position of Kirschner wire is resetted:
" the fracture of calcaneus digital model after reset " inner insertion is resetted into Kirschner wire, main purpose be make it is several with Sclerite forms rigidly connected direction object, is fixed temporarily and plays the role of label;
Step 5: before determining the reduction of the fracture, the position of Kirschner wire is resetted:
By " the fracture of calcaneus digital model after reset " of having connected reset Kirschner wire inner each sclerite by step Position in one in " 3 D stereo fracture of calcaneus digital model " is restored, and is maintained to reset Kirschner wire and is corresponded to sclerite Relative position is constant, resets the orientation that Kirschner wire is placed in before obtaining the reduction of the fracture;
Step 6: steering tool before the design reduction of the fracture:
On computers, design " reset before steering tool ", the steering tool can only be incorporated in by unique orientation with Around bone, and only unique orientation is combined with " the reset Kirschner wire before the reduction of the fracture ";
Step 7: design fracture inside-fixture is placed in guide plate;
On computers, " fracture inside-fixture merging steering tool " is designed, which can only pass through unique side Position combines " the reset Kirschner wire after the reduction of the fracture ", and only unique orientation is combined with " inner fixing device ";
Step 8: all steering tools are prepared by 3D printing, and test:
Above-mentioned all steering tools are prepared by 3D printing, and are tested, if qualified, are carried out disinfection, It is spare, later practical operation is carried out according to the model of above-mentioned design.
Further, in the step 1, CT data are DICOM format, and software is Mimisc softwares.
Compared with the existing technology, beneficial effects of the present invention are:
The method of the present invention designs fracture operation scheme by virtual technology, and by by the auxiliary of 3D printing tool, helps Surgical procedure whole process is carried out by Design scheme, to ensure personalized precisely medical treatment, is existed to solve the operation at present A series of deficiencies, reduce operating time, reduce wound and complication, reduce X-ray examination in art, be conducive to protect doctor and trouble Person.
Generally speaking, exactly make surgical procedure faster, it is more accurate, safer:
1. it is preoperative, it can be visually known the details of fracture of calcaneus, and accomplish to have at fingertips to fracture situation, in the heart There is number;
2. it is preoperative, surgery planning, simulation operation intuitively can be repeatedly carried out, so that it is determined that in fracture of calcaneus closed reduction The scheme of fixed operation;
3. it is preoperative, interior fixed type, model can be determined substantially;
4. in art, it is no longer necessary to which row small notch exposes subtalar joint face;
5. in art, by the guiding of guide plate, the reset for completing fracture can be settled at one go by preoperative plan;
6. in art, by the guiding of guide plate, preoperative plan precisely installation inner fixing device can be pressed;
7. in art, by the guiding of guide plate, installation inner fixing device can be settled at one go by preoperative plan;
8. in art, use is reduced even without using X-ray examination in art;
Operating time is reduced, surgical injury is reduced, complication is reduced, reduces the x-ray radiation of medical worker.
Description of the drawings
Fig. 1 is fixed schematic diagram in the method for the present invention.
Fig. 2 be the method for the present invention in Kirschner wire be bonded armor combination schematic diagram.
Fig. 3 is structural schematic diagram after present invention fitting armor wearing.
Fig. 4 is the structural schematic diagram of steering tool before the reduction of the fracture of the present invention.
The side view of steering tool before Fig. 5 reduction of the fracture of the present invention.
Specific implementation mode
Technical solution of the present invention is described in further detail with reference to the accompanying drawings and detailed description:
As shown in Figs. 1-5,
Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool.Including:Preoperative computer Design and steering tool make and two large divisions is implemented in operation, wherein preoperative Computer Design and steering tool make specific step Suddenly it is:
Step 1: modeling, analysing patient's condition:
The preoperative fracture of calcaneus CT data of patient are imported into computer, " 3 D stereo fracture is obtained after being rebuild by software Digital model ", and analysing patient's condition;
Step 2: the simulation reduction of the fracture:
By " 3 D stereo fracture of calcaneus digital model ", Magics software implementations " fracture block reset " are used on computers
Step 3: determining the position of inner fixing device:
By the installation of " the fracture of calcaneus digital model after reset " of computer inner simulation inner fixing device, test repeatedly Card, until completing Surgery simulation;
Step 4: after determining the reduction of the fracture, the position of Kirschner wire is resetted:
" the fracture of calcaneus digital model after reset " inner insertion is resetted into Kirschner wire, main purpose be make it is several with Sclerite forms rigidly connected direction object, is fixed temporarily and plays the role of label;
Step 5: before determining the reduction of the fracture, the position of Kirschner wire is resetted:
By " the fracture of calcaneus digital model after reset " of having connected reset Kirschner wire inner each sclerite by step Position in one in " 3 D stereo fracture of calcaneus digital model " is restored, and is maintained to reset Kirschner wire and is corresponded to sclerite Relative position is constant, resets the orientation that Kirschner wire is placed in before obtaining the reduction of the fracture;
Step 6: steering tool before the design reduction of the fracture:
On computers, design " reset before steering tool ", the steering tool can only be incorporated in by unique orientation with Around bone, and only unique orientation is combined with " the reset Kirschner wire before the reduction of the fracture ";
Step 7: design fracture inside-fixture is placed in guide plate:
On computers, " fracture inside-fixture merging steering tool " is designed, which can only pass through unique side Position combines " the reset Kirschner wire after the reduction of the fracture ", and only unique orientation is combined with " inner fixing device ";
Step 8: all steering tools are prepared by 3D printing, and test:
Above-mentioned all steering tools are prepared by 3D printing, and are tested, if qualified, are carried out disinfection, It is spare, later practical operation is carried out according to the model of above-mentioned design.
