CN112075995B - Femoral tunnel locator for reconstructing medial patellofemoral ligament and preparation method thereof - Google Patents
Femoral tunnel locator for reconstructing medial patellofemoral ligament and preparation method thereof Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
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- B29—WORKING OF PLASTICS; WORKING OF SUBSTANCES IN A PLASTIC STATE IN GENERAL
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Abstract
The invention relates to a femoral tunnel positioner for reconstructing an inner patellofemoral ligament and a preparation method thereof, and belongs to the technical field of joint surgery. The positioner is designed according to the individuation of CT data before a patient operates, is printed and formed rapidly by a 3D printer, and can accurately position the medial patellofemoral ligament femoral tunnel through the medial patellofemoral ligament reconstruction standard (patella and medial femoral condyle midline) longitudinal incision. This locator includes bone laminating part, registration arm and handle: the bone joint part adopts the contact joint positioning design of the medial surface of the medial condyle of the femur and the adductor tubercle, the positioning point of the positioning tube is designed individually according to the preoperative three-dimensional reconstruction data of the patient, and the handle is convenient for fixing the positioner. The individualized inner patellofemoral ligament reconstruction femoral tunnel positioner is simple and novel in structure and is suitable for individualized inner patellofemoral ligament reconstruction.
Description
Technical Field
The invention belongs to the technical field of joint surgery, and particularly relates to a femoral tunnel locator for reconstructing an inner patellofemoral ligament and a preparation method thereof.
Background
The patella dislocation is a common clinical disease, the cause of the disease is complex, surgical treatment is a main treatment means of the patella dislocation, and medial patellofemoral ligament (MPFL) reconstruction surgery is a surgical mode which is researched more in recent years and aims at the patella dislocation. But the complication after the reconstruction operation of the medial patellofemoral ligament is up to 261%, in addition, for adolescents and children with immature epiphyseal development, there is a risk of epiphyseal injury when performing medial patellofemoral ligament reconstruction surgery, mainly due to tunnel positioning and inaccurate tunnel direction of the bone at the femoral end. Clinical multiple passes
The method is used for positioning, and an operator is required to perform knee joint standard lateral position perspective by using an intraoperative C-arm X-ray machine during MPFL reconstruction, so that the positioning is performed. In addition, Sanchs-Alfonso et al propose that intraoperative C-arm X-ray machine fluoroscopy cannot increase the accuracy of femoral positioning point positioning in MPFL reconstruction. These phenomena are all appreciated by surgeons and biomechanical testing experts, and computer-assisted surgery and its resultant 3D navigation templates have the potential to address the above dilemma in theory and practice.
In the previous period, a great deal of research is carried out on a three-dimensional patellar dislocation model and a virtual operation, MPFL reconstruction is successful, but the inventor finds that a device for accurately and quantitatively positioning a femoral tunnel is not available at present, so that a 3D printing individualized inner patellar femoral ligament reconstruction femoral tunnel positioner is developed to be suitable for individualized inner patellar femoral ligament reconstruction.
In summary, the present invention solves the following problems:
(1) the existing MPFL reconstruction operation technology adopts the conventional bony mark and is based on
The position of the bone marrow is determined by intraoperative perspective of the method, and personalized and precise reconstruction cannot be carried out on patellar dislocation needing MPFL reconstruction;
(2) the standard positioning points of the femoral tunnel in the prior art are as follows: the far end of the adductor tubercle is 10mm and 5mm behind, the upper part of the femoral condyle is slightly near, the adductor tubercle is searched by visual inspection and hand touch of an operating doctor, meanwhile, the accuracy of the positioning point is verified again by perspective in the operation, the error is large, the time is long, and the adductor tubercle is easily influenced by the technology and experience of the operating doctor.
Disclosure of Invention
The invention aims to provide a preparation method of a medial patellofemoral ligament reconstruction femoral tunnel positioner for MPFL injured patients, aiming at overcoming the defects in the prior art.
