CN108720923B - 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 PDFInfo
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- CN108720923B CN108720923B CN201810281382.8A CN201810281382A CN108720923B CN 108720923 B CN108720923 B CN 108720923B CN 201810281382 A CN201810281382 A CN 201810281382A CN 108720923 B CN108720923 B CN 108720923B
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- A—HUMAN NECESSITIES
- 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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- B—PERFORMING OPERATIONS; TRANSPORTING
- 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
- B33Y10/00—Processes of additive manufacturing
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- B—PERFORMING OPERATIONS; TRANSPORTING
- 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
- B33Y50/00—Data acquisition or data processing for additive manufacturing
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- B—PERFORMING OPERATIONS; TRANSPORTING
- 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
- B33Y80/00—Products made by additive manufacturing
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- A—HUMAN NECESSITIES
- 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
- A61B2034/108—Computer aided selection or customisation of medical implants or cutting guides
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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
Technical field
The present invention relates to 3D printings and reduction of the fracture fixed network, in particular to the calcaneum based on digitlization 3D printing tool
Householder method is fixed in fracture closed reduction.
Background technique
Fracture closed reduction internal fixation: referring to and fracture first carried out 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 and not exposing 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 on computers, determines optimal operation plan.
3D printing: being 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 the 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 patient's technical requirements to close reset, it is easy to cause reset dissatisfied, fixed dissatisfied, 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
Operation thinking fixed in the completely new fracture of calcaneus closed reduction of one kind is invented by development, this team.
It solves:
1. it is preoperative, the details of fracture of calcaneus cannot be intuitively understood;
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 row miniature incision exposure subtalar joint face;
5. in art, it is necessary to could be bright by real time inspection (such as: subtalar joint miniature incision, repeatedly X-ray examination in art)
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 verifying could install inner fixing device.The problems such as.
Summary of the invention
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 carry out by Design scheme, to ensure personalized precisely medical treatment.
In order to achieve the above objectives, the technical solution of the present invention is as follows:
Householder method is fixed in fracture of calcaneus closed reduction based on digitlization 3D printing tool.It include: preoperative computer
Two large divisions is implemented in design and steering tool production and operation, wherein preoperative Computer Design and the specific step of steering tool production
Suddenly are as follows:
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 rebuilding 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 ", on computers with Magics software implementation " fracture block reset "
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: resetting the position of Kirschner wire after determining the reduction of the fracture:
" the fracture of calcaneus digital model after reset " inner insertion is resetted into Kirschner wire, main purpose be production it is several with
Sclerite forms rigidly connected direction object, is fixed temporarily and plays the role of label;
Step 5: resetting the position of Kirschner wire before determining the reduction of the fracture:
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 front of 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, practical operation is carried out according to the model of above-mentioned design later.
Further, in the step 1, CT data are DICOM format, and software is Mimisc software.
Compared with the existing technology, the invention has the benefit that
The method of the present invention designs fracture operation scheme, and the auxiliary that will pass through 3D printing tool by virtual technology, 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 quasi-, safer:
1. it is preoperative, the details of fracture of calcaneus can be intuitively understood, 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 row small notch exposure subtalar joint face;
5. in art, by the guidance of guide plate, the reset for completing fracture can be settled at one go by preoperative plan;
6. in art, by the guidance of guide plate, can precisely install inner fixing device by preoperative plan;
7. in art, by the guidance 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.
Detailed description of the invention
Fig. 1 is schematic diagram fixed 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 embodiment
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.It include: preoperative computer
Two large divisions is implemented in design and steering tool production and operation, wherein preoperative Computer Design and the specific step of steering tool production
Suddenly are as follows:
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 rebuilding 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 ", on computers with Magics software implementation " fracture block reset "
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: resetting the position of Kirschner wire after determining the reduction of the fracture:
" the fracture of calcaneus digital model after reset " inner insertion is resetted into Kirschner wire, main purpose be production it is several with
Sclerite forms rigidly connected direction object, is fixed temporarily and plays the role of label;
Step 5: resetting the position of Kirschner wire before determining the reduction of the fracture:
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 front of 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, practical operation is carried out according to the model of above-mentioned design later.
Further, in the step 1, CT data are DICOM format, and software is Mimisc software.
Experimental example 1:
The preoperative Computer Design of first part and steering tool production
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 software
" 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 angle Bohler is 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 format, carries out illness analysis with Magics software, and counting
Implement " fracture block reset " on calculation machine, after reset, calcaneum varus is corrected, and the angle Bohler is 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 is horizontal through the fixed subtalar joint of 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 subtalar joint face, this 3 kirschner
Needle and corresponding sclerite form rigid connection, can not only be resetted for holding sclerite, but also can be used to guide 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 subtalar joint face.
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 guidance 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, 3 piece of 3.0 Kirschner wire is implanted into the pilot hole for limiting deep function by 3 later
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 temporarily maintain the reduction of the fracture using it
Position:
Installation " fracture fixation object is placed in guide plate ", is resetted by preoperative planning, utilizes " 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, guidance 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 guidance
(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 guidance and uses up into drilling, then with big sleeve
Guide the installation of os integumentale screw.
Hollow nail guiding parts is also double sleeve design, first with the implantation of small sleeve guidance guide pin, then with big sleeve steering
The installation of hollow nail.
12, guide plate and Kirschner wire are removed, operation is completed:
After checking that fracture and interior fixed position are satisfied under C arm, 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 scope should be determined by the scope of protection defined in the claims.
Claims (2)
1. fixing-aid device in the fracture of calcaneus closed reduction based on digitlization 3D printing, which is characterized in that the system of the device
It is standby to include the following steps:
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 rebuilding 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 ", on computers with Magics software implementation " fracture block reset "
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: resetting the position of Kirschner wire after determining the reduction of the fracture:
" 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: resetting the position of Kirschner wire before determining the reduction of the fracture:
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 front of 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,
Practical operation is carried out according to the model of above-mentioned design later.
2. the apparatus according to claim 1, which is characterized in that in the step 1, CT data are DICOM format, software
For Mimisc software.
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