CN115444633A - 全髋关节置换术中股骨柄假体安装调整方法 - Google Patents

全髋关节置换术中股骨柄假体安装调整方法 Download PDF

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CN115444633A
CN115444633A CN202211173370.6A CN202211173370A CN115444633A CN 115444633 A CN115444633 A CN 115444633A CN 202211173370 A CN202211173370 A CN 202211173370A CN 115444633 A CN115444633 A CN 115444633A
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耿霄
田华
王静芝
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Peking University Third Hospital Peking University Third Clinical Medical College
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Abstract

本发明涉及关节置换技术领域,具体为全髋关节置换术中股骨柄假体安装调整方法,包括实时跟踪骨盆位置及姿态,模拟并求得股骨柄假体安装规划路线,具体包括如下步骤:(1)读入假体库模型相关信息;(2)将含有运动传感器的跟踪装置固定在患者骨盆上;(3)结合运动传感器捕获的位置与姿态信息;(4)采集股骨上A,B两点,记录此时的股骨姿态pos(A,B);(5)结合髋臼杯假体轴线方向及骨盆坐标系之间的关系,获取髋臼杯假体安装角度;本发明实现精准的股骨柄型号的选择与术中调整操作,避免脂凭借医生经验产生误差较大的判定,有效利用导航系统提供的数据,同时可以快速的找到合适的假体型号,无需反复试错,节省了手术时长。

