计算机辅助导航模板在DDH患儿股骨截骨中的临床应用  

Clinical application of computer-assisted navigational template for femoral corrective osteotomy in developmental dysplasia of the hip

作　　者：史强[1] 李旭[1] 吴伟平[1] 李鉴轶[2] 孔祥雪[2] 戴双武[1] 谭为[1] 金大地[1] 

机构地区：[1]南方医科大学第三附属医院(广东省骨科研究院)儿童骨科,广州510630 [2]南方医科大学人体解剖学教研室

出　　处：《中华小儿外科杂志》2015年第7期506-508,512,共4页Chinese Journal of Pediatric Surgery

摘　　要：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Imagewarel2．0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。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 avaseular 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.

关 键 词：髋脱位 截骨术 外科手术 计算机辅助 

分 类 号：R726.8[医药卫生—儿科]