In order to achieve the purpose, the technical scheme adopted by the invention is as follows:
a preparation method of a femoral tunnel locator for reconstructing medial patellofemoral ligament is characterized by comprising the following steps:
(1) before operation, performing knee joint straightening position CT scanning on a patient, and then reconstructing a three-dimensional digital model of the knee joint at the affected side by using CT data in Mimics19.0 software;
(2) in the three-dimensional digital model of the knee joint obtained in the step (1), according to the classic method
Determining a locating point of a femoral tunnel of an inner patellar femoral ligament, simulating and reconstructing the femoral tunnel through the locating point of the femoral tunnel by a 4cm longitudinal incision on the central line of the patella and the inner side condyle of the femur, and marking by using a cylinder I;
(3) storing the knee joint femoral model and the cylinder I on the affected side as STL files, guiding the STL files into Geomagic Studio 2015 software, selecting the bone surface on the femoral insertion point of the medial patellofemoral ligament, enabling the bone surface to surround the femoral insertion point, the cylinder I and the adductor tubercle, and taking out the shell for 2mm towards the far end to form a bone attaching part of the positioner, named as a bone attaching shell, and storing the bone attaching shell as the STL files;
the knee femoral model, cylinder i and boney shell were introduced into Materialise Magics21.0 and part cylinder ii, shear cube, was created. And simultaneously selecting the cylinder I and the cylinder II, aligning to ensure that the two are superposed, selecting the cylinder II for translation, and adjusting the cylinder II to the optimal position. Selecting a shearing cube, performing translation and rotation operations, and adjusting to an optimal position;
selecting a bone attaching shell, a cylinder II and a shearing cube, and combining parts to form a combined body; performing Boolean operation-reduction on the union body I and the femur model to obtain an initial locator, performing Boolean operation-reduction on the initial locator and the cylinder I to obtain a locator, and storing the locator as an STL file;
(4) and (4) importing the STL file of the inner patellofemoral ligament reconstruction femoral tunnel locator model obtained in the step (3) into Cura layering software, adjusting printing parameters (adjusting the angle to enable the bone attachment surface to be upward, adjusting the support surface to be full-support, adjusting the wall thickness to be 1.2mm, and adjusting the filling degree to be 50%), exporting to be in a gcode format, then printing by using a 3D printer, and removing a support structure to obtain the personalized inner patellofemoral ligament reconstruction femoral tunnel locator.
Further, the CT is 64 rows CT, coronal scan and layer thickness is 0.1 mm.
Further, in the step (1), CT is imported into Mimics19.0 interactive medical image processing software, and CT data are used for reconstructing a three-dimensional digital model of the knee joint at the affected side.
Furthermore, the radius of the cylinder I is 1.5mm, and the length of the cylinder I is 150 mm; the radius of the cylinder II is 4.0mm, and the length is 30-60 mm.
Further, in the step (3), the bone-facing surface of the locator is selected from the Geomagic Studio 2015 software to be capable of surrounding the femoral insertion point and the cylinder 1, wherein the distance between the upper, lower and front boundaries and the edge of the cylinder 1 is 10mm, 5mm and 15mm, and the distance between the rear boundary and the posterior 15mm of the adductor tubercle.
Further, in the step (4), the printing parameters are that the wall thickness is 1.2mm and the filling is 50%.
An inner patellofemoral ligament reconstruction femoral tunnel positioner prepared by a preparation method of the inner patellofemoral ligament reconstruction femoral tunnel positioner.
Further, individualized inboard patellofemoral ligament rebuilds thighbone tunnel locator adopts the PLA material to print, uses in the low temperature plasma disinfection backup operation.
The invention also provides the medial patellofemoral ligament reconstruction femoral tunnel positioner prepared by the preparation method of the medial patellofemoral ligament reconstruction femoral tunnel positioner.
The design of the bone joint part of the locator in the locator is convenient for the bone joint part to pass through the standard incision of the operation and firmly joint the medial surface of the medial condyle of the femur and the adductor tubercle.