Description

全髋关节置换术中股骨柄假体安装调整方法
技术领域
本发明涉及关节置换技术领域,具体为全髋关节置换术中股骨柄假体安装调整方法。
背景技术
全髋关节置换(Total hip arthroplasty,THA)是一种治疗髋关节疾病的新技术,可以有效地纠正关节畸变,改善关节功能,缓解骨质坏死等疾病,极大地提高患者的生活质量。随着医疗影像技术与现代化医疗器械的发展,术前规划与手术导航系统不仅可以有效辅助医生操作,也大幅提高了手术精度。
在手术过程中,需要用人工假体替换坏死的髋臼杯和股骨头,髋关节置换的假体组件包括髋臼杯,内衬,球头和股骨柄。在置换过程中一方面要保证假体间装配关系稳定,同时也要保证股骨柄假体型号及植入位置合理,否则极有可能导致患者术后假体脱落或患者不舒适等问题。
计算机辅助系统在髋关节置换中的应用,大幅度的提高了手术准确性,缩短了手术时间。通常情况下,计算机辅助系统包含术前规划与术中规划,通过术前3D模型与术中骨骼解剖结构配准,确定假体放置姿态。但是,在手术过程中,对于股骨柄型号的选择与术中调整,只能凭借外科医生的经验判断,无法有效利用导航系统提供的数据,往往为了找到合适的假体型号,需要反复试错,增加了手术时长。
发明内容
本发明的目的在于提供全髋关节置换术中股骨柄假体安装调整方法,包括实时跟踪骨盆位置及姿态,模拟并求得股骨柄假体安装规划路线,具体包括如下步骤:
(1)读入假体库模型相关信息;
(2)将含有运动传感器的跟踪装置固定在患者骨盆上;
(3)结合运动传感器捕获的位置与姿态信息;
(4)采集股骨上A,B两点,记录此时的股骨姿态pos(A,B);
(5)结合髋臼杯假体轴线方向及骨盆坐标系之间的关系,获取髋臼杯假体安装角度;
(6)再次采集股骨上A′,B′两点,记录此刻的股骨姿态pos(A′,B′);
(7)计算相对于术前的腿长及偏心距的变化;
(8)最终得出股骨柄安装规划路线,根据路线完成安装。
可选的,所述步骤(1)假体库模型相关信息具体包括但不限于:模型型号,模型参数,初始条件和边界条件。
可选的,所述步骤(3)通过采点注册将术前3D模型与术中骨骼解剖结构进行配准,获取股骨柄假体的位置与姿态信息的转换关系。
可选的,所述步骤(5)具体是骨盆坐标系由r,l,p三个特征点确定,其中r表示右侧髂前上棘,l表示左侧髂前上棘,p表示耻骨联合;分别用向量
Figure BDA0003864289210000021
表示r指向l的向量,
Figure BDA0003864289210000022
表示l指向p的向量;其中
Figure BDA0003864289210000023
表示骨盆x轴,向量
Figure BDA0003864289210000024
与向量
Figure BDA0003864289210000025
叉乘向量表示骨盆Y轴,向量
Figure BDA0003864289210000026
与向量
Figure BDA0003864289210000027
叉乘向量表示骨盆Z轴。
可选的,所述步骤(7)计算腿长及偏心距的具体步骤如下:
a)根据术前3D模型与术中骨骼解剖结构实时配准关系确定股骨头中心Hc;
B)根据髋臼杯假体中心及骨盆坐标系之间的关系确定髋臼杯植入中心Cc;
c)根据两次股骨验证钉采集到的姿态信息确定矫正转换矩阵:
R1=Rotate(pos(A,B),pos(A′,B′)) (1)
并计算新的股骨姿态:
pos(A″,B″)=R1(pos(A′,B′)) (2)
d)根据pos(A,B)和股骨头中心Hc确定相对位置关系:
T=Trans(pos(A,B),Hc), (3)
并更新矫正后的股骨姿态
pos(A″′,B″′)=T(pos(A″,B″),Cc) (4);
根据pos(A,B)与pos(A′,B′)计算相对于术前的腿长及偏心距变化。
可选的,所述步骤(8)股骨柄安装规划路线具体求解过程如下:
a)读入假体库模型相关信息θ;
b)根据腿长和偏心距的变化,以及当前股骨柄模型信息θ0,求解调整方向△1和△o,分别表示腿长和偏心距调整方向;
c)根据假体库模型相关信息,求解调整数值L和O,分别表示腿长和偏心距调整幅度;
d)求解规划路线调节方案f=F(△1,△o,L,O)。
与现有技术相比,本发明的有益效果是:
本发明通过读入假体库模型信息,利用运动传感器的跟踪患者骨盆的位置与姿态信息,采集股骨上A,B两点,记录此时的股骨姿态pos(A,B),结合髋臼杯假体轴线方向及骨盆坐标系之间的关系,获取髋臼杯假体安装角度,再次采集股骨上A′,B′两点,记录此刻的股骨姿态pos(A′,B′),根据两次股骨验证钉采集到的姿态信息确定矫正转换矩阵,并计算新的股骨姿态,根据pos(A,B)和股骨头中心Hc确定相对位置关系,并更新矫正后的股骨姿态,然后根据pos(A,B)与pos(A′,B′)计算相对于术前的腿长及偏心距变化,根据股骨柄安装规划路线,从而的得出规划路线调节方案为f=F(△l,△o,L,O),从而实现精准的股骨柄型号的选择与术中调整操作,避免脂凭借医生经验产生误差较大的判定,有效利用导航系统提供的数据,同时可以快速的找到合适的假体型号,无需反复试错,节省了手术时长。
附图说明
图1为本发明股骨柄调节示意图。
本发明目的的实现、功能特点及优点将结合实施例,参照附图作进一步说明。
具体实施方式
