摘要
目的 探讨股骨转子间骨折及股骨远端骨折三维数字化模型的建立及其在可视化仿真手术中的应用. 方法 分别采集1例男性右侧股骨转子间骨折（年龄为45岁）和1例女性左侧股骨远端骨折（年龄为34岁）患者64排螺旋CT的原始扫描数据,通过自适应区域生长算法对CT序列图像进行图像程序分割和自动提取,再采用自行研发的医学图像处理软件MIPS对图像数据进行三维重建,并导入FreeForm Modeling System V9.0软件中进行图像修饰,利用计算机设计与制造软件Unigraphics NX4.0和FreeForm Modeling System V9.0软件开发出动力髋螺钉（DHS）、股骨远端微创内固定系统（LISS）钢板和逆行髓内钉仿真手术器械,利用PHANTOM力反馈设备进行骨折患者术前的可视化仿真手术研究. 结果 骨折三维重建模型以及DHS、LISS钢板和逆行髓内钉仿真手术器械直观、立体、逼真,立体可视化效果好,可以从任意方位和角度观察、截图.在骨折的仿真手术系统中,股骨转子间骨折采DHS固定,股骨远端骨折分别用LISS钢板和逆行交锁髓内钉固定,利用仿真手术器械和PHANTOM力反馈设备完成的仿真手术效果逼真.股骨转子间骨折与股骨远端骨折患者虚拟手术设计从三维模型的建立至内固定完成所需时间分别为1.2、1.5h. 结论 股骨转子间骨折与股骨远端骨折可视化仿真手术可以让术者术前对骨折块的三维结构有清晰的了解,有利于合理选择个体化手术方案,提高手术效果.
Objective To study the application of three-dimensional （3D） models of femoral intertrochanteric and distal fractures in visualized simulative surgery.Methods Enrolled in this study were a male patient （45 years old） with right femoral intertrochanteric fracture and a female patient （34 years old） with left femoral distal fracture.Their original image data of 64-slice spiral CT were obtained.Using adaptive region growing algorithm,the serial CT images were segmented and automatically extracted for 3D reconstruction of the femur and its anatomically related structures with a self-designed program.The model was then processed with Freeform Modeling System for image modification and smoothing.Next Computer Aided Design （CAD） software Unigraphics NX4.0 and Freeform Modeling System V9.0 were used to develop dynamic hip screw system,femoral retrograde intramedullary nailing system and less invasive stable system.With the assistance of GHST SDK and PHANTOM software,preoperative simulative surgery for femoral fractures was performed on the basis of the established femoral model.Results The reconstructed 3D model clearly and freely demonstrated the 3D images of the femoral structures,the intertrochanteric fracture with dynamic hip plate fixation,the femoral distal fracture with AO LISS plating and retrograde intramedullary nailing.During the simulative surgery for femoral fractures,the GHOST SDK system allowed effective application of the virtual surgical instruments.The use of PHANTOM software produced a surgical experience highly resembling that from an actual operation.The whole process from the start of model establishment till the finish of internal fixation lasted 1.2 hours for the femoral intertrochanteric fracture and 1.5 hours for the femoral distal fracture.Conclusion Since the visualized simulative surgery for femoral intertrochanteric and distal fractures on the 3D model can familiarize surgeons with the 3D structures of the fracture,it has a great value in individualized surgical planning and
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第5期410-414,共5页
Chinese Journal of Orthopaedic Trauma
基金
河南省卫生厅医学科技攻关计划项目（2011020026）
关键词
髋骨折
股骨骨折
成像
三维
可视化仿真手术
Hip fractures
Femoral fractures
Imaging, three-dimensional
Visual simulationsurgery
