CN109087387B - Individuation 3D printing multifunctional artificial eye seat and preparation method thereof - Google Patents
Individuation 3D printing multifunctional artificial eye seat and preparation method thereof Download PDFInfo
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Classifications
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B29—WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE IN GENERAL
- B29D—PRODUCING PARTICULAR ARTICLES FROM PLASTICS OR FROM SUBSTANCES IN A PLASTIC STATE
- B29D11/00—Producing optical elements, e.g. lenses or prisms
- B29D11/02—Artificial eyes from organic plastic material
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/14—Eye parts, e.g. lenses, corneal implants; Implanting instruments specially adapted therefor; Artificial eyes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2240/00—Manufacturing or designing of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
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Abstract
The invention discloses a personalized 3D printing multifunctional artificial eye seat and a preparation method thereof. The surface of the artificial eye seat is provided with a porous structure, the holes of the porous structure are round holes, the porous structure on the surface is arranged in a gradient manner, and the holes in the porous structure are arranged at intervals on the surface of the artificial eye seat; the artificial eye seat is provided with a special structure for fixing four extraocular muscles, the special structure is two mutually communicated elliptical holes which are arranged close to each other, the preset suture lines on the extraocular muscles pass through the two elliptical holes and are mutually knotted and fixed at the mutually communicated positions, and the suture lines are arranged at four intersection points of 30 degrees of north latitude of the artificial eye seat and 0 degrees, 90 degrees, 180 degrees and 270 degrees of longitude respectively, and the artificial eye seat is directly printed by a digital model of the artificial eye seat by utilizing a 3D printing technology. The invention has high matching degree between the artificial eye seat and the healthy eye, and reduces the exposure and infection risk after the implantation of the eye seat; has good activity, achieves good simulation effect by matching with the individuation eye-prosthesis tablet, and has good clinical application value.
Description
Technical Field
The invention relates to a medical material and a preparation method thereof, in particular to a personalized 3D printing multifunctional artificial eye seat and a preparation method thereof.
Background
The eyeball excision is the final surgical treatment scheme for treating absolute glaucoma, severe eyeball fracture injury and intraocular malignant tumor at present, but the permanent vision loss, upper eyelid collapse and orbital depression caused by postoperative eyeball deficiency bring heavy mental and psychological burden to patients. The eye seat implantation method is selected to implant the proper artificial eye seat to make up for the loss of orbital contents and wear the proper artificial eye piece, so that the eye seat implantation method is an ideal treatment scheme for repairing the eyeball loss and restoring the facial appearance.
Most of clinically used eye seats are spherical eye seats with fixed shapes, and individual selection cannot be performed according to the characteristics of the eye sockets of patients. At present, the main reasons for the eyeball excision operation are eye trauma, and complicated eye trauma patients often incorporate orbital fracture, orbital soft tissue contusion, scar contracture deformity after sharp cutting injury and the like. Therefore, according to the characteristics of the bone structure of the orbit of the patient and the soft tissue structure in the orbit, the personalized artificial eye seat is designed and implanted into the orbit of the patient, so that the defect of the content of the affected orbit can be compensated as much as possible, the matching with the healthy orbit is achieved, and the facial appearance of the patient can be restored to the greatest extent.
The 3D Printing (3D Printing) technology, also called rapid prototyping (Rapid Prototyping and Manufacturing, RP or RP & M for short), is a new technology that changes the traditional processing method of "material removal" into the processing method of "material addition". 3D printing technology has been developed and widely used worldwide since it was first proposed in 1987. The method can quickly, high-accurately and individually manufacture the computer model and CT scanning data into the implant with any shape and structure. Therefore, by adopting the advanced analysis and processing technology of digital medical images, the intraosseous structure and the intraorbital soft tissue of the orbit are measured, the imaging fine change of the soft tissue such as extraocular muscles, orbital fat and the like is accurately read, the structure and volume change of the orbit tissue are accurately reconstructed, and the accurate three-dimensional modeling and measurement of the hard tissue and the soft tissue of the orbit can be realized. The method is characterized in that 3DMed software is used as a development platform, a Graph Cut segmentation algorithm is used as a basis, a medical image segmentation method which can be applied to clinic and has a convenient interaction mode and is used for segmenting eye socket soft tissues (such as extraocular muscles, eye socket fat and the like) is designed and constructed, visual three-dimensional reconstruction and volume measurement of the eye socket bone tissues, the extraocular muscles, the intra-ocular fat and the like can be carried out, data analysis and conversion are carried out on the basis, an individuation eye socket digital model with the most suitable eye socket size and shape is designed, and the porous eye socket is directly printed by using a 3D printing rapid prototyping technology.
