CN115137440A - Perspective developing and positioning bone cutting guide plate and design method and application thereof - Google Patents

Abstract

The invention relates to a design method of a perspective developing positioning bone cutting guide plate, which comprises the following steps: establishing a skeleton anatomy three-dimensional model according to CT or/and nuclear magnetic data before a patient operation, and performing simulated osteotomy in the skeleton anatomy three-dimensional model to determine an osteotomy position and direction; after the osteotomy position and the direction are determined, the individualized design of the osteotomy guide plate is carried out according to the surface characteristics of the skeleton, and the characteristic position relation between the characteristic anatomical structure which can be positioned under perspective in the three-dimensional model reference operation of the osteotomy guide plate and the osteotomy position is obtained; designing a developing structure which can be positioned by perspective of a perspective device on the three-dimensional model of the bone cutting guide plate according to the characteristic position relation; and processing and preparing the designed and confirmed individualized bone cutting guide plate. The invention can be calibrated according to the developing structure and the characteristic anatomical position, realizes the accurate placement position of the osteotomy guide plate, further realizes the accurate confirmation of the relationship between the osteotomy position and the characteristic anatomical position, provides support and guarantee for the later high-precision osteotomy, and finally implements the accurate osteotomy.

Description

A kind of fluoroscopic imaging positioning osteotomy guide and its design method and application

technical field

The invention relates to an osteotomy guide plate, in particular to a fluoroscopic visualization positioning osteotomy guide plate and a design method and application thereof, belonging to the technical field of medical devices.

Background technique

In orthopaedic clinical surgery, osteotomy is one of the basic and very important operations. The traditional osteotomy method is based on the anatomical reference object by the orthopaedic surgeon to roughly judge the position and direction. The osteotomy tools are wire saw, pendulum saw and bone knife. However, with the increasing precision requirements of surgical operations, the traditional osteotomy method cannot meet the precision requirements, and the error is generally at the level of 1 cm. The current navigation technology used in orthopedic surgery can significantly improve the pre-operational position accuracy (the operation accuracy can be increased to 4-5mm), and achieve higher-precision intraoperative positioning, but due to the expensive equipment, preoperative imaging examination, intraoperative Operations such as registration incur additional costs and time costs. With the emergence of 3D printing technology, 3D modeling can be carried out based on preoperative CT data of patients to customize personalized osteotomy guides. Current studies agree that the accuracy of 3D printed personalized osteotomy guides can be stably controlled at about 2mm. For complex deformities and tumor resection, this precision enables more precise osteotomy and bone tumor resection.

However, the intraoperative matching of the osteotomy guide to the exact position has not been well resolved. During the operation, the osteotomy guide is placed on the bone surface for matching with reference to the anatomical feature surface. However, due to the degree of intraoperative soft tissue dissection and the bone surface Both feature degrees seriously affect placement accuracy. In order to improve the placement accuracy of the osteotomy guide, some doctors also use the navigation technology in orthopedic surgery to assist the placement of the osteotomy guide. However, due to the high cost of equipment and complicated operations, its application and popularization are limited, and it is difficult to achieve ease of use and usability. The majority of orthopedic surgeons actual clinical work requirements.

SUMMARY OF THE INVENTION

In view of the above problems, one of the objects of the present invention is to provide a design method for a fluoroscopic visualization positioning osteotomy guide; the second object of the present invention is to provide a fluoroscopic visualization positioning osteotomy guide prepared by using the design method; The third object of the present invention is to provide an application of the fluoroscopic visualization positioning osteotomy guide plate in osteotomy correction and bone tumor resection.

To achieve the above object, the present invention adopts the following technical solutions:

In a first aspect, the present invention provides a method for designing an osteotomy guide that can be visualized and positioned, comprising the following steps:

Establish a three-dimensional model of bone anatomy according to the patient's preoperative CT or/and MRI data, and perform a simulated osteotomy in the three-dimensional model of bone anatomy to determine the position and direction of the osteotomy;

After the position and direction of the osteotomy are determined, the individualized design of the osteotomy guide is carried out according to the bone surface characteristics, and the three-dimensional model of the osteotomy guide is obtained;

The characteristic position relationship was established with reference to the characteristic anatomical structure and osteotomy position that could be located under intraoperative fluoroscopy;

According to the characteristic positional relationship, a developing structure that can be positioned by fluoroscopy equipment is designed on the 3D model of the osteotomy guide;

The individualized osteotomy guides are processed and prepared after the design has been confirmed.

In the design method, preferably, the bone surface features include bone surface features at the position of the patient to be osteotomy and bone surface features of a three-dimensional model of bone anatomy.