The invention relates to a femoral tunnel positioner for reconstructing an inner patellofemoral ligament, which comprises a bone fitting part, a positioning tube and a handle;
the bone joint part is firmly jointed with the inner side surface of the medial condyle of the femur and the muscle-contracting nodule (which can change according to different bony characteristics of each patient), the joint surface is designed in a personalized way according to the preoperative CT three-dimensional reconstruction data of the patient, and the inner side surface of the medial condyle of the femur and the muscle-contracting nodule are used as the joint surface;
the outer diameter of the positioning tube is 8mm, the inner diameter is 3mm, and the positioning tube is formed by a patient femur model
The method determines the position of the positioning tube.
The bone surface attaching design concept of the tunnel positioner is beneficial to the accurate positioning and firm fixation of the positioner through a conventional standard operation incision; in the specific implementation, the CT digital three-dimensional model of the knee joint at the affected side of the patient is taken as a reference basis
The MPFL femoral dead center position is measured by the method, and then the MPFL femoral tunnel of the knee joint on the affected side of the positioner is used for positioning in the operation. The positioner provides a new tool for the personalized reconstruction of the medial patellofemoral ligament caused by patella dislocation.
Advantageous effects of the invention
The existing MPFL reconstruction operation technology adopts the conventional bony mark and is based on
The bone marrow to-position is determined through intraoperative perspective of the method, individualized and accurate reconstruction cannot be carried out on patella dislocation needing MPFL reconstruction, the positioner disclosed by the invention is customized by using patella scanning data of a patient, is suitable for individualized and accurate medial patellar femoral ligament reconstruction surgery of patella dislocation caused by different reasons, and is wide in application range.
Meanwhile, the positioner has the advantage of personalized design, and compared with the traditional positioning mode, the positioner greatly improves the positioning accuracy of the femoral tunnel of the medial patellofemoral ligament and greatly improves the operation efficiency.
The locator of the invention is designed on the software of Mimics, Geomagic Studio and Materialise Magics, the operation is simple, no medical engineer is needed, the design can be completed by a clinician, and the popularization is strong.
The standard positioning points of the femoral tunnel in the prior art are as follows: the far end of the adductor tubercle is 10mm and 5mm behind, the upper part of the femoral condyle is slightly near, the adductor tubercle is searched by visual inspection and hand touch of an operating doctor, meanwhile, the accuracy of the positioning point is verified again by perspective in the operation, the error is large, the time is long, and the adductor tubercle is easily influenced by the technology and experience of the operating doctor. Compared with the prior art, the 3D printing femoral tunnel positioner can give the effect of quantitative data, reduces the influence of the skill and experience of operating physicians on the positioning accuracy while reducing the time required for positioning in the operation, and enables young physicians and physicians with less experience to complete high-quality MPFL reconstruction.
Drawings
FIG. 1 is a three-dimensional digital model of a knee joint;
FIG. 2 is
Determining the positioning point of the femoral tunnel of the medial patellofemoral ligament by the method, and simulating and reconstructing the femoral tunnel and the marking schematic diagram of the cylinder I;
FIG. 3 is a bone engaging portion of the medial patellofemoral ligament femoral insertion side bone surface locator;
FIG. 4 is a schematic diagram of alignment, rotation, and translation of a cylinder II and shear cube adjusted to an optimal position;
FIG. 5 is a schematic view of a positioner;
FIG. 6 is a rear view of the positioner;
FIG. 7 is an inside view of the positioner;
FIG. 8 is a front view of the positioner;
FIG. 9 is a real operation diagram of the 3D printing positioner placing the surface of the femur through a standard incision and drilling the individualized femoral tunnel with the K-wire through the positioning hole on the positioner;
FIG. 10 is an accurate view of the post-operative CT scan finding the reconstructed MPFL femoral tunnel position;
FIG. 11 is a precise view of post-operative X-ray film finding of reconstructed MPFL femoral tunnel position.