On the other hand, eye socket exposure, infection is the most common complication after an eye socket implantation operation, and insufficient vascularization of an eye socket is the main cause of eye socket infection, exposure. After the porous eye seat is implanted, the process of the new blood vessel and the fibrous connective tissue penetrating from the periphery to the inside along the porous pore canal is the vascularization of the eye seat. The vascularization efficiency of the ocular insert material is not only related to the ocular insert material composition, but also to the tunnel penetration and tunnel microstructure of the porous ocular insert. Research shows that the internal pore size, morphology and arrangement mode of the porous scaffold material can directly influence the behaviors of cell adhesion, proliferation, migration and the like. The weight of the normal eyeball is generally 7 g, the weight of the artificial eye piece is about 2g, the ideal artificial eye seat weight is lower than 5 g, and the density is lower than 1.2g/cm 3 Therefore, the higher porosity can effectively reduce the weight of the artificial eye seat, and is beneficial to fully keeping the mobility of the artificial eye. By means of 3D printing technology, the performance of complete penetration and high porosity of the internal pore canal of the porous seat is ensured. The traditional porous bracket manufacturing method is mainly in a decrement manufacturing mode, mainly comprises an organic foam dipping method, a freeze drying method, a pore-forming agent method, a gas foaming method, a thermal induced phase separation method and the like, and has the defects of complex operation, nonuniform pore diameter, poor penetrability, difficult effective control of pores and the like, while the 3D printing technology belongs to an increment manufacturing technology, and has incomparable advantages in rapid molding of the bracket, penetrability of internal pore channels and controllability of pore dimensions. The 3D printing technology can effectively solve the problems of the cooperation of the through performance of the pore canal, the adjustability of the pore canal dimension and the higher porosity, improves the biological efficacy of the porous eye seat, promotes the rapid vascularization of the eye seat, and makes the whole quality of the eye seat lighter, further improves the mobility of the eye seat, and makes the patient obtain more lifelike appearance effect.
In the surface structure design, the porous pore diameter of the surface of the traditional artificial eye seat is uniform, although the porous eye seat is beneficial to fibrous blood vessel ingrowth, the porous surface is relatively rough, and can generate cutting and friction effects on conjunctiva covered on the surface of the porous eye seat, and the design of the gradient front surface pore diameter can greatly reduce the front surface roughness of the artificial eye seat, effectively reduce the abrasion of the artificial eye seat on conjunctiva tissues on the surface of the artificial eye seat and reduce the incidence rate of eye seat exposure. In addition, conventional prosthetic eye seat surfaces also lack sites for extraocular muscle attachment. In order to fix the extraocular muscle on the artificial eye seat, a common method is to wrap the artificial eye seat by using a wrapping material (such as Moke, dermal tissue, decellularized cornea matrix, terylene surgical repair material and the like), and then suture and fix the extraocular muscle on the wrapping material, but the wrapping material is compact and is unfavorable for vascular tissue ingrowth, thereby delaying vascularization of the eye seat, and wrapping treatment is performed in the implantation of the eye seat, so that the operation is complicated, the operation time is prolonged, additional tissue damage is caused, postoperative recovery is unfavorable, and the hidden trouble of postoperative infection is also increased. Therefore, a special structure for the attachment of the extraocular muscles is designed in advance on the surface structure design, and the artificial eye seat which is designed in an individual way is realized by means of the 3D printing technology, so that the extraocular muscles can be fixed in an operation simply and conveniently, the operation time is shortened, the tissue injury is reduced, and the activity of the eye seat is effectively improved.
Disclosure of Invention
In order to overcome the defect that the conventional artificial eye seat in clinic can not be selected individually according to the characteristics of a patient, the invention provides the individualized 3D printing multifunctional artificial eye seat and the preparation method thereof, which can effectively improve the biological performance of the artificial eye seat, promote the rapid vascularization of the eye seat, increase the matching degree of a patient side and a healthy side, improve the activity of the artificial eye seat, finally improve the appearance of the patient and improve the life quality of the patient.
