数字化骨科手术新方法的建立及其临床广泛应用

目的研究出独特的数字化骨科手术新方法 ,广泛应用于脊柱外科手术、骨关节创伤治疗、韧带重建修复、骨肿瘤切除重建、骨关节严重畸形矫正等骨科各分支领域,探讨数字化骨科手术的特点和临床效果,以期运用现代计算机辅助技术和图像分析处理技术提高骨科疾患诊治水平。方法按反求工程的基本原理,通过CT/MRI扫描获取患者骨骼的二维图像资料,采用计算机辅助三维重建技术建立骨关节解剖模型,将骨关节解剖模型输入计算机辅助设计(computer assisted design,CAD)软件进行精确分析,进一步采用先进制造技术——快速成型(rapid prototyping,RP)技术制作骨关节原型并进行实物原型分析,而后将骨关节解剖模型输入计算机进行外科手术过程的设计和预演,合适内固定材料的选择以及基于CAD-RP技术外科手术辅助模板、个性化植入物的制作等,最后精确实施骨科手术。结果采用该方法治疗123例骨科疾患,在以下临床数字骨科学领域获得成熟经验:(1)计算机辅助骨关节畸形精确数字化矫形;(2)计算机辅助设计个性化假体:如全膝、全髋、半骨盆等;(3)计算机辅助前、后交叉韧带重建;(4)计算机辅助特殊疑难假体置换:如发育不良性髋脱位假体置换及翻修手术、髋臼发育不良并骨性关节炎全髋置换手术等;(5)计算机辅助特殊疑难骨折、关节内骨折以及陈旧性骨折的复位固定等;(6)骨肿瘤个性化切除的设计、结构与功能重建;(7)脊柱侧弯的个性化矫形设计与精确实施;(8)脊柱后凸的个性化矫形设计与精确实施;(9)计算机辅助齿状突骨折复位固定;(10)计算机辅助寰枢椎后路内固定的手术设计和精确置钉技术;(11)计算机辅助颈椎椎弓根的形态分析、测量与精确置钉技术。结论借助现代计算机技术和先进制造技术,术者可以通过CAD、骨关节原型制作、计算机辅助手术设计和预演、个性化辅助手术模板及个性化骨缺损修复植入物制作等手段精确实施骨科手术,实现骨科手术的数字化、个性化和精确化,从而进一步提高手术安全性,改善临床效果。

Establishment of a new method of digital orthopedic surgery and its clinical widespread application

Objective To create an unique new method of digital orthopedic surgery and widely apply in spinal surgery, treatment of bone and joint injuries, ligament reconstruction and repair, bone tumor resection and reconstruction, serious bone and joint malformation correction. This method can be used to investigate the clinical and surgical characteristics of digital orthopedic surgery by using a modern computer assisted processing and image analysis technique, therefore to improve diagnosis and therapy level for orthopedic patients. Methods According to fundamental principles of reverse engineering, 2D bone images scanned by CT/MRI were gained, then 3D anatomic models of bone and joint were reconstituted with computer-aided technique which were then inputted into computer assisted design（CAD） software and analyzed exactly. Entities of bone and joint models were manufactured using rapid prototyping （RP） technique. Subsequently anatomic models were inputted into computer to carry out the design and preoperative rehearsal for surgical procedure, selection of suitable internal fixation materials, and the manufacturing of CAD-RP aided surgical templates and individualized implants. Eventually, orthopedic surgery was performed precisely. Results One hundred and twenty-three orthopedic patients were treated by this methods and the experiences were obtained in the following clinical digital orthopedic fields： 1. computer-aided digital precise correction of bone and joint malformation. 2. CAD-based individualized prosthesis of total knee, total hip, half pelvis. 3. computer-aided reconstruction of anterior and posterior cruciate ligament. 4. computer-aided prosthetic displacement in some special and difficult cases, such as prosthetic displacement or revision surgery for developmental dislocation of hip, total hip displacement for acetabular dysplasia with osteoarthritis. 5. computer-aided reduction and fixation for some special and difficult fractures, intra-articular fractures and neglected fractures. 6. individualized resection design, structural and functional reconstruction of bone tumor. 7. individualized orthopedic design and precise operation for scoliosis patients. 8. individualized orthopedic design and precise operation for kyphosis patients. 9. computer-aided reduction and fixation for treating odontoid bone fracture. 10. computer-aided operation design and exact pedicle screw placement for posterior atlantoaxial internal fixation. 11. computer-aided cervical pedicle shape analysis, measurement and accurate pedicle screw placement. Conclusions Depending on modern computer and advanced manufacturing techniques, orthopedic surgery can be performed precisely by the measures of CAD, bone and joint prototyping, computer assisted surgical design and rehearsal, individualized manufacturing of aided surgical templates, and bone defect implants, and then improve surgical safety and clinical effects.