三维重建结合快速成形术制作模板定位髋臼假体临床应用.doc

三维重建结合快速成形术制作模板定位髋臼假体临床应用 　 作者：杜浩，赵致良，干阜生，潘檀，王丹，裴国献 【摘要】 ［目的］利用三维重建、逆向工程设计方法、并结合快速成形技术为髋关节置换中髋臼假体植入提供一种精确定位的个体化设计方案。［方法］筛选出6例单侧股骨头坏死患者，收集CT扫描数据。将原始Dicom格式数据导入Amira 3.1软件，三维重建髋关节模型，以STL格式保存，导入Imageware 12.0软件，确定病变侧的正常髋臼旋转中心，设计出假体的最佳固定方向即中心轴，并提取髋臼表面解剖学形态。将二者结合，拟合成定位模板。再利用快速成形技术生成实物模型，术中将模型与髋臼凹面相匹配对假体置入方向进行定位。［结果］测量术后标准髋关节前后位片，髋臼假体外展角(46.00±2.49)°、前倾角(15.68±2.85)°，显示假体位置均达到预期定位效果。［结论］术前设计、构建的定位模板可以对髋臼假体植入精确定位，避免术中操作误差。 【关键词】 三维重建; 髋臼; 定位; 模板 Abstract：［Objective］To provide a precise individualized design proposal for locating acetabular prosthesis by means of 3D reconstruction,reverse engineering software and rapid prototyping technology.［Method］3D CT scan pelvis image data were obtained from six patients,which displayed osteonecrosis of femoral head on one side.The data were transferred via a DICOM network into a computer workstation.A 3D model of hip was reconstructed using Amira 3.1 software,and saved in STL format.Then the 3D model was imported into Imageware 12.0 software.The normal hip joint centre of abnormal side was determined and the best orientation of the prosthesis (which was central axial ray of acetabula) was defined using reverse engineering.Locating template was designed according to the anatomic features of the acetabula and the central axial ray.Entity model was produced by rapid prototyping technology.The orientation of the prosthesis was located by matching the model to acetabular concavity at operation.［Result］By measuring postoperative standard hip anteroposterior film,the abduction angle of acetabular prosthesis was (46.00±2.49)° and the anteversion angle was (15.68±2.85)°.The expected result was obtained.［Conclusion］The navigation template designed and constructed preoperatively can provide precise location for acetabular prosthesis and avoid procedural errors at operation. Key words：threedimensional reconstruction; acetabula; location; template 髋臼假体的准确定位一直是临床研究的热点及难点。传统的术中定位技术存在明显缺陷，而近10年来兴起的手术导航系统是也因设备昂贵、过程复杂、学习曲线长等原因，难以广泛推广。作者利用患者术前CT数据，