Further, in the step 1, CT data are DICOM format, and software is Mimisc softwares.
Experimental example 1:
The preoperative Computer Design of first part and steering tool make
1, it models, analysing patient's condition:
The CT data (DICOM format) of the preoperative fracture of calcaneus of patient are imported into computer, are rebuild by Mimisc softwares " the 3 D stereo fracture digital model " for obtaining fracture of calcaneus afterwards, fully understands fracture situation, analysing patient's condition, it is known that left calcaneum Comminuted fracture, 18 ° of calcaneum varus, the angles Bohler are reduced to 11 °, subtalar joint face and calcaneocuboid articulation all out-of-flatnesses.
2, the reduction of the fracture is simulated:
" 3 D stereo fracture digital model " is saved as into SLT formats, carries out illness analysis with Magics softwares, and counting Implement " fracture block reset " on calculation machine, after reset, calcaneum varus is corrected, and the angles Bohler are restored to 32 °, subtalar joint face and Calcaneocuboid articulation all restores smooth.
3, fixed position in determining:
On computer, in the installation of " the fracture digital model after reset " inner simulation inner fixing device, after verifying repeatedly It learns, needs 3 inner fixing devices, be with one piece of long 36mm respectively, the os integumentale screw ecto-entad of diameter 5mm is in the past away under Articular surface fixes subtalar joint horizontal through two layers of cortex, from tuberosity of calcaneus dead astern one piece of long 76mm, the sky of diameter 6.5mm Heart nail string arrives calcaneocuboid articulation, from the hollow nail string of tuberosity of calcaneus lower section one piece of long 56mm, diameter 6.5mm to middle subtalar joint.
4, after determining the reduction of the fracture, the position of Kirschner wire is resetted:
On computer, " the fracture digital model after reset " inner insertion is resetted into Kirschner wire, by making repeated attempts, is found It is suitable that 1 3.0 Kirschner wire is respectively placed on the outside of the tuberosity of calcaneus back lower place, sustentaculum of talus and middle-range inferior articular surface, this 3 kirschner Needle forms rigid connection with corresponding sclerite, can not only be resetted for holding sclerite, but also can be used for guiding fracture Block orientation.
5, before determining the reduction of the fracture, the position of Kirschner wire is resetted:
On computer, " the fracture digital model after reset " the inner each sclerite for resetting Kirschner wire will be placed in and pressed Fracture front position is restored, and maintains the relative position for resetting Kirschner wire and corresponding sclerite constant, is obtained multiple before the reduction of the fracture The orientation of position Kirschner wire merging
6, design resets Kirschner wire implantation guide plate:
On computer, design resets Kirschner wire and is implanted into guide plate, which designs armor shape, can only pass through unique orientation It is incorporated in ankle and foot on the right side of patient, and resets Kirschner wire and only has unique orientation to pass through the guide plate by under after tuberosity of calcaneus Corresponding sclerite is entered on the outside of side, sustentaculum of talus and middle-range inferior articular surface.
After designing satisfied, Kirschner wire implantation guide plate will be resetted and made with 3D printing method, sterilized after repeated examinations It is spare.
7, design inside-fixture is implanted into guide plate:
It on computer, designs " inside-fixture implantation guide plate ", which can only be combined by unique orientation resets kirschner Needle, and possess the guiding parts in 3 each unique orientation, guide the merging of 1 piece of os integumentale screw and 2 pieces of hollow nails.
After designing satisfied, inside-fixture implantation guide plate is made with 3D printing method, is sterilized after repeated examinations standby With.