In the design method, preferably, the locatable characteristic anatomical structures include but are not limited to articular surfaces, femoral condyles or acetabulum.

In the design method, preferably, the established characteristic position relationship includes but is not limited to the distance and angle between the osteotomy position and a certain characteristic anatomical structure.

In the design method, preferably, the developing structure is a metal wire or a metal rod.

In the design method, preferably, the fluoroscopy device is a C-shaped arm or a G-shaped arm.

In the above-mentioned design method, preferably, when designing a developing structure on the three-dimensional model of the osteotomy guide that can be positioned by a fluoroscopy device, it is necessary to fully consider the characteristics of the angle error in the perspective of the C-shaped arm or the G-shaped arm. The developing structure is designed in both perspective and lateral perspective to increase the alignment of the projection angle.

In a second aspect, the present invention provides a fluoroscopic visualization positioning osteotomy guide, which is prepared by using the above-mentioned design method.

For the fluoroscopic visualization positioning osteotomy guide, preferably, the osteotomy guide is a distal femoral osteotomy guide, and the distal femoral osteotomy guide has connections with the distal end of the femoral condyle, the intercondylar fossa, and the precondyle of the femoral condyle. The positioning part of the distal end of the femoral condyle, the positioning part of the intercondylar fossa and the locating part of the precondyle of the femoral condyle are respectively fitted; The fixation pin is passed through the fixation hole for temporarily fixing the osteotomy guide plate, the distal femoral condyle locating portion and the femoral condyle anterior condyle locating portion are provided with a transverse osteotomy slot suitable for the osteotomy tool to pass through. The socket positioning part is provided with a longitudinal osteotomy groove suitable for the osteotomy tool to pass through; the developing structure includes a perspective angle correcting member vertically protruding from the positioning part of the anterior condyle of the femoral condyle and a perspective angle correcting member arranged in the same direction as the perspective angle correcting member. The 90° orthogonal arrangement of the characteristic position relationship positioning member, the perspective angle correcting member is used for angle correction positioning under the anteroposterior perspective of the fluoroscopic device, so as to ensure that the fluoroscopic device and the distal femoral osteotomy guide are at an absolute 90° ; The characteristic positional relationship positioning member is used to identify the characteristic positional relationship between the locatable characteristic anatomical structure and the osteotomy position.

In a third aspect, the present invention also provides the application of the above-mentioned fluoroscopic visualization positioning osteotomy guide in osteotomy correction and bone tumor resection.

The present invention has the following advantages due to taking the above technical solutions:

Aiming at the problem of the placement accuracy of the individualized osteotomy guide, the present invention adds a developing structure that can be positioned through a C-arm or a G-arm fluoroscopically in the design of the individualized osteotomy guide, and calibrates according to the developing structure and the characteristic anatomical position to realize Precise placement of the osteotomy guide plate, so as to accurately confirm the relationship between the osteotomy position and the characteristic anatomical position, provide support and guarantee for the need for high-precision osteotomy in the future, and finally implement precise osteotomy.

Description of drawings

1 is a schematic flowchart of a design method provided according to an embodiment of the present invention;

2 is a schematic structural diagram of an osteotomy guide prepared by the design method of the present invention from a first perspective;

3 is a schematic structural diagram of an osteotomy guide prepared by the design method of the present invention from a second perspective;

Fig. 4 is a state diagram of an osteotomy guide prepared according to the design method of the present invention under intraoperative fluoroscopy equipment.

Detailed ways

In order to make the objectives, technical solutions and advantages of the present invention clearer, the technical solutions of the present invention will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are some, but not all, embodiments of the present invention. Based on the embodiments of the present invention, all other embodiments obtained by those of ordinary skill in the art without creative efforts shall fall within the protection scope of the present invention.

In the description of the present invention, it should be noted that the orientation or positional relationship indicated by the terms "upper", "lower", etc. is based on the orientation or positional relationship shown in the accompanying drawings, and is only for the convenience of describing the present invention and simplifying the description, It is not intended to indicate or imply that the system or element referred to must have a particular orientation, be constructed and operate in a particular orientation, and therefore should not be construed as limiting the invention.

In the description of the present invention, it should be noted that, unless otherwise expressly specified and limited, the terms "assembly", "arrangement" and "connection" should be understood in a broad sense, for example, it may be a fixed connection or a detachable connection Connection, or integral connection; can be mechanical connection, can also be electrical connection; can be directly connected, can also be indirectly connected through an intermediate medium, can be internal communication between two elements. For those of ordinary skill in the art, the specific meanings of the above terms in the present invention can be understood in specific situations.