The invention adopts 3D printing technology to prepare the individual porous eye seat. The artificial eye seat with different functions and purposes is formed by regulating and controlling the overall shape, the surface structure and the internal pore canal structure of the porous eye seat. The artificial eye seat has the characteristic of individuation, and the shape and the size of the corresponding artificial eye seat are designed by calculating the orbital bone structure and the soft tissue structure of a patient and combining with contralateral eye care. Meanwhile, according to different performance requirements, a digital model containing a rectus stitching fixing structure of the artificial eye seat, a gradient surface structure and a precise internal pore canal structure is designed on a digital development platform, and finally the individualized porous artificial eye seat with accurate appearance and controllable pores is realized by means of a 3D printing technology.
The invention adopts the specific technical scheme that:
1. 3D prints multi-functional artificial eye seat:
the surface of the artificial eye seat is provided with a porous structure, the porous structure on the surface is arranged in a gradient way, and holes in the porous structure are arranged at intervals on the surface of the artificial eye seat. The surface having a porous structure means that the surface is arranged with a porous structure.
The porous structure on the surface of the artificial eye seat is arranged in a gradient way, and specifically comprises the following steps: the aperture of each hole in the range of 45-90 degrees of north latitude on the front surface of the artificial eye seat is gradually increased, so that the smoothness of the front surface is improved, the cutting and friction effects on conjunctiva covered by the front surface are reduced, and the exposure risk of the eye seat is reduced.
The holes of the porous structure are round holes.
The artificial eye seat is provided with a special structure for fixing four extraocular muscles, the special structure is two elliptical holes which are communicated with each other and are arranged close to each other, the extraocular muscles are attached to the elliptical holes, the preset suture lines on the extraocular muscles penetrate through the two elliptical holes and are fixed by knotting each other at the communicated positions, and the special structure is arranged at four intersection points of 30 degrees of north latitude of the artificial eye seat and 0 degree, 90 degrees, 180 degrees and 270 degrees of longitude respectively, so that the four extraocular muscles are fixed at the four intersection points respectively.
The porous structure of the artificial eye seat is completely communicated in the artificial eye seat through an internal pore canal, and the porous structure is regulated according to the requirements of tissue growth and vascularization.
The artificial eye seat is prepared by a 3D printing technology, and the 3D printing technology is one or a combination of a plurality of grouting 3D printing, thermoplastic 3D printing, lamination 3D printing and inkjet 3D printing.
The synthetic material of the artificial eye seat is one or a mixture of more of hydroxyapatite, calcium phosphate, calcium silicate, calcium carbonate, alumina, bioactive glass, glass ceramic, polyethylene, polymethyl methacrylate, polytetrafluoroethylene and silicone rubber.
2. A preparation method of a 3D printing multifunctional artificial eye seat comprises the following steps:
the artificial eye seat is formed by directly printing an artificial eye seat digital model containing information such as the whole shape and size, a surface structure, an internal pore canal structure and the like of the artificial eye seat by using a 3D printing technology through model conversion.
The shape and size of the artificial eye seat are constructed according to the characteristics of the intraorbital bone structure and the intraorbital soft tissue structure of a patient and are combined with the orbital structure of the contralateral eye.
The artificial eye seat digital model is a Digital Imaging and Communication (DICOM) data of the orbital bone structure and the intraorbital soft tissue of the patient suffering from the eye and the healthy eye obtained through CT scanning, and the Digital Imaging and Communication (DICOM) data of the orbital bone structure and the intraorbital soft tissue structure are segmented, modeled and analyzed in a three-dimensional mode, so that an individual digital model is obtained.
The method for specifically constructing the artificial eye seat digital model comprises the following steps of:
1) Performing volume data clipping on medical Digital Imaging and Communication (DICOM) data obtained by CT scanning of a patient eye socket to obtain an eye socket local region of interest, and selecting medical Digital Imaging and Communication (DICOM) data of the eye socket local region of interest to form eye socket local volume data; the partial orbital data include three types of data including unilateral orbital bones, extraocular muscles, intra-orbital fat and connective tissues, wherein the orbital bones belong to an orbital bone structure, and the extraocular muscles, the intra-orbital fat and the connective tissues belong to intra-orbital soft tissues.
2) The method comprises the steps of regarding the orbit local volume data as a set of pixels to construct an image, defining P as an image formed by all pixel sets corresponding to the orbit local volume data, and E as a set formed by any two adjacent pixels;
and then, roughly marking four tissue areas on the image P according to three classes of classification of the partial orbit data, wherein each tissue area is marked with one piece, in particular, one orbital bone area, one extraocular muscle area, one intra-orbital fat and connective tissue area and one non-concerned area, and the non-concerned area belongs to any area except the orbital bone area, the extraocular muscle area, the intra-orbital fat and connective tissue area.
