A kind of acetabular bone navigation guide plate, preparation method and application method using 3D printing designTechnical field
The invention belongs to medical instruments fields, and in particular to a kind of to utilize the acetabular bone navigation guide plate of 3D printing design, preparationMethod and application method.
Background technique
Full bones of the body joint is made of bones of the body mortar and femoral head, and full bones of the body joint replacement surgery is to utilize artificial full bones of the body joint replacement human bodyThe full bones of the body joint of lesion.Need to carry out bones of the body mortar cleaning in full bones of the body joint replacement surgery, the process of cleaning includes soft tissue excision, boneSuperfluous excision and bones of the body mortar rasion.Bones of the body mortar rasion is to carry out deepening to increase to bones of the body mortar using bones of the body mortar file being easily installed mortar cup to be formedThe mortar bed of (artificial bones of the body mortar), the depth and width and mortar bed axial line of mortar bed and the registration of patient's bones of the body mortar axis are to influence mortar cupAn important factor for mounting stability.Therefore, it requires to file using the top rake of bones of the body mortar and angle of splay as bones of the body mortar respectively in clinicRasion angle carries out rasion.However, relying primarily on the professional standards and warp of doctor at present due to being difficult to position rasion angleIt tests and subjective judgement is carried out to rasion angle, the marrow mortar axis of the axial line and patient's script that are thus easy to cause mortar bed occurs larger inclinedDifference influences operative effect so as to cause mortar cup implantation position deviation.It can be seen that how to improve the positioning accuracy of rasion angleIt is the key factor for improving mortar cup prosthesis implantation precision.In addition, the bones of the body mortar form of different patients is deposited due to the difference between individualDifference (top rake or angle of splay have differences), the rasion angle that different patients need is also different.
For technological deficiency existing for acetabular bone rasion, the prior art proposes a variety of different and technical solution, but existingThere is certain technological deficiency in technology, make a concrete analysis of as follows:
If the patent of Publication No. CN204072394U discloses a kind of marrow mortar guide plate, which includes in the form of sheets and interior tableThe ontology that face matches at least part of marrow mortar inner surface, body edges and marrow margo infraglenoidalis marrow mortar incisura and marrow mortar lip shapeState is consistent, is equipped with positioned at marrow mortar rotation center and runs through a guide post of ontology on the body, is a centre bore among guide post,The axis and patient's acetabular bone axis co-axial of the centre bore.In surgical procedure, by the lower edges of guide plate and marrow margo infraglenoidalis incisuraIt is matched with marrow mortar lip to be accurately positioned, in the centre bore by guide-localization nail across guide post, so that it is determined that marrow mortarRotation center, according to guide-localization nail direction carry out next step marrow mortar processing and mortar cup prosthesis install.
The technological deficiency performance of the technology is specific as follows:In use, since marrow mortar guide plate does not fix device, using leadingWhen column centre bore follows closely locating pin, certain displacement is likely to cause during manual operation；Due to the bone of acetabular bone mortar nest bottomMatter is relatively thin, and dynamics grasp is inappropriate, be easy to cause secondary injury；After locating pin determines the rotation center of acetabular bone, need to determinePosition nail takes out, and removes acetabular bone guide plate, then polishes acetabular bone, during bruting process, the top rake and angle of splay of bones of the body mortarConfirm completely by doctor's eyesight, is easy to appear deviation.
For another example the patent of Publication No. CN104887361B discloses a kind of customization individuation manually full marrow joint replacement handArt marrow mortar prepares template system, which includes marrow mortar positioning guiding plate, deep-controlled drill bit and have color depth indicating bar,Marrow mortar positioning guiding plate includes: fossa ovalis positioning plate, is attached on fossa ovalis according to fossa ovalis anatomical shape;Mortar bottom positioning plate is setIt sets in the outer rim of fossa ovalis positioning plate, is attached on marrow mortar cartilage surface according to marrow mortar anatomical shape;The setting of depth guide cylinder existsOn the positioning plate of mortar bottom, guiding and depth limit are carried out to deep-controlled drill bit;Deep-controlled drill bit is by depth guide cylinder in marrowIt drills on mortar, the body portion of deep-controlled drill bit is provided with the depth limiting ring of prominent drill bit, and depth limiting ring is limited in depth by depth guide cylinderSpend the end of guide cylinder.There is color depth indicating bar length identical with drilling depth, inserts in the hole and prompt the effect of depth and direction.Marrow mortar positioning guiding plate is removed, acetabular bone is carried out to be polishing to supracotyloid coloration indicating bar disappearance.
