CN113576661B - Ankle joint fracture postoperative early-stage quantitative rehabilitation method oriented to fracture surgical robot - Google Patents
Ankle joint fracture postoperative early-stage quantitative rehabilitation method oriented to fracture surgical robot Download PDFInfo
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Abstract
The invention discloses an ankle fracture postoperative early-stage quantitative rehabilitation method facing a fracture surgical robot, which is based on finite element analysis, adopts inter-bone movement as a limiting condition of safe movement, and establishes a quantitative method of ankle fracture postoperative early-stage passive rehabilitation training. Through finite element analysis, the change rule of biomechanical behaviors in the ankle joint in the motion process can be revealed. The method overcomes the defect of the rehabilitation training method aiming at ankle fracture in the traditional biomechanical research. Meanwhile, the invention has universality for other types of ankle fracture which can be reconstructed. The method does not need a large number of circulation tests, can greatly reduce time cost and economic cost, can be directly applied to robot auxiliary rehabilitation engineering, reduces postoperative complication probability, and improves rehabilitation quality.
Description
Technical field:
the invention relates to the crossing field of robots and rehabilitation medical engineering, in particular to an ankle fracture postoperative early-stage quantitative rehabilitation method facing a fracture operation robot.
The background technology is as follows:
ankle fracture is a multiple disease and dislocation fracture must be treated by surgery. Accurate anatomic reduction and strong internal fixation can maximally restore the physiological structure of the ankle joint. However, post-operative resting may result in loss of ankle function. Early rehabilitation training has been demonstrated to reduce or even avoid deep vein thrombosis, muscle contractures, joint adhesions, and traumatic arthritis. Generally, ankle fracture postoperative rehabilitation training is divided into two modes, passive rehabilitation and active rehabilitation. Passive rehabilitation is usually performed by a doctor or an instrument to assist a patient in dorsiflexion/plantarflexion rehabilitation training, and is the most common rehabilitation mode in early postoperative period. At present, the formulation of a passive rehabilitation training scheme depends on the experience of doctors, and an improper or excessive movement range can prevent healing and even secondary injury, so far, no definite early-stage quantitative rehabilitation method after ankle fracture operation exists.
Determining early biomechanical behavior of ankle fractures is critical to quantifying the range of rehabilitation motion. Finite element analysis is one of the most effective techniques to solve biomechanical problems. The prior research provides a method for establishing a complete ankle joint finite element model, and reveals the mechanical behavior of different types of injuries of the ankle joint under the action of static load. However, the law of influence of ankle flexion and extension movements on the internal mechanical environment of the joint (especially the fracture site) is not revealed yet. This is the core and difficulty in quantifying the scope of early postoperative rehabilitation training.
The invention comprises the following steps:
the invention aims to provide a universal ankle fracture postoperative early-stage quantitative rehabilitation method for a fracture surgical robot based on finite element analysis means.
The technical scheme adopted for solving the technical problems is as follows:
the early-stage quantitative rehabilitation method for the ankle fracture operation facing the fracture operation robot comprises the following steps:
and 1, performing three-dimensional reconstruction on a CT data set of a healthy volunteer.
CT images of the ankle joint of healthy volunteers are acquired, and are imported into medical image processing software for threshold segmentation and other operations, and reconstructed into a 3D geometric surface model comprising tibia, fibula, talus, calcaneus (comprising cortical bone and cancellous bone), tibial cartilage, talus cartilage and two pieces of calcaneal cartilage. And (3) introducing the three-dimensional solid into reverse reconstruction software to perform accurate surface operation to form the three-dimensional solid.
And 2, performing virtual fracture and operation on the geometric model of the healthy ankle joint.
Virtual truncation is carried out in three-dimensional drawing software to simulate various ankle fracture types, and internal fixation instrument models are used for virtual internal fixation according to actual conditions.
And 3, establishing a complete ankle fracture postoperative finite element model.
Inserting a spring unit into finite element simulation software to simulate an ankle ligament, applying fixed constraint to the tibiofibular joint near end, establishing an ankle movement coordinate system at the far end, applying a movement load of dorsiflexion 20-plantar flexion 32 degrees, forming an ankle fracture postoperative finite element model, and performing simulation calculation.
And 4, establishing a relation between the inter-bone displacement and the movement angle, and setting safety conditions to obtain a rehabilitation training range.
The average displacement difference between the fracture surface of the bone mass and the fracture surface of the body at each fracture site is defined as the inter-bone displacement. Outputting the relation between the displacement and the movement angle between bones. According to the previous research result, the early passive recovery range after ankle fracture operation can be quantified by the relation obtained in the step 4 by taking 150 μm as a safety limit condition.
The beneficial effects of the invention are as follows:
the invention provides a method for establishing a complete ankle fracture postoperative finite element model, which analyzes the biomechanical behavior of the inside of a joint under rehabilitation exercise stimulation by applying flexion and extension exercise load. Provides a universal ankle fracture postoperative early-stage quantitative rehabilitation method facing a fracture surgical robot. Theoretically, the method is applicable to any type of ankle fracture that can be reconstructed in three dimensions. Solves the blindness and experience problems of early rehabilitation training after ankle fracture operation.