Detailed Description
The present invention will be described in further detail with reference to examples.
It will be appreciated by those skilled in the art that the following examples are illustrative of the invention only and should not be taken as limiting the scope of the invention. The examples do not specify particular techniques or conditions, and are performed according to the techniques or conditions described in the literature in the art or according to the product specifications. The components and instruments used are not indicated by manufacturers, and all are conventional products which can be obtained by purchasing.
1 preoperative knee joint ACL three-dimensional modeling
(1) Before operation, the patients are examined by CT at the two knee joint straight positions, and the images are stored and recorded on a CD-ROM in a DICOM format on a workstation (CT: using 64 rows of CT, coronal scanning and a layer thickness of 0.1 mm.).
(2) Reconstruction of a three-dimensional digital model of a human knee joint: on a computer workstation, a knee joint scanning image (DICOM) is imported into Mimics19.0 interactive medical image processing software (Materialise, Belgium), and a CT image is adopted to reconstruct a three-dimensional digital model of the knee joint (figure 1).
(3) According to the classic
The method determines the locating point of the femoral tunnel of the medial patellar femoral ligament, simulates and reconstructs the femoral tunnel by longitudinally cutting the femoral tunnel locating point by 4cm on the midline of the patella and the medial condyle of the femur, and marks the femoral tunnel by a cylinder I (figure 2).
2 preoperative personalized tibia tunnel locator three-dimensional modeling and 3D printing
(1) The design of the tibial positioner was done on the geographic Studio 2015 and materials Magics21.0 software: in the Geomagic Studio 2015 software, the medial patellofemoral ligament femoral insertion side bone surface is selected to be capable of wrapping the femoral insertion point, the column I and the adductor tubercle, and the shell is pulled out for 2mm towards the far end to form a bone joint part of the positioner (figure 3). Creating a part cylinder II and a shearing cube in a Materialise magics21.0, and adjusting to an optimal position by adopting alignment, translation and rotation operations (figure 4); selecting a bone attaching shell, a cylinder II and a shearing cube, and combining the parts to form a combined body. Performing Boolean operation-reduction on the united body and the femur model to obtain an initial positioner, and performing Boolean operation-reduction on the united body and the cylinder I to obtain a positioner (figure 5); medial patellofemoral ligament femoral locator model (fig. 6, 7, 8); the medial patellofemoral ligament femoral locator model was exported as an STL file.
(2) And (3) leading the femoral locator model of the medial patellofemoral ligament into Cura layering software, adjusting the angle, supporting and printing parameters, leading out the model into a geocode format, and storing the layered model into an SD card.
(3) And inserting the SD card into a 3D printer of a medical image three-dimensional reconstruction entity planning system, and printing the personalized inner patellofemoral ligament femoral tunnel positioner by using a PLA material. After the support structure is removed, the support structure is sterilized by low-temperature plasma and is prepared for use in the operation.
3 applying medial patellofemoral ligament femoral tunnel locator in art
(1) In arthroscopic surgery, the 3D printed individualized inner patellofemoral ligament reconstruction femoral tunnel positioner is attached to the bone surface through a standard incision (fig. 9).
(2) The tunnel locator is adjusted to firmly attach to the inner side of the femoral medial condyle and the adductor tubercle so as to be completely matched with the inner side of the femoral medial condyle and the adductor tubercle. And drilling the personalized femoral tunnel by using a Kirschner wire through a positioning tube on the positioner. After operation, CT scanning and X-ray film are carried out to find that the position of the MPFL femoral tunnel is reconstructed accurately (figures 10 and 11).
Clinical application of 4-inner patellofemoral ligament femoral tunnel positioner
After 15 cases of patients with MPFL injury caused by patellar dislocation are all informed, personalized MPFL reconstruction is performed. After the locator is sterilized, the locator is clinically applied according to the operation technology, and the personalized MPFL reconstruction is successfully completed as a result.