Second part operation is implemented
8, the guiding of installation guide plate penetrates reset Kirschner wire:
Armor formula is resetted into Kirschner wire implantation guide plate and is installed to ankle and foot on the right side of patient, at this time one and only one posture energy So that guide plate is installed in place, later by 3 pilot holes with the deep function of limit, 3 piece of 3.0 Kirschner wire is implanted into
9, it removes guide plate and utilizes Kirschner wire reseting fracture:
" Kirschner wire implantation guide plate " is removed, and retains reset Kirschner wire, is resetted later by preoperative plan
10, installation fracture fixation object is placed in guide plate, guides the reduction of the fracture using it, and maintain the reduction of the fracture temporarily using it Position:
Installation " fracture fixation object is placed in guide plate ", is resetted by preoperative planning, is utilized " fracture fixation object is placed in guide plate " With the uniqueness of " resetting Kirschner wire " relative position, sclerite is precisely resetted, utilizes its interim maintenance reduction of the fracture position It sets
11, guiding installation os integumentale screw and hollow nail:
By the guide of guide plate, 1 piece of os integumentale screw (fixed subtalar joint, diameter 5mm, long 36mm) and 2 pieces are installed in guiding (1 piece is beaten to calcaneocuboid articulation, diameter 6.5mm, long 76mm hollow nail;Another 1 piece is beaten to subtalar joint, diameter 6.5mm, long 56mm).
Os integumentale screw guiding parts is double sleeve designs, is first bored with small sleeve guiding and uses up into drilling, then with big sleeve Guide the installation of os integumentale screw.
Hollow nail guiding parts is also double sleeve designs, first guides the implantation of guide pin with small sleeve, then with big sleeve steering The installation of hollow nail.
12, guide plate and Kirschner wire are removed, operation is completed:
After checking fracture and the satisfaction of interior fixed position under C arms, guide plate and Kirschner wire are removed, operative incision is rinsed, stitches skin, Pressure dressing completes operation.
The above description is merely a specific embodiment, but scope of protection of the present invention is not limited thereto, any The change or replacement expected without creative work, should be covered by the protection scope of the present invention.Therefore, of the invention Protection domain should be determined by the scope of protection defined in the claims.

Claims (2)

1. fixing householder method in the fracture of calcaneus closed reduction based on digitlization 3D printing tool, which is characterized in that including such as Lower step:
Step 1: modeling, analysing patient's condition:
The preoperative fracture of calcaneus CT data of patient are imported into computer, " 3 D stereo fracture number is obtained after being rebuild by software Change model ", and analysing patient's condition;
Step 2: the simulation reduction of the fracture:
By " 3 D stereo fracture of calcaneus digital model ", Magics software implementations " fracture block reset " are used on computers
Step 3: determining the position of inner fixing device:
By the installation of " the fracture of calcaneus digital model after reset " of computer inner simulation inner fixing device, verify repeatedly, Until completing Surgery simulation;
Step 4: after determining the reduction of the fracture, the position of Kirschner wire is resetted:
" the fracture of calcaneus digital model after reset " inner insertion is resetted into Kirschner wire, main purpose is to make several and fracture Block forms rigidly connected direction object, is fixed temporarily and plays the role of label;
Step 5: before determining the reduction of the fracture, the position of Kirschner wire is resetted:
By " the fracture of calcaneus digital model after reset " of having connected reset Kirschner wire inner each sclerite by step 1 Position in " 3 D stereo fracture of calcaneus digital model " is restored, and is maintained to reset Kirschner wire and is corresponded to the opposite of sclerite Position is constant, resets the orientation that Kirschner wire is placed in before obtaining the reduction of the fracture;
Step 6: steering tool before the design reduction of the fracture:
On computers, design " steering tool before resetting ", which can only be incorporated in calcaneum week by unique orientation It encloses, and only unique orientation is combined with " the reset Kirschner wire before the reduction of the fracture ";
Step 7: design fracture inside-fixture is placed in guide plate:
On computers, " fracture inside-fixture merging steering tool " is designed, which can only pass through unique orientation knot It closes " the reset Kirschner wire after the reduction of the fracture ", and only unique orientation is combined with " inner fixing device ";
Step 8: all steering tools are prepared by 3D printing, and test:
Above-mentioned all steering tools are prepared by 3D printing, and are tested, if qualified, are carried out disinfection, it is spare, Later practical operation is carried out according to the model of above-mentioned design.
2. according to the method described in claim 1, it is characterized in that, in the step 1, CT data are DICOM format, software For Mimisc softwares.
CN201810281382.8A 2018-04-02 2018-04-02 Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool Expired - Fee Related CN108720923B (en)

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CN113520612A (en) * 2020-04-14 2021-10-22 昆明医科大学附属口腔医院(云南省口腔医院) Automatic manufacturing method and device for soft tissue positioning guide plate

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