Description of the drawings:
FIG. 1 is a flow chart of a quantification method of an early rehabilitation training range after ankle fracture operation, which is proposed by the invention;
FIG. 2 is a schematic representation of fracture simulation of one example of the present invention;
FIG. 2a is a schematic illustration of a lateral malleolus fracture;
FIG. 2b is a schematic representation of a medial malleolus fracture;
FIG. 2c schematic view of the rear ankle fracture line definition;
FIG. 2d is a schematic view of a posterior ankle fracture;
FIG. 3 is a schematic representation of a post-operative finite element model of one example of the present invention;
fig. 3a front side;
fig. 3b back side;
wherein: 1-bone membrane; 2-anterior tibiofibular ligament; 3-tibiofibular posterior ligament; 4-tibial distance anterior ligament; 5-tibial distance posterior ligament; 6-anterior talofibular ligament; 7-talofibular posterior ligament; 8-calcaneofibular ligament; 9-the tibialis ligament; 10-distance calcaneal ligament; 11-distance calcaneal ligament; 12-distance calcaneal ligament;
FIG. 4 is a graph of inter-bone displacement versus angle of motion for one example of the present invention;
the specific embodiment is as follows:
the technical scheme of the present invention will be clearly and completely described below with 44A3.3 type fracture as one of the embodiments of the present invention.
Referring to fig. 1, the early-stage quantitative rehabilitation method for ankle fracture operation facing the fracture operation robot provided by the invention comprises the following steps:
and step 1, CT images of the healthy volunteers are acquired and imported into medical image processing software, and a complete ankle joint three-dimensional solid model is reconstructed by combining reverse engineering software.
In one embodiment of the invention, CT images are imported into a Mimic for thresholding to segment the positions and general contours of the tibia, talus, fibula and calcaneus. The 4 bone internal cavities were filled in combination with manual operations to form 4 complete masks. At this time, the cortical bone and the cancellous bone are not segmented. The corresponding cancellous bone mask was segmented from 4 complete bone masks using morphological erosion operations in combination with manual modification. And (5) segmenting out the corresponding cortical bone mask by using Boolean operation. According to the CT image and the anatomical position of the ankle cartilage, manually drawing the tibia cartilage, the talus cartilage and 2 pieces of talus cartilage from corresponding bone masks, dividing the cartilage from the bone masks by using Boolean operation and combining manual modification to form 4 pieces of cartilage masks. After reconstructing them into three-dimensional surfaces, smoothing and mesh reduction are performed and saved in STL format.
In one embodiment of the invention, the obtained 12 models are imported into a geomatic Studio to perform accurate surface operation to form a three-dimensional solid model, and the three-dimensional solid model is stored in a STEP format.
In one embodiment of the invention, cortical bone and cartilage are opened in SolidWorks to perform Boolean operation, so that contact smoothness between models is ensured without interference. Stored in STEP format.
And 2, performing virtual truncation simulation on ankle fracture in three-dimensional drawing software, and performing virtual internal fixation operation by using an internal fixation instrument model according to actual conditions.
In one embodiment of the invention, the resulting tibia and fibula models were imported into SolidWorks. The simulation of fractures was performed according to AO-typing. Referring to fig. 2, the fibular fracture is simulated by cutting in a plane 22mm from the anterior edge of the lateral malleolus and parallel to the transverse plane; the medial malleolus fracture is cut off at the malleolus tenon position by a plane with an included angle of 30 degrees with the cross section; the two bulges AB at the outer side of the distal end of the tibia are connected to serve as reference lines, the point C at 1/4 of the intersection point O of the posterior ankle and the medial malleolus and the AB line are connected to serve as fracture lines, and the plane of the OC line and the cross section of the fracture simulation of the posterior malleolus is cut off by 60 degrees.
In one embodiment of the invention, the internal fixation instrument comprises a steel plate, which is a model reconstructed from CT images, and a screw, which is replaced by a cylindrical model. And assembling the fracture model and the internal fixation instrument model to form a three-dimensional solid model after fracture operation, and storing the three-dimensional solid model in a STEP format.
And 3, establishing a complete ankle fracture postoperative finite element model in finite element simulation software.
In one embodiment of the present invention, referring to FIG. 3, the entire model is imported into Ansys Workbench for the next operation. Ligament simulations were performed using linear springs, and were considered to include 12: the interosseous membrane (Int), the anterior warp ligament (ATiFL), the posterior tibiofibular ligament (PTiFL), the anterior tibiofibular ligament (ATiTL), the posterior tibiofibular ligament (PTiTL), the anterior tibiofibular ligament (ATaFL), the posterior tibiofibular ligament (PTaFL), the calcaneofibular ligament (CaFL), the tibiofibular ligament (TiCL), the medial calcaneal ligament (MTaCL), the lateral calcaneal ligament (LTaCL) and the posterior tibiofibular ligament (PTaCL). The stiffness and number of ligaments are listed in table 1.