下面将结合本发明实施例中的附图,对本发明实施例中的技术方案进行清楚、完整地描述,显然,所描述的实施例仅仅是本发明一部分实施例,而不是全部的实施例。基于本发明中的实施例,本领域普通技术人员在没有做出创造性劳动前提下所获得的所有其他实施例,都属于本发明保护的范围。
请参阅图1,本发明提供全髋关节置换术中股骨柄假体安装调整方法,包括实时跟踪骨盆位置及姿态,模拟并求得股骨柄假体安装规划路线,具体包括如下步骤:
(1)读入假体库模型相关信息,假体库模型相关信息具体包括但不限于:模型型号,模型参数,初始条件;
所述假体库模型包括多种人或动物假体的模型,例如,股骨柄假体的模型。其中,所述模型型号是指假体模型的型号。所述模型参数是模型内部的可配置变量。具体地,所述模型参数可以包括假体颈干角、柄体宽度和颈干长度。所述初始条件即为预先确定的假体规格、参数等。具体地,所述初始条件可以包括股骨柄头部位置、股骨颈干方向和柄体方向。
(2)将含有运动传感器的跟踪装置固定在患者骨盆上。
所述运动传感器原理为:人体体温一般恒定在37度,会发出特定波长(如10微米左右)的红外线。运动传感器内置的红外探头刚好可以探测到人体发射的波长为10微米左右的红外线。所述波长为10微米左右的红外线通过菲涅尔滤光片增强后聚集到红外感应源上,红外感应源通常采用热释电元件,这种元件在接收到人体红外辐射温度发生变化时就会失去电荷平衡,向外释放电荷,产生电信号。检测人体辐射出的红外线的位置,达到检测人体运动的目的。
(3)结合运动传感器捕获的位置与姿态信息,将术前股骨柄3D模型与术中股骨柄假体结构进行配准,进而对股骨柄假体与股骨柄3D模型结构进行尺寸特征对比,根据尺寸特征,获取股骨柄假体的位置与姿态信息的转换关系;
(4)采集股骨上A,B两点的坐标位置,记录此时的股骨姿态pos(A,B);
(5)结合髋臼杯假体轴线方向及骨盆坐标系之间的关系,获取髋臼杯假体安装角度,髋臼杯假体安装角度具体为:先确定骨盆坐标系,在骨盆坐标系下根据前倾角为40,外展角为20,计算杯口法向在世界坐标系下的表示,骨盆坐标系由r,l,p三个特征点确定,其中r表示右侧髂前上棘,l表示左侧髂前上棘,p表示耻骨联合;分别用向量
Figure BDA0003864289210000051
表示r指向l的向量,
Figure BDA0003864289210000052
表示l指向p的向量;其中
Figure BDA0003864289210000053
表示骨盆x轴,向量
Figure BDA0003864289210000054
与向量
Figure BDA0003864289210000055
叉乘向量表示骨盆Y轴,向量
Figure BDA0003864289210000056
与向量
Figure BDA0003864289210000057
叉乘向量表示骨盆Z轴;
(6)在股骨运动过后,再次采集股骨上A',B'两点的坐标位置(A'与A为股骨上的同一点,B'与B为股骨上的同一点),记录此刻的股骨姿态pos(A',B');
(7)计算相对于术前的腿长及偏心距的变化,计算腿长及偏心距的具体步骤如下:
a)根据术前3D模型与术中骨骼解剖结构实时配准关系,结合股骨运动进而确定股骨头中心点Hc,且股骨头可近似看做一个球,而中心点即为股骨头这个球的中心;
b)根据髋臼杯假体中心及骨盆坐标系之间的关系,确定髋臼杯植入中心Cc;
c)根据两次股骨验证钉(两次分别对应A,B两点与A′,B′两点)采集到的姿态信息确定矫正转换矩阵R1,所述矫正转换矩阵R1用于确定需要矫正的位置:
R1=Rotate(pos(A,B),pos(A′,B′)), (1)
并计算新的股骨姿态(术后矫正后的股骨姿态),其中理想状态下,术前与术后测量腿长和偏心距时,股骨姿态应该保持一致;但是,在手术过程中,患者股骨位置与姿态不可避免会发生位移和姿态的变化,为了避免位姿变化引起的误差,会在术前和术后采集股骨验证钉(验证钉与股骨相对位置固定),将术后股骨矫正至术前状态,再计算腿长和偏心距的变化,新的股骨姿态即为术后矫正后的股骨姿态。
pos(A″,B″)=R1(pos(A′,B′)), (2)
d)根据pos(A,B)和股骨头中心Hc确定相对位置关系,其中,pos(A,B)是指股通过验证钉获取的(可近似看做髓腔轴方向),在手术过程中,认为该方向与股骨头中心的相对位置保持一致:
T=Trans(pos(A,B),Hc), (3)
并更新矫正后的股骨姿态:
pos(A″′,B″′)=T(pos(A″,B″),Cc), (4);
根据pos(A,B)与pos(A′,B′)结合上述(1)、(2)、(3)和(4)来计算相对于术前的腿长及偏心距变化,其中偏心距为两次股骨头中心的位移距离;
(8)最终得出用于安装股骨柄假体的股骨柄安装规划路线,股骨柄安装规划路线具体求解过程如下:
a)读入假体库模型相关信息θ;
b)根据腿长和偏心距的变化,以及当前股骨柄模型信息θ0,求解调整方向△l和△o,分别表示腿长调整方向和偏心距调整方向;
c)根据假体库模型相关信息,求解调整数值L和O,分别表示腿长调整幅度和偏心距调整幅度;
d)求解规划路线调节方案f=F(△l,△o,L,O),其中F表示整个算法流程。
以上内容是结合具体实施方式对本发明作进一步详细说明,不能认定本发明具体实施只局限于这些说明,对于本发明所属技术领域的普通技术人员来说,在不脱离本发明的构思的前提下,还可以做出若干简单的推演或替换,都应当视为属于本发明所提交的权利要求书确定的保护范围。