3) For each of an orbital bone region, an extraocular muscle region, an intra-orbital fat and connective tissue region as a subject region, the following procedure was adopted:
3.1 Taking the object area as a foreground, taking other three areas except the object area as a background, clustering pixels in the foreground and the background into two classes by a K-means method through gray values, wherein the clustering centers of the two classes are expressed as two setsAnd-> And->Respectively representing the centers of corresponding classes of foreground and background;
3.2 For pixel p, the gray energy term is calculated using its distance relationship from the foreground-background cluster center using the following formula:
wherein E is 1 (x p ) Representing gray energy term, x p A judgment value, x, representing whether the current pixel belongs to the foreground or the background p E {0,1}, when x p =1, then the current pixel p belongs to the foreground, when x p =0, then the current pixel p belongs to the background; k represents a weight parameter and,representing the minimum distance of pixel p from the cluster center of the foreground corresponding class in color space, +.>Representing the minimum distance of the pixel p from the clustering center of the corresponding class of the background in the color space; m represents foreground, B represents background, U represents unknown region;
minimum distanceAnd->The following formula is used for calculation:
wherein V (p) represents the gray value of pixel p, and n and m represent the foreground and background labels, respectively;
as can be seen from the above formula, pixels close to the foreground satisfy E 1 (1)<E 1 (0) The optimal solution of the formula is such that x p =1, i.e. classified as foreground.
3.3 For pixel p and pixel q, the gradient energy term E is calculated using the following formula with the contrast of the two pixels p and q expressed as N (p, q) 2 The larger the gradient energy term, the smaller the corresponding energy, i.e. the least cost of being segmented at the image boundary:
wherein V (p) represents the gray value of pixel p, V (q) represents the gray value of pixel q, and n and m represent the foreground, respectivelyAnd background, x p A judgment value, x, indicating whether the current pixel p belongs to the foreground or the background q A judgment value indicating whether the current pixel q belongs to the foreground or the background;
3.4 Calculating the total energy term E (x) with the following formula:
wherein, alpha represents a weight coefficient, E represents a set formed by any two adjacent pixels;
the present invention regards the segmentation of object regions as a pair x p Solving a marker problem of (1) to establish a solution to a segmentation problemWhich translates into a problem of minimal energy.
3.5 In the segmentation process, sequentially selecting one tissue region from the four tissue regions as a foreground, segmenting the image P by using other tissue regions as a background to obtain segmentation results, and finally splicing and displaying the segmentation results correspondingly obtained by the tissue regions to obtain segmentation regions of different tissues;
4) After finishing the segmentation areas of the orbital bones, the extraocular muscles, the intra-orbital fat and the connective tissues, the three-dimensional models of different tissues are established and used as the artificial eye seat digital model.
According to the characteristic of the orbit of the affected eye and combining the shape and the size of the artificial eye seat designed by the contralateral eye, an artificial eye seat digital model containing the shape, the size, the surface structure and the internal pore canal information of the artificial eye seat is constructed, and the individual artificial eye seat is directly printed by utilizing a 3D printing technology.
The design of the front surface of the eye seat is smooth, so that the exposure and infection risk after the implantation of the eye seat can be reduced; meanwhile, the artificial eye seat fixes four rectus muscles in situ, has good activity, can achieve the simulation effect by being matched with an individualized artificial eye piece, and has good clinical application value.
The invention has the beneficial effects that:
the artificial eye seat is designed in an individuation mode according to the bone structure and the soft tissue structure of the orbit on the affected side and the healthy side of the patient, so that the matching degree of the affected eye and the healthy eye is high, the defect of the orbit volume is effectively supplemented, and the appearance of the patient is improved.
The artificial eye seat adopts a 3D printing technology, realizes the controllable design of the gradient pore and internal pore structure of the front surface of the artificial eye seat surface structure, reduces the roughness of the front surface of the eye seat, promotes the rapid vascularization of the eye seat, and can effectively reduce the exposure and infection risks of the eye seat.
The artificial eye seat has a specially designed extraocular muscle fixing site, so that extraocular muscles can be conveniently sutured on the eye seat, and the activity of the eye seat is improved. Meanwhile, the 3D printed high-porosity artificial eye seat is lighter in overall mass, and can further improve the mobility of the eye seat, so that a patient can obtain a more lifelike appearance effect.