Table 1 ligament stiffness
All bones and implants were assumed to be isotropic linear elastic characteristics and the material properties used are listed in table 2. Due to the complexity of bone and cartilage surfaces, a free meshing approach is chosen. The mesh model has 58627 nodes, 28730 cells. In order to make the whole model more approximate to the real biomechanical conditions, the interaction type is carefully selected, and binding between the screw and the bone simulates the pre-tightening force of the screw. Binding constraints are applied between cartilage and bone to fix their relative positions. Between the cartilages, the friction type was defined between the fractured bone pieces and the body, with friction coefficients of 0.1 and 0.4, respectively.
Table 2 material properties
According to the definition of the International society of biomechanics on an ankle joint coordinate system, taking the midpoint of a connecting line between an inner ankle tip and an outer ankle tip as an origin and the connecting line as a rotation axis, establishing the ankle joint coordinate system, respectively applying dorsiflexion 20 degrees and plantar flexion 32 degrees rotation loads in the normal motion range of the ankle joint, applying 3mm y-axis negative displacement and 2mm z-axis negative displacement during dorsiflexion during rotation and applying 3mm y-axis positive displacement and 1mm z-axis negative displacement during plantar flexion through multiple experiments, and applying fixed constraint on the proximal surfaces of tibia and fibula.
And 4, establishing a relation between the inter-bone displacement and the movement angle, and setting safety conditions to obtain a rehabilitation training range.
In one embodiment of the invention, the average displacement is output by the fracture surface of the lateral malleolus, the medial malleolus, the rear malleolus and the fracture surface of the body respectively, and the data is saved in csv format. Data arrangement and calculation are performed in Matlab to obtain the change of the relative displacement difference between the bone block and the body with time, and the relative displacement difference is called as the inter-bone displacement. Referring to fig. 4, the time-step motion angle change is mapped to the inter-bone movement to obtain a graph of the inter-bone movement and the motion angle.
In one embodiment of the invention, reference is made to the studies of Fujie H et al and Shimamura Y et al. (see reference: fujie H. Negative effects of mechanical stimulation on fracture healing [ J ]. Jscbrr,1988,10. And Shimamura Y, kaneko K, kume K, et al. Initial safe range of motion of ankle joint after three internal fixation methods to simulate a medial malleolus fracture. Clinical Biomechanics,2006,21 (6): 617-622.) the post-operative early safe range of motion of this example was found using 150 μm as a safety constraint (FIG. 4): dorsiflexion is 10.1 deg. to 12.5 deg. plantarflexion.
In conclusion, the quantitative method for early passive rehabilitation training after ankle fracture operation is established based on finite element analysis by adopting the inter-bone movement as a limiting condition of safe movement. Through finite element analysis, the change rule of biomechanical behaviors in the ankle joint in the motion process can be revealed. The method overcomes the defect of the rehabilitation training method aiming at ankle fracture in the traditional biomechanical research. Meanwhile, the invention has universality for other types of ankle fracture which can be reconstructed. The method does not need a large number of circulation tests, can greatly reduce time cost and economic cost, can be directly applied to robot auxiliary rehabilitation engineering, reduces postoperative complication probability, and improves rehabilitation quality.
The embodiments of the present invention are not limited to the specific examples described above. Other changes and modifications may be made by one of ordinary skill in the art without departing from the spirit of the invention and the scope of the claims, which are intended to be covered thereby.
Claims (2)
1. An ankle joint fracture postoperative early-stage quantitative rehabilitation method facing a fracture operation robot is characterized by comprising the following steps of:
step 1, performing three-dimensional reconstruction on CT data sets of healthy volunteers;
CT images of the ankle joints of healthy volunteers are acquired, are guided into medical image processing software to carry out threshold segmentation operation, and are reconstructed into a 3D geometric surface model containing tibia, fibula, talus, calcaneus, tibial cartilage, talus cartilage and two pieces of calcaneal cartilage; introducing reverse reconstruction software to perform accurate surface operation to form a three-dimensional entity;
step 2, performing virtual fracture and operation on the geometric model of the healthy ankle joint;
virtual truncation is carried out in three-dimensional drawing software to simulate various ankle fracture types, and an internal fixation instrument model is used for carrying out virtual internal fixation according to actual conditions;
step 3, establishing a complete ankle fracture postoperative finite element model;
inserting a spring unit into finite element simulation software to simulate an ankle ligament, applying fixed constraint to the tibiofibular joint near end, establishing an ankle movement coordinate system at the far end, applying a movement load of dorsiflexion 20-plantar flexion 32 degrees, forming an ankle fracture postoperative finite element model, and performing simulation calculation;
step 4, establishing a relation between the inter-bone displacement and the movement angle, and setting safety conditions to obtain a rehabilitation training range;
defining the average displacement difference between the fracture surface of the bone piece and the fracture surface of the body of each fracture part as the inter-bone displacement; outputting the relation between the displacement and the movement angle between bones; according to the previous research result, the early passive recovery range after ankle fracture operation can be quantified by the relation obtained in the step 4 by taking 150 μm as a safety limit condition.
2. The method for early post-operative quantitative rehabilitation of ankle fractures facing a fracture surgical robot according to claim 1, wherein the calcaneal bone in step 1 comprises cortical bone and cancellous bone.
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