Claims (6)

1.全髋关节置换术中股骨柄假体安装调整方法,其特征在于:包括实时跟踪骨盆位置及姿态,模拟并求得股骨柄假体安装规划路线,具体包括如下步骤:
(1)读入假体库模型相关信息;
(2)将含有运动传感器的跟踪装置固定在患者骨盆上;
(3)结合运动传感器捕获的位置与姿态信息;
(4)采集股骨上A,B两点,记录此时的股骨姿态pos(A,B);
(5)结合髋臼杯假体轴线方向及骨盆坐标系之间的关系,获取髋臼杯假体安装角度;
(6)再次采集股骨上A',B'两点,记录此刻的股骨姿态pos(A',B');
(7)计算相对于术前的腿长及偏心距的变化;
(8)最终得出股骨柄安装规划路线,根据路线完成安装。
2.根据权利要求1所述的全髋关节置换术中股骨柄假体安装调整方法,其特征在于:所述步骤(1)假体库模型相关信息具体包括但不限于:模型型号,模型参数,初始条件和边界条件。
3.根据权利要求1所述的全髋关节置换术中股骨柄假体安装调整方法,其特征在于:所述步骤(3)通过采点注册将术前3D模型与术中骨骼解剖结构进行配准,获取股骨柄假体的位置与姿态信息的转换关系。
4.根据权利要求1所述的全髋关节置换术中股骨柄假体安装调整方法,其特征在于:所述步骤(5)具体是骨盆坐标系由r,l,p三个特征点确定,其中r表示右侧髂前上棘,l表示左侧髂前上棘,p表示耻骨联合;分别用向量
Figure FDA0003864289200000011
表示r指向l的向量,
Figure FDA0003864289200000012
表示l指向p的向量;其中
Figure FDA0003864289200000013
表示骨盆x轴,向量
Figure FDA0003864289200000014
与向量
Figure FDA0003864289200000015
叉乘向量表示骨盆Y轴,向量
Figure FDA0003864289200000016
与向量
Figure FDA0003864289200000017
叉乘向量表示骨盆Z轴。
5.根据权利要求1所述的全髋关节置换术中股骨柄假体安装调整方法,其特征在于:所述步骤(7)计算腿长及偏心距的具体步骤如下:
a)根据术前3D模型与术中骨骼解剖结构实时配准关系确定股骨头中心Hc;
b)根据髋臼杯假体中心及骨盆坐标系之间的关系确定髋臼杯植入中心Cc;
c)根据两次股骨验证钉采集到的姿态信息确定矫正转换矩阵:
R1=Rotate(pos(A,B),pos(A′B′)) (1)
并计算新的股骨姿态:
pos(A″,B″)=R1(pos(A′,B′)) (2)
d)根据pos(A,B)和股骨头中心Hc确定相对位置关系:
T=Trans(pos(A,B),Hc), (3)
并更新矫正后的股骨姿态
pos(A″′,B″′)=T(pos(A″,B″),Cc); (4)
根据pos(A,B)与pos(A′,B′)计算相对于术前的腿长及偏心距变化。
6.根据权利要求1所述的全髋关节置换术中股骨柄假体安装调整方法,其特征在于:所述步骤(8)股骨柄安装规划路线具体求解过程如下:
a)读入假体库模型相关信息θ;
b)根据腿长和偏心距的变化,以及当前股骨柄模型信息θ0,求解调整方向Δl和Δo,分别表示腿长和偏心距调整方向;
c)根据假体库模型相关信息,求解调整数值L和O,分别表示腿长和偏心距调整幅度;
d)求解规划路线调节方案f=F(Δl,Δo,L,O)。
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