The design method of the fluoroscopic visualization positioning osteotomy guide provided by the present invention includes the following steps: establishing a three-dimensional model of bone anatomy according to the preoperative CT or/and nuclear magnetic data of the patient, and performing a simulated osteotomy in the three-dimensional model of bone anatomy to determine the osteotomy Position and direction; after determining the position and direction of the osteotomy, the individualized design of the osteotomy guide is carried out according to the bone surface characteristics, and the three-dimensional model of the osteotomy guide is obtained, referring to the characteristic anatomical structure that can be located under intraoperative fluoroscopy and the position of the osteotomy to establish the characteristic position relationship ; Design a developing structure on the three-dimensional model of the osteotomy guide plate according to the characteristic position relationship, which can be positioned through a fluoroscopy device; process and prepare the individualized osteotomy guide plate after the design and confirmation. The invention can calibrate according to the developing structure and the characteristic anatomical position, realize the accurate placement of the osteotomy guide plate, and further realize the accurate confirmation of the relationship between the osteotomy position and the characteristic anatomical position, and provide support and guarantee for the need for high-precision osteotomy in the future. Finally, a precise osteotomy was performed.

Hereinafter, the design method of the fluoroscopic visualization positioning osteotomy guide provided by the embodiments of the present invention will be described in detail with reference to the accompanying drawings.

As shown in FIG. 1 , the design method of the fluoroscopic visualization positioning osteotomy guide provided by the embodiment of the present invention includes the following steps:

S100. Create a three-dimensional model of bone anatomy in CAD three-dimensional modeling software according to the patient's preoperative CT or/and MRI data, and perform a simulated osteotomy in the three-dimensional model of bone anatomy to determine the position and direction of the osteotomy.

S200. After determining the position and direction of the osteotomy, carry out the individualized design of the osteotomy guide plate according to the bone surface characteristics, and obtain a three-dimensional model of the osteotomy guide plate. Wherein, the bone surface features include the bone surface features at the position of the patient to be osteotomy and the bone surface features of the three-dimensional model of bone anatomy.

S300. Establish a characteristic position relationship with reference to the locatable characteristic anatomical structure and the osteotomy position under intraoperative fluoroscopy, including the distance and angle between the osteotomy position and a certain characteristic anatomical structure, etc.; wherein, the locatable characteristic anatomical structure may be Characteristic locations such as articular surfaces, femoral condyles or acetabulum.

S400. Design a developing structure that can be positioned fluoroscopically by a fluoroscopic device on the three-dimensional model of the osteotomy guide in step 200 according to the characteristic positional relationship.

S500. Use 3D printing technology to process and prepare individualized osteotomy guides that have been designed and confirmed by orthopaedic surgeons.

In the above embodiment, preferably, the shape and outline of the developing structure can be designed as required, including but not limited to any shape such as strip, wire, etc. For example, the developing structure can be a metal wire or a metal rod.

In the above embodiment, preferably, the fluoroscopy device is a C-shaped arm or a G-shaped arm that is most widely used in orthopaedic clinical surgery.

In the above-mentioned embodiment, preferably, in the process of performing step S400, it is necessary to fully consider the characteristics of the angle error of the C-arm or G-arm perspective, and if necessary, it is necessary to design both the front and rear perspective and the lateral perspective. Developed structure to increase the alignment of the projection angle.

Figures 2 and 3 show an example of the application of an osteotomy guide designed for a patient with a distal femoral tumor. The osteotomy guide has distal femoral condyle positioning that fits with the distal femoral condyle, the intercondylar fossa, and the precondyle of the femoral condyle, respectively. Section 1, intercondylar fossa positioning section 2 and femoral anterior condyle positioning section 3, femoral condyle distal end positioning section 1, intercondylar fossa positioning section 2 and femoral anterior condyle positioning section 3 are provided with suitable for fixing nails to pass through. The fixation hole 6 for the temporary fixation of the osteotomy guide, the positioning part 1 of the distal end of the femoral condyle and the positioning part 3 of the anterior condyle of the femoral condyle are provided with a transverse osteotomy slot 4 suitable for the osteotomy tool (such as a saw blade of an electric oscillating saw) to pass through , the positioning portion 2 of the intercondylar fossa is provided with a longitudinal osteotomy groove 5 suitable for the osteotomy tool to pass through. The developing structure includes a perspective angle correcting member 7 vertically protruding from the positioning portion 3 of the anterior condyle of the femoral condyle, and a characteristic positional relationship positioning member 8 arranged at 90° orthogonal to the perspective angle correcting member 7. The perspective angle correcting member 7 is used in the perspective equipment. It is used for angle correction and positioning under the anteroposterior fluoroscopy to ensure that the fluoroscopy equipment and the osteotomy guide are at an absolute 90° (at this time, the perspective angle correction column 7 is a point under the anteroposterior fluoroscopy). The characteristic positional relationship positioning member 8 is used to identify the characteristic positional relationship between the locatable characteristic anatomical structure and the osteotomy position. As shown in Figure 4, in this application example, the distance between the transverse osteotomy groove and the bone edge of the distal femur is 23mm, so that the distal end of the transverse osteotomy line is aligned with the edge of the femoral condyle, which can be accurately positioned 23mm away from this position. This improves the placement accuracy of the osteotomy guide, and provides support and guarantee for the subsequent high-precision osteotomy.

Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention, but not to limit them; although the present invention has been described in detail with reference to the foregoing embodiments, those of ordinary skill in the art should understand that it can still be The technical solutions described in the foregoing embodiments are modified, or some technical features thereof are equivalently replaced; and these modifications or replacements do not make the essence of the corresponding technical solutions deviate from the spirit and scope of the technical solutions of the embodiments of the present invention.

Claims (10)

1. A design method of a perspective developing positioning bone cutting guide plate is characterized by comprising the following steps:

establishing a skeletal anatomy three-dimensional model according to CT or/and nuclear magnetic data before a patient operation, and carrying out simulated bone cutting in the skeletal anatomy three-dimensional model to determine a bone cutting position and a bone cutting direction;

after the bone cutting position and the bone cutting direction are determined, the individualized design of the bone cutting guide plate is carried out according to the surface characteristics of bones, and a three-dimensional model of the bone cutting guide plate is obtained;

establishing a characteristic position relation with a characteristic anatomical structure which can be positioned under fluoroscopy in an operation and an osteotomy position;

designing a developing structure which can be positioned in a perspective manner through perspective equipment on the three-dimensional model of the osteotomy guide plate according to the characteristic position relation;

and processing and preparing the designed and confirmed individualized bone cutting guide plate.

2. The design method of claim 1, wherein the bone surface features comprise bone surface features at a location of a patient to be osteotomy and bone surface features of a three-dimensional model of bone anatomy.

3. The design method of claim 1, wherein the positionable feature anatomy includes, but is not limited to, an articular surface, a femoral condyle, or an acetabulum.

4. The design method of claim 1, wherein the established characteristic positional relationship includes, but is not limited to, a distance and an angle between an osteotomy position and a certain characteristic anatomical structure.

5. The design method of claim 1, wherein the development structure is a wire or a rod.

6. The design method of claim 1, wherein the fluoroscopy device is a C-arm or a G-arm.

7. The design method according to claim 6, wherein when designing the visualization structure that can be positioned by fluoroscopy with a fluoroscopy device on the three-dimensional model of the osteotomy guide, the characteristic of angular error of C-arm or G-arm fluoroscopy needs to be fully considered, and if necessary, the visualization structure is designed in both directions of front-back fluoroscopy and lateral fluoroscopy to increase the correction of the projection angle.

8. A perspective visualization positioning bone cutting guide, characterized in that the bone cutting guide is prepared by the design method as claimed in any one of claims 1 to 8.

9. The perspective visualization positioning bone cutting guide plate according to claim 8, wherein the bone cutting guide plate is a distal femur bone cutting guide plate, the distal femur bone cutting guide plate has a distal femur condyle positioning portion, an intercondylar notch positioning portion and a anterior femur condyle positioning portion respectively fitted with a distal femur condyle, an intercondylar notch and an anterior femur condyle, the distal femur condyle positioning portion, the intercondylar notch positioning portion and the anterior femur condyle positioning portion are respectively provided with fixing holes suitable for fixing nails to pass through for temporarily fixing the bone cutting guide plate, the distal femur condyle positioning portion and the anterior femur condyle positioning portion are provided with transverse bone cutting grooves suitable for a bone cutting tool to pass through, and the intercondylar notch positioning portion is provided with longitudinal bone cutting grooves suitable for the bone cutting tool to pass through; the developing structure comprises a perspective angle correcting part vertically protruding out of the femoral condyle anterior condyle positioning part and a characteristic position relation positioning part orthogonally arranged at 90 degrees with the perspective angle correcting part, and the perspective angle correcting part is used for correcting and positioning the angle in the front and back perspective of perspective equipment so as to ensure that the perspective equipment and the femoral distal osteotomy guide plate are in an absolute 90 degree angle; the characteristic position relationship locator is used for identifying the characteristic position relationship between the characteristic anatomical structure and the osteotomy position.

10. Use of the perspective visualization positioning bone cutting guide plate of claim 8 or 9 in osteotomy correction and bone tumor resection.

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