Drawings
FIG. 1 is a schematic perspective view of an artificial eye seat according to the present invention;
FIG. 2 is a schematic top view of the artificial eye seat of the invention;
FIG. 3 is a schematic diagram showing the process of three-dimensional volume data clipping for the orbital region of interest according to example 1 according to the preparation method of the invention;
FIG. 4 is a diagram showing an example of coarse markers before orbit soft tissue segmentation according to example 1 of the present invention;
FIG. 5 is a three-dimensional block diagram example of an individualized prosthetic eye seat and orbital soft tissue according to embodiment 1 of the invention;
FIG. 6 is a graph showing evaluation of vascularization performance of an experimental eye seat for animals according to example 2 of the present invention;
FIG. 7 is a graph showing the activity performance evaluation of the experimental eye seat for animals according to example 2 of the present invention.
Detailed Description
The invention is further described below with reference to the drawings and examples.
As shown in fig. 1 and 2, the surface of the artificial eye seat 1 is provided with a porous structure 2, the holes of the porous structure are round holes, the porous structure 2 on the front surface is arranged in a gradient manner, and the holes in the porous structure 2 are arranged at intervals on the surface of the artificial eye seat.
As shown in fig. 2, the porous structure of the surface of the artificial eye seat is arranged in a gradient manner, specifically: the aperture of each hole in the range of 45-90 degrees of north latitude on the front surface of the artificial eye seat is gradually increased, so that the smoothness of the front surface is improved, the cutting and friction effects on conjunctiva covered by the front surface are reduced, and the exposure risk of the eye seat is reduced.
As shown in fig. 1, a special structure 3 for fixing four extraocular muscles is arranged on the artificial eye seat 1, the special structure 3 is two elliptical holes which are mutually communicated and are arranged close to each other, the extraocular muscles are attached to the elliptical holes, a suture preset on the extraocular muscles passes through the two elliptical holes and is mutually knotted and fixed at the mutually communicated positions, and the special structure is arranged at four intersection points of 30 degrees of north latitude of the artificial eye seat and 0 degrees, 90 degrees, 180 degrees and 270 degrees of longitude respectively, so that the four extraocular muscles are respectively fixed at the four intersection points, and the four special structures are used for respectively fixing the four extraocular muscles at the positions of the surface of the eye seat.
The porous structure 2 of the artificial eye seat 1 is completely communicated in the artificial eye seat through an internal pore canal, and the porous structure is regulated according to the requirements of tissue growth and vascularization. The pore canal dimensions are respectively 200um, 300um, 400um, 500um, 600um, 700um and 800um. The pore canal forms are respectively round holes, square holes, triangular holes and nearly spherical holes, and the porosity is 70-85%.
The invention forms the artificial eye seat with different functions and purposes by regulating and controlling the overall shape, the surface structure and the internal pore canal structure of the porous eye seat.
Embodiments of the invention are as follows:
example 1
The artificial eye seat 1 is directly printed by a digital model of the artificial eye seat by using a 3D printing technology.
The artificial eye seat digital model is a Digital Imaging and Communication (DICOM) data of the orbital bone structure and the intraorbital soft tissue of the patient suffering from the eye and the healthy eye obtained through CT scanning, and the Digital Imaging and Communication (DICOM) data of the orbital bone structure and the intraorbital soft tissue structure are segmented, modeled and analyzed in a three-dimensional mode, so that an individualized digital model is constructed.
The 3DMed medical image processing and analyzing system is taken as a development platform, and an image segmentation algorithm is taken as a core for development, so that an interactive image segmentation method is constructed.
The method for specifically constructing the artificial eye seat digital model comprises the following steps:
1) Performing volume data clipping on medical Digital Imaging and Communication (DICOM) data obtained by CT scanning of the eye sockets of a patient to obtain eye sockets and eye-strengthening areas, and selecting the medical Digital Imaging and Communication (DICOM) data of the eye sockets and the eye-strengthening areas to form the eye socket local volume data; the partial orbital data include three types of data including unilateral orbital bones, extraocular muscles, intra-orbital fat and connective tissues, wherein the orbital bones belong to an orbital bone structure, and the extraocular muscles, the intra-orbital fat and the connective tissues belong to intra-orbital soft tissues.
The process of three-dimensional volume data cropping of the region of interest of the orbit is shown in fig. 3, which is a volumetric data cropping interface of the CT image of the orbit of the patient after the left-side sphere removal operation. In fig. 3, the upper left corner represents a horizontal slice orbital CT image, the region indicated by the arrow is the region of interest selected and to be clipped and extracted, mainly including the left orbital bone and intra-orbital tissue, the upper right corner represents the operation interface for clipping the volume data, the lower left corner represents a coronal slice orbital CT image and the selected region of interest of the same patient, and the lower right corner represents a sagittal slice orbital CT image and the selected region of interest of the same patient, and the three slices correspond to the same clipping region.