The wounds of 15 patients heal at the same stage after operation, no early complications exist, CT scanning is carried out after the operation, so that the positions of the palliative tunnels are accurate, and the knee joints of the patients after the operation have good functions.
The foregoing shows and describes the general principles, essential features, and advantages of the invention. It will be understood by those skilled in the art that the present invention is not limited to the embodiments described above, which are described in the specification and illustrated only to illustrate the principle of the present invention, but that various changes and modifications may be made therein without departing from the spirit and scope of the present invention, which fall within the scope of the invention as claimed. The scope of the invention is defined by the appended claims and equivalents thereof.
Claims (8)
1. A preparation method of a femoral tunnel locator for reconstructing medial patellofemoral ligament is characterized by comprising the following steps:
(1) before operation, performing knee joint straightening position CT scanning on a patient, and then reconstructing a three-dimensional digital model of the knee joint at the affected side by using CT data in Mimics19.0 software;
(2) in the three-dimensional digital model of the knee joint obtained in the step (1), according to the classic method
Determining a locating point of a femoral tunnel of an inner patellar femoral ligament, simulating and reconstructing the femoral tunnel through the locating point of the femoral tunnel by a 4cm longitudinal incision on the central line of the patella and the inner side condyle of the femur, and marking by using a cylinder I;
(3) storing the knee joint femoral model and the cylinder I on the affected side as STL files, guiding the STL files into Geomagic Studio 2015 software, selecting the bone surface on the femoral insertion point of the medial patellofemoral ligament, enabling the bone surface to surround the femoral insertion point, the cylinder I and the adductor tubercle, and taking out the shell for 2mm towards the far end to form a bone attaching part of the positioner, named as a bone attaching shell, and storing the bone attaching shell as the STL files;
introducing the knee joint femur model, the cylinder I and the bone pasting shell into Materialise magics21.0, and creating a part cylinder II and a shearing cube; simultaneously selecting a cylinder I and a cylinder II, aligning to ensure that the two cylinders are superposed, selecting the cylinder II for translation, and adjusting the cylinder II to the optimal position; selecting a shearing cube, performing translation and rotation operations, and adjusting to an optimal position;
selecting a bone attaching shell, a cylinder II and a shearing cube, and combining parts to form a combined body; performing Boolean operation-reduction on the union body I and the femur model to obtain an initial locator, performing Boolean operation-reduction on the initial locator and the cylinder I to obtain a locator, and storing the locator as an STL file;
(4) and (4) importing the STL file of the inner patellofemoral ligament reconstruction femoral tunnel locator model obtained in the step (3) into Cura layering software, adjusting the angle to enable the bone attachment surface to be upward, and exporting the printing parameter to be in a gcode format after being supported to be a fully-supported printing parameter, then printing the printing parameter by using a 3D printer, and removing a support structure to obtain the personalized inner patellofemoral ligament reconstruction femoral tunnel locator.
2. The method for preparing a medial patellofemoral ligament reconstruction femoral tunnel locator according to claim 1, wherein the method comprises the following steps: the CT is 64 rows CT, coronal scan and layer thickness of 0.1 mm.
3. The method for preparing a medial patellofemoral ligament reconstruction femoral tunnel locator according to claim 1, wherein the method comprises the following steps: and (2) in the step (1), importing CT into Mimics19.0 interactive medical image processing software, and reconstructing a three-dimensional digital model of the knee joint on the affected side by using CT data.
4. The method for preparing a medial patellofemoral ligament reconstruction femoral tunnel locator according to claim 1, wherein the method comprises the following steps: the radius of the cylinder I is 1.5mm, and the length of the cylinder I is 150 mm; the radius of the cylinder II is 4.0mm, and the length is 30-60 mm.
