CAJ | 학술논문

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.
목적 탐토고골전자간골절급고골원단골절삼유수자화모형적건립급기재가시화방진수술중적응용. 방법 분별채집1례남성우측고골전자간골절(년령위45세)화1례녀성좌측고골원단골절(년령위34세)환자64배라선CT적원시소묘수거,통과자괄응구역생장산법대CT서렬도상진행도상정서분할화자동제취,재채용자행연발적의학도상처리연건MIPS대도상수거진행삼유중건,병도입FreeForm Modeling System V9.0연건중진행도상수식,이용계산궤설계여제조연건Unigraphics NX4.0화FreeForm Modeling System V9.0연건개발출동력관라정(DHS)、고골원단미창내고정계통(LISS)강판화역행수내정방진수술기계,이용PHANTOM력반궤설비진행골절환자술전적가시화방진수술연구. 결과 골절삼유중건모형이급DHS、LISS강판화역행수내정방진수술기계직관、입체、핍진,입체가시화효과호,가이종임의방위화각도관찰、절도.재골절적방진수술계통중,고골전자간골절채DHS고정,고골원단골절분별용LISS강판화역행교쇄수내정고정,이용방진수술기계화PHANTOM력반궤설비완성적방진수술효과핍진.고골전자간골절여고골원단골절환자허의수술설계종삼유모형적건립지내고정완성소수시간분별위1.2、1.5h. 결론 고골전자간골절여고골원단골절가시화방진수술가이양술자술전대골절괴적삼유결구유청석적료해,유리우합리선택개체화수술방안,제고수술효과.
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 improving the surgical efficacy.