CAJ | 학술논문

目的利用逆向工程(reverse engineering,RE)和快速成型(rapid prototyping,RP)技术设计一种新的DDH患儿股骨截骨的方法,并探讨其临床应用.方法对2011年7月至2012年4月收治的11例DDH患儿进行CT连续扫描,将原始数据导入Mimics软件,三维重建患侧股骨模型,以.stl格式保存,导入Imageware12.0软件,定位三维参考平面,利用RE原理设计股骨短缩旋转截骨的最佳截骨平面和克氏针定位的最佳进钉钉道.提取股骨的表面解剖学形态及针道模型,建立与其解剖学形态一致的模板.拟合模板和克氏针针道成截骨模板,通过激光RP技术生产出实物模板.手术时首先将导航模板与股骨截骨部相吻合,置入克氏针后,沿导航模板进行截骨.术后根据X线片和CT扫描评价前倾角的大小.结果通过11例DDH患儿建立了制作个体化导航模板的方法,术后随访12～18个月,无1例出现再脱位和股骨头缺血坏死等并发症,所有患儿实际的前倾角纠正角度和术前设计一致.结论利用RE和RP技术生产出的导航模板具有较好的准确性,为DDH患儿股骨短缩旋转截骨提供了一种新的方法,具有较大的应用前景.
목적 이용역향공정(reverse engineering,RE)화쾌속성형(rapid prototyping,RP)기술설계일충신적DDH환인고골절골적방법,병탐토기림상응용.방법 대2011년7월지2012년4월수치적11례DDH환인진행CT련속소묘,장원시수거도입Mimics연건,삼유중건환측고골모형,이.stl격식보존,도입Imageware12.0연건,정위삼유삼고평면,이용RE원리설계고골단축선전절골적최가절골평면화극씨침정위적최가진정정도.제취고골적표면해부학형태급침도모형,건립여기해부학형태일치적모판.의합모판화극씨침침도성절골모판,통과격광RP기술생산출실물모판.수술시수선장도항모판여고골절골부상문합,치입극씨침후,연도항모판진행절골.술후근거X선편화CT소묘평개전경각적대소.결과 통과11례DDH환인건립료제작개체화도항모판적방법,술후수방12～18개월,무1례출현재탈위화고골두결혈배사등병발증,소유환인실제적전경각규정각도화술전설계일치.결론 이용RE화RP기술생산출적도항모판구유교호적준학성,위DDH환인고골단축선전절골제공료일충신적방법,구유교대적응용전경.
Objective To develop and validate a novel method of femoral corrective osteotomy by reverse engineering and rapid prototyping and explore its clinical application.Methods Between July 2011 and April 2012,computed tomography (CT) scans were performed for 11 cases of developmental dysplasia of the hip (DDH).The imaging data were transferred into the Mimics software.After reconstruction,a three-dimensional femoral model was established,saved in.stl format and imported into Imageware 12.0 software for determining the three-dimensional plane of reference.The optimal Kirschner wire channel for derotational femoral shortening osteotomy was extracted according to the principle of reverse engineering.The template was designed according to anatomic features of femoral surface and optimal osteotomy channel.Template was overlapped with navigational template manufactured by rapid prototyping.The template was placed distally on external femur.And the location for Kirschner wire insertion was defined by navigation template.The accuracy of screw placement was confirmed by postoperative radiology and CT scan.Results The digital navigational template had been established and used in all 11 cases.During a follow-up period of 12-18 months,there was no onset of such major osteotomy-related complications as redislocation or avascular necrosis.All actual femoral anteversion angles corresponded almost exactly to the planned corrective ones.Conclusions A novel method of derotational femoral shortening osteotomy has been developed with reverse engineering and rapid prototyping.And navigational template has a high accuracy and holds great prospects.It provides a new method of managing DDH in children.