计算机辅助技术在骨关节疾病中的应用

背景：以往采用二维图像资料如X射线片、CT、MRI扫描等进行骨关节病手术设计，在反映骨关节病变严重程度、病变位置和畸形情况等方面不全面、欠准确，而且缺少直观性。 目的：研究计算机辅助设计和快速成型技术辅助骨关节伤病手术治疗的新方法。 方法：按反求工程的基本原理，采用医学CT/MRI扫描获取106例骨伤病患者骨骼二维图像资料，采用计算机辅助三维重建建立骨、关节解剖模型，将骨、关节解剖模型输入CAD软件进行精确分析，进一步采用快速成型技术制作骨关节原型进行实物原型分析，然后将骨关节解剖模型输入计算机进行外科手术过程设计、预演，选择合适的内固定材料，计算机辅助设计、快速成型技术制作外科手术辅助模板、个性化植入物等，最后精确实施骨关节外科手术。 结果与结论：31例骨关节畸形患者术后恢复良好的解剖外形和功能；17例前后交叉韧带损伤患者术后膝关节功能良好；31例骨折患者术后3~6个月获得骨折愈合；7例个性化假体和8例内固定重建肿瘤切除后骨缺损患者，随访期间未发现内固定器械断裂、假体松动和肿瘤复发；12例髋臼发育不良患者术后恢复正常髋臼包容和良好髋关节功能。提示计算机辅助技术可应用于骨关节畸形精确数字化矫形，设计个性化假体，辅助前后交叉韧带重建，疑难假体置换，辅助特殊疑难骨折、关节内骨折、陈旧性骨折复位、固定，骨肿瘤的个性化切除设计、结构与功能重建。

Application of computer aided technique in osteoarthrosis

BACKGROUND: Previous two-dimensional (2D) image data, such as X-ray film, CT, MRI scans has been used for surgery design of osteoarthrosis, which reflect the severity of osteoarthrosis, pathological location, and deformation, such as incomplete, less accurate, and the lack of intuitive. OBJECTIVE: To investigate new method of computer aided design and rapid prototyping (RP) technology for surgery treatment in osteoarthrosis. METHODS: According to fundamental principle of reverse engineering, 2D bone image of 106 cases with osteoarthrosis were scanned by medical CT/MRI, and three dimensional (3D) anatomy model of bone and joint was reconstituted with computer-aided technique. Anatomy model of bone and joint was inputted into CAD software and exactly analyzed. The entity of bone and joint model was manufactured with modern manufacture technique-RP technique to undergo the analysis of entity prototyping. Then anatomy model of bone and joint was inputted into computer to design and preview the process of surgical operation. A suitable internal fixation material was selected and surgical operation aided template and individual implant were manufactured with CAD and RP technique. Eventually bone and joint surgical operation was exactly performed. RESULTS AND CONCLUSION: A total of 31 cases of bone and joint deformity recovered good anatomy form and function. Seventeen cases of anterior cruciate ligament or posterior cruciate ligament had a good knee joint function. Thirty-one cases of fracture obtained the union of fracture after postoperative 3-6 months. Seven cases of customize individual prosthesis and 8 cases of internal fixation of bone defect reconstruction after tumor resection. No internal fixation equipment failure, prosthesis loosening, and tumor recurrence were occurred during the follow-up. Twelve cases of acetabular dysplasia recovered the normal acetabulum containment and good hip joint function. It is indicated that computer aided technique can be applied to precise digital orthopedics operation of bone and joint deformity, design individual prosthesis, support anterior cruciate ligament or posterior cruciate ligament reconstruction and difficult prosthesis replacement, assist special difficult fractures, intraarticular fracture, obsolete fracture reposition, fixation, personalized excision design, structure, and functional reconstruction of bone tumor.