自主研发的计算机辅助设计软件／快速成型／髋臼定位器系统模拟臼杯假体精准植入的实验研究  

Pre-clinical application of self-developed computer assisted design/rapid prototyping and guidancesystem to assist precise acetabular component placement： A pilot study

作　　者：邬培慧[1] 刘志涛[2] 张英琪[3] 杨子波[1] 盛璞义[1] 赵光华[1] 康焱[1] 张志奇[1] 傅明[1] 廖威明[1] 

机构地区：[1]中山大学附属第一医院关节外科,广州510080 [2]中科院广州电子技术有限公司,广州510070 [3]同济大学附属同济医院骨科,上海200065

出　　处：《中华创伤骨科杂志》2017年第4期323-328,共6页Chinese Journal of Orthopaedic Trauma

基　　金：广东省科技计划项目（20158010125005）;广东省科技计划项目（20168090916002）;国家自然科学基金（81501877）;广东省自然科学基金（2015A030310207）

摘　　要：目的探讨自主研发的计算机辅助设计软件／快速成型／术中定位器（CAD／RP／G）系统模拟臼杯假体精准植入的准确性和临床适用性。方法收集2016年1月至2017年1月10例（10髋）行全髋关节置换术（THA）的髋臼形态严重畸形的髋关节骨关节炎患者的术前髋关节CT原始数据。比较自主研发的CAD软件与Mimicsv17．0软件在导入这些CT数据、重建模型、分割模型、调节臼杯植入位置和导出STL文件所需的总时间；采用自主开发的DLP3D打印机与市售的StratasysObjet30打印机、StratasysDemensionSSTl200es打印机对每例患者所生成的3种髋臼模型进行RP，比较、评估这3种打印机的成型效率和精度；评估通过髋臼定位器辅助定位的模拟手术臼杯植入的精准度。结果自主研发的CAD软件与Mimicsv17．0软件完成术前三维分析所需平均时间分别为（7．7±1．3）、（52．5±15．9）min，差异有统计学意义（P〈0．001）。两种软件生成的同一患者的三维模型进行pointbased形态对比分析，平均差异为（0．0721±0．0691）mm；DLP3D打印机、SLA打印机和FDM打印机RP髋臼模型平均耗时分别为（5．3±0．6）、（10．8±0．5）、（9．3±0．6）h，差异有统计学意义（P〈0．001）。髋臼定位器辅助定位准确，臼杯在3D打印的实体髋臼模型的植入位置与目标位置差异无统计学意义（p〉0．05）。结论自主研发的CAD／RP／G系统具有良好准确性和临床适用性，可以为臼杯假体准确安放提供新的辅助措施。Objective To introduce a self-developed computer-assisted design/rapid prototyping and guidance system used for precise placement of the acetabular component in total hip arthroplasty. Methods We collected the preoperative pelvic CT scanning data of 10 hips with acetabular dysplasia that had undergone primary total hip arthroplasty from January 2016 to January 2017. The total time for import of radiographic images, model reconstruction, model segmentation, aeetabular component position design and STL model export was calculated and compared between our self-designed software and Mimics v17.0. Three kinds of STL model from each case were imported into our self-developed 3D printing device, Stratasys Objet30 and Stratasys Demension SST1200es respectively for rapid prototyping. The printing efficiency and accuracy were compared among the 3 printers. The accuracy of placing acetabular component with guidance system was e- valuated. Results The average time for preoperative planning was 7.7 ± 1.3 min by our self-designed softwareand 52. 5 ＋ 15.9 min by Mimics v17. O, showing a significant difference （ P 〈 0. 001 ） . In morphological point-based comparison for each case, the 3D models exported by the 2 different kinds of software showed an average difference of 0. 072 1 ± 0. 069 1 mm. The average durations for rapid prototyping by the 3 different printers were 5.3± 0.6 h, 1.3.8 ± O. 5 h, and 9.3 ±3.6 h, respectively, showing significant differences （P 〈 0. 001） . The guidance system resulted in precise placement. The locations of the ac- etabular component achieved by guide-assisted placement were not significantly different from the target ones （P 〉 0. 05） . Conclusion Our self-developed preoperative planning software, rapid prototyping device and guidance apparatus for acetabular component placement may lead to good accuracy and high efficiency.

关 键 词：关节成形术 置换 髋 计算机辅助设计 假体和植入物 3D打印 

分 类 号：R687.4[医药卫生—骨科学] TP391.72[医药卫生—外科学]