2) The method comprises the steps of regarding the orbit local volume data as a set of pixels to construct an image, defining P as an image formed by all pixel sets corresponding to the orbit local volume data, and E as a set formed by any two adjacent pixels;
then, roughly marking four tissue areas on the image P according to three categories of the partial orbit data, wherein each tissue area is marked with one piece, in particular, one orbital bone area, one extraocular muscle area, one intra-orbital fat and connective tissue area and one non-concerned area, and the non-concerned area belongs to any area except the orbital bone area, the extraocular muscle area, the intra-orbital fat and connective tissue area;
the orbital bone region, extraocular muscle region, intra-orbital fat and connective tissue region, and Non-region of interest are denoted as "mole", "bone", "fat", "Non-region", respectively, and for any one pixel P e P, belong to the region r= { "mole", "bone", "fat", "Non-region" }.
The method comprises the steps of marking image pixels, and in particular implementation, automatically dividing the foreground and the background by simply marking the foreground and the background by using different color brushes to define seed pixels.
4 brushes are arranged for different structural areas of the eye socket CT image, wherein red represents muscle tissue, green represents soft tissue such as fat, brown represents bone-like structure and blue represents background. Taking muscle segmentation as an example, a user simply marks the eye external muscle region with a red brush, and pixels marked by the red line are defined as muscle seed pixels M of the foreground, and pixels marked by other brushes are all defined as background seed pixels B.
As shown in fig. 4, the red brush/region is muscle tissue, the green brush/region is soft tissue such as fat, and the brown brush is bone tissue/eye seat. The upper left hand corner of fig. 4 shows the marking of tissue in a CT image with brushes representing different tissue to define seed pixels, wherein the line a is the red brush for marking muscle tissue, the line B is the green brush for marking fat tissue, and the line C is the brown brush for marking bony density; the upper right corner represents the marked segmented structure, and the area A is a muscle tissue area; the lower left corner indicates the marked divided structure, the region B is the adipose tissue region, the lower right corner indicates the marked divided structure, and the region C is the artificial eye seat region having the bone mineral density.
3) For each of an orbital bone region, an extraocular muscle region, an intra-orbital fat and connective tissue region as a subject region, the following procedure was adopted:
3.1 With the object area as the foreground, divide the object areaThe other three areas outside the domain are used as the background, pixels in the foreground and the background are clustered together into two classes by a K-means method according to gray values, and the clustering centers of the two classes are expressed as two setsAnd-> And->Respectively representing the centers of corresponding classes of foreground and background;
when the extraocular Muscle region (muscule) is divided, the extraocular Muscle region is defined as a "foreground", and all other tissue regions are collectively regarded as a "background", at this time, the image is divided into two regions, namely, defined as r= { "muscule", "Non-region" }. Similarly, when the intra-orbital Fat and connective tissue region (Fat) is segmented, the intra-orbital Fat and connective tissue region is defined as "foreground", and the other tissue region is collectively regarded as "background", and is defined as r= { "Fat", "Non-region" }.
3.2 For pixel p, the gray energy term is calculated using its distance relationship from the foreground-background cluster center using the following formula:
wherein E is 1 (x p ) Representing gray energy term, x p A judgment value, x, representing whether the current pixel belongs to the foreground or the background p E {0,1}, when x p =1, then the current pixel p belongs to the foreground, when x p =0, then the current pixel p belongs to the background; k represents a weight parameter and,representing pixel p in colorMinimum distance of clustering center of spatial distance foreground corresponding class, +.>Representing the minimum distance of the pixel p from the clustering center of the corresponding class of the background in the color space; m represents foreground, B represents background, U represents unknown region, i.e. region except foreground and background;
minimum distanceAnd->The following formula is used for calculation:
wherein V (p) represents the gray value of pixel p, and n and m represent the foreground and background labels, respectively;
as can be seen from the above formula, pixels close to the foreground satisfy E 1 (1)<E 1 (0) The optimal solution of the formula is such that x p =1, i.e. classified as foreground.