5. The method for preparing a medial patellofemoral ligament reconstruction femoral tunnel locator according to claim 1, wherein the method comprises the following steps: in the step (3), the bone-facing surface of the positioner is selected from Geomagic Studio 2015 software to be capable of surrounding a femoral insertion point and a cylinder I, the distance between the upper, lower and front boundaries and the edge of the cylinder I is 10mm, 5mm and 15mm, and the distance between the rear boundary and the posterior 15mm of a adductor tubercle.
6. The method for preparing a medial patellofemoral ligament reconstruction femoral tunnel locator according to claim 1, wherein the method comprises the following steps: in the step (4), the printing parameters are that the wall thickness is 1.2mm and the filling is 50%.
7. A medial patellofemoral ligament reconstruction femoral tunnel locator made according to the method of making the medial patellofemoral ligament reconstruction femoral tunnel locator of any one of claims 1-6.
8. The medial patellofemoral ligament reconstruction femoral tunnel locator of claim 7, wherein: the femoral tunnel locator is rebuild to inboard patellofemoral ligament adopts the PLA material to carry out 3D and prints, uses in the back-up art through low temperature plasma disinfection.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010778569.6A CN112075995B (en) | 2020-08-05 | 2020-08-05 | Femoral tunnel locator for reconstructing medial patellofemoral ligament and preparation method thereof |
| AU2021100591A AU2021100591A4 (en) | 2020-08-05 | 2021-01-29 | 3d printed femoral tunnel locator for medial patellofemoral ligament reconstruction and preparation method |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN202010778569.6A CN112075995B (en) | 2020-08-05 | 2020-08-05 | Femoral tunnel locator for reconstructing medial patellofemoral ligament and preparation method thereof |
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| CN112075995A CN112075995A (en) | 2020-12-15 |
| CN112075995B true CN112075995B (en) | 2021-06-18 |
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| AU (1) | AU2021100591A4 (en) |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US20230270451A1 (en) * | 2020-09-02 | 2023-08-31 | Shanghai Droidmeds Medical Co., Ltd. | Positioning system and method for posteromedial structure, posterolateral structure and medial patellofemoral ligament reconstruction |
| CN113116353B (en) * | 2021-04-06 | 2022-03-22 | 骨圣元化机器人(深圳)有限公司 | Pressure measurement system and pressure measurement method for knee joint replacement surgery |
Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6187011B1 (en) * | 1997-12-05 | 2001-02-13 | Smith & Nephew, Inc. | Positioning a tibial tunnel |
| CN209136705U (en) * | 2018-08-01 | 2019-07-23 | 昆明医科大学第一附属医院 | A kind of individuation tibial insertion of anterior cruciate ligament tunnel locator |
| CN110192916A (en) * | 2019-05-28 | 2019-09-03 | 昆明医科大学第一附属医院 | A kind of 3D printing personalization Healing in Anterior Cruciate Ligament Reconstruction tibial tunnel locator and preparation method thereof |
Family Cites Families (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US7736364B2 (en) * | 2006-02-02 | 2010-06-15 | Biomet Sports Medicine, Llc | Method and apparatus for performing ACL reconstruction |
| SG10201401326SA (en) * | 2009-04-16 | 2014-10-30 | Conformis Inc | Patient-specific joint arthroplasty devices for ligament repair |
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2020
- 2020-08-05 CN CN202010778569.6A patent/CN112075995B/en active Active
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Patent Citations (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6187011B1 (en) * | 1997-12-05 | 2001-02-13 | Smith & Nephew, Inc. | Positioning a tibial tunnel |
| CN209136705U (en) * | 2018-08-01 | 2019-07-23 | 昆明医科大学第一附属医院 | A kind of individuation tibial insertion of anterior cruciate ligament tunnel locator |
| CN110192916A (en) * | 2019-05-28 | 2019-09-03 | 昆明医科大学第一附属医院 | A kind of 3D printing personalization Healing in Anterior Cruciate Ligament Reconstruction tibial tunnel locator and preparation method thereof |
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| AU2021100591A4 (en) | 2021-04-22 |
| CN112075995A (en) | 2020-12-15 |
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