3.3 For pixel p, the gradient energy term is calculated with the contrast of the two pixels p and q denoted as N (p, q) using the following formula, the larger the gradient energy term the smaller the corresponding energy, i.e. the least cost of being segmented at the image boundary:
wherein V (p) represents the gray value of pixel p, V (q) represents the gray value of pixel q, and n and m represent the labels of the foreground and the background, respectively;
3.4 Taking extraocular muscle segmentation as an example,treating it as a pair x p Where P e P. The total energy term is calculated using the following formula:
wherein, alpha represents a weight coefficient, E represents a set formed by any two adjacent pixels;
3.5 In the segmentation process, sequentially selecting one tissue region from the four tissue regions as a foreground, segmenting the image P by using other tissue regions as a background to obtain segmentation results, and finally splicing and displaying the segmentation results correspondingly obtained by the tissue regions to obtain segmentation regions of different tissues;
4) After finishing the segmentation areas of the orbital bones, the extraocular muscles, the intra-orbital fat and the connective tissues, the three-dimensional models of different tissues are established and used as the artificial eye seat digital model.
After the artificial eye seat digital model is obtained, the data of the orbital bone structure, the orbital volume, the soft tissue distribution, the volume and the like are further analyzed. Comparing the healthy eyes with the orbit and intra-orbit soft tissues of the affected eyes through Hough transformation and Fourier fitting to obtain the distribution and volume difference of the bilateral intra-orbit soft tissues, so as to obtain the proper volume size of the affected side implanted artificial eye seat (the volume of the affected side implanted artificial eye seat is the volume difference of the bilateral intra-orbit soft tissues), and designing and obtaining the shape (such as circular shape, cone shape and ellipsoid shape) of the affected side orbit inner soft tissues according to the distribution rule of the affected side orbit inner soft tissues.
As shown in fig. 5, an example of a spherical prosthetic eye seat, which is individually designed from a patient's orbit and soft tissue analysis: the right eye of the patient is the artificial eye, and the left eye is the healthy side. The left graph in fig. 5 shows the intra-orbital adipose tissue, 4 extraocular muscles, and simulated eyeball-missing volume, and the right graph in fig. 5 shows the effect of the personalized ocular insert after implantation.
5) After the digital model of the whole shape and the size design of the eye seat is completed, the digital model containing the rectus stitching fixed structure of the artificial eye seat, the gradient surface structure and the accurate internal pore canal structure is designed on the digital development platform.
6) And (3) converting the artificial eye seat digital model integrating the shape, the size, the surface structure and the internal pore canal information of the artificial eye seat into a 3D printing program, and directly printing the individual artificial eye seat by using a 3D printing technology.
Example 2: animal experiment
The 3D printed hydroxyapatite ocular stent prepared in example 1 was used as an experimental group, and the hydroxyapatite ocular stent prepared with the pore-forming agent was used as a control group, and the vascularization efficiency and the ocular motility of the ocular material were evaluated. The results are shown in FIG. 6: the density of the grown-in new blood vessels of the 3D printing hydroxyapatite artificial eye seat is higher than that of a control group (A is the control group, B is the experimental group, and the arrow shows the grown-in new blood vessels). Fig. 7 shows the range of upward, downward, left and right movement of the prosthetic eye after implantation of the prosthetic eye, showing good mobility of the prosthetic eye.
Claims (7)
1. A multifunctional artificial eye seat for 3D printing is characterized in that: the surface of the artificial eye seat (1) is provided with a porous structure (2), the porous structure (2) on the surface is arranged in a gradient manner, and all holes in the porous structure (2) are arranged at intervals on the surface of the artificial eye seat;
the artificial eye seat (1) is directly printed by a digital model of the artificial eye seat by using a 3D printing technology;
the artificial eye seat digital model is constructed in the following way:
1) Performing volume data clipping on medical digital imaging and communication data obtained by CT scanning of the patient's orbit to obtain an orbit local region of interest, and selecting the medical digital imaging and communication data of the orbit local region of interest to form orbit local volume data;
2) The method comprises the steps of regarding the orbit local volume data as a set of pixels to construct an image, defining P as an image formed by all pixel sets corresponding to the orbit local volume data, and E as a set formed by any two adjacent pixels;
then, roughly marking four tissue areas on the image P according to three classes of classification of the partial orbit data, wherein each tissue area is marked with one block, specifically, one orbit bone area, one extraocular muscle area, one intra-orbit fat and connective tissue area and one non-concerned area;
3) For each of an orbital bone region, an extraocular muscle region, an intra-orbital fat and connective tissue region as a subject region, the following procedure was adopted:
3.1 Taking the object area as a foreground, taking other three areas except the object area as a background, clustering pixels in the foreground and the background into two classes by a K-means method through gray values, wherein the clustering centers of the two classes are expressed as two setsAnd-> And->Respectively representing the centers of corresponding classes of foreground and background;
3.2 For pixel p, the gray energy term is calculated using the following formula:
wherein E is 1 (x p ) Representing gray energy term, x p A judgment value, x, representing whether the current pixel belongs to the foreground or the background p E {0,1}, when x p =1, then the current pixel p belongs to the foreground, when x p =0, then the current pixel p belongs to the background; k represents a weight parameter and,representing the minimum distance of pixel p from the cluster center of the foreground corresponding class in color space, +.>Representing the minimum distance of the pixel p from the clustering center of the corresponding class of the background in the color space; m represents foreground, B represents background, U represents unknown region;
minimum distanceAnd->The following formula is used for calculation:
wherein V (p) represents the gray value of pixel p, and n and m represent the foreground and background labels, respectively;
3.3 For pixel p and pixel q, the gradient energy term E is calculated using the following formula 2 ：
Wherein V (p) represents the gray value of pixel p, V (q) represents the gray value of pixel q, n and m represent the labels of foreground and background, respectively, x p A judgment value, x, indicating whether the current pixel p belongs to the foreground or the background q A judgment value indicating whether the current pixel q belongs to the foreground or the background;
3.4 Using the following formula to calculate the total energy term E (x):
wherein, alpha represents a weight coefficient, E represents a set formed by any two adjacent pixels;
3.5 In the segmentation process, sequentially selecting one tissue region from the four tissue regions as a foreground, segmenting the image P by using other tissue regions as a background to obtain segmentation results, and finally splicing and displaying the segmentation results correspondingly obtained by the tissue regions to obtain segmentation regions of different tissues;
4) After finishing the segmentation areas of the orbital bones, the extraocular muscles, the intra-orbital fat and the connective tissues, establishing respective three-dimensional models of different tissues as artificial eye seat digital models;
the porous structure on the surface of the artificial eye seat is arranged in a gradient way, and specifically comprises the following steps: the front surface of the artificial eye seat is gradually increased from the aperture of each hole in the range of 45-90 degrees of north latitude.
2. The 3D printing multifunctional artificial eye seat according to claim 1, wherein: the holes of the porous structure are round holes.
3. The 3D printing multifunctional artificial eye seat according to claim 1, wherein: the artificial eye seat (1) is provided with a special structure (3) for fixing four extraocular muscles, the special structure (3) is two elliptical holes which are communicated with each other and are close to each other, the extraocular muscles are attached to the elliptical holes, the preset sutures on the extraocular muscles penetrate through the two elliptical holes and are knotted and fixed at the positions which are communicated with each other, and the special structure is arranged at four intersection points of 30 degrees of north latitude of the artificial eye seat and 0 degree, 90 degrees, 180 degrees and 270 degrees of longitude respectively, so that the four extraocular muscles are fixed at the four intersection points respectively.
4. The 3D printing multifunctional artificial eye seat according to claim 1, wherein: the porous structure (2) of the artificial eye seat (1) is completely communicated in the artificial eye seat through an inner pore canal.
5. The 3D printing multifunctional artificial eye seat according to claim 1, wherein: the artificial eye seat (1) is prepared and obtained by a 3D printing technology, and the 3D printing technology is one or a combination of a plurality of grouting 3D printing, thermoplastic 3D printing, lamination 3D printing and inkjet 3D printing.
6. The 3D printing multifunctional artificial eye seat according to claim 1, wherein: the synthetic material of the artificial eye seat (1) is one or a mixture of more of hydroxyapatite, calcium phosphate, calcium silicate, calcium carbonate, aluminum oxide, bioactive glass, glass ceramic, polyethylene, polymethyl methacrylate, polytetrafluoroethylene and silicone rubber.
7. A preparation method of a 3D printing multifunctional artificial eye seat is characterized by comprising the following steps: the 3D printing multifunctional artificial eye seat is an artificial eye seat (1) according to any one of claims 1-6.
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| CN112891022B (en) * | 2021-02-04 | 2022-03-04 | 广东省第二人民医院（广东省卫生应急医院） | Artificial eye and manufacturing method thereof |
| EP4129234A1 (en) | 2021-08-03 | 2023-02-08 | Optomed Piotr Jaworski | An ocular prosthesis and a method of fabrication thereof |
| CN113633830B (en) * | 2021-08-11 | 2022-06-17 | 浙江大学 | Multifunctional artificial eye seat with adjustable microporous structure and preparation method thereof |
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