The technological deficiency performance of the technology is specific as follows:The technology has been polishing to color depth instruction by carrying out to acetabular boneStick disappears, and due to only having several points in acetabular bone, in acetabular bone bruting process, does not represent mortar nest just in place to point polishingComply fully with operation needs, it is also necessary to which whether other positions are suitable by the micro-judgment of doctor, and rule of thumb polishThere can be certain error；The use needs that the acetabular bone prepares template system are first fixed it, then drill, take outAcetabular bone prepares template system, and color depth indicating bar has been squeezed into in the drilling of acetabular bone, has then been polished acetabular bone, whole flow processRequired time is longer, increases operating time, extends operating time.
For another example the patent of Publication No. CN105559951B discloses a kind of bones of the body mortar guide plate of personalized customization, which leadsPlate include hemispheric cup body, by cup edge be folded upward at extension and interruption-like setting two registration arm, by cup body appearanceFace protrudes out the abutting foot of setting and upwardly extends the guide part of setting by bottom of cup.The registration arm have with around marrow mortarThe contact portion that position abuts, the abutting foot are abutted with marrow mortar nest.The guide part has a longitudinally disposed pilot hole.It is describedAxis is set by preoperative planning and is overlapped with the central axis of marrow mortar where the extending direction of the pilot hole of marrow mortar guide plate.
The technological deficiency performance of the technology is specific as follows:Structure is complex, and the acetabular bone navigation panel set time is longer, makesWith complex steps, occupancy operating time is longer, extends operating time；Before acetabular bone polishing, need to lead the acetabular boneBoat plate is taken away, after acetabular bone is taken away, although there is hole location that polishing is assisted to carry out angle modification on acetabular bone, and due to only with doctors experience,It is easy to produce certain error.
For another example the patent of Publication No. CN108742770A disclose for full marrow joint replacement surgery rasion guide plate andIts manufacture, application method, the rasion guide plate include carrying out 3D according to the threedimensional model of patient's marrow mortar mortar nest with the ratio of 1:1 to beatThe nest shape guide plate of print is evenly distributed at least two hollow guide posts on the outside of the edge of nest shape guide plate opening;Nest shape guide plate and marrowAfter the fitting of mortar mortar nest inner surface, the axis of hollow guide post is enabled to be parallel to patient's marrow mortar axis.In use, in hollow guide postSteel nail is squeezed into, rasion guide plate is removed, so that marrow mortar file can carry out rasion along the axis direction of steel nail.
The technological deficiency performance of the technology is specific as follows:It polishes before acetabular bone, needs to take away on rasion guide plate, hip of polishingWhen mortar, doctors experience is only leaned on, is polished along steel nail acetabular bone using rasion, result can there is a certain error for polishing；The preparation time before polishing acetabular bone is longer, extends operating time.
From above-mentioned analysis as it can be seen that the acetabular bone guide plate of the prior art has a common ground, devises and match with acetabular bone mortar nestThe hemispheric cup body of class, and set hole on cup body, position acetabular bone axle center in conjunction with 3D technology.And when in use, it is positioningAfter, it requires to remove on acetabular bone guide plate, then be polished according to location hole acetabular bone.The guide plate although such acetabular bone navigatesPolishing accuracy rate is improved to a certain extent, but only relies on location hole in polishing and grinding accuracy is modified, however it remainsCertain error, and existing acetabular bone guide plate use is complex, needs to occupy longer time before acetabular bone polishing, extendOperating time.
Therefore, it is necessary to a kind of acetabular bone navigation guide plates that can be modified at any time to polishing in acetabular bone bruting process.
Summary of the invention
Based on the status and problem referred in background technique, the invention proposes a kind of acetabular bones using 3D printing design to leadNavigate guide plate and preparation method thereof, the acetabular bone guide plate that navigates is different from traditional acetabular bone and navigates guide plate, does not design and matches with acetabular boneThe hemispheric cup body of class is fought each other in real time using the fixed special acetabular bone navigation guide plate of limbus of acetabulum, it can be achieved that in acetabular bone bruting processMill precision is modified.
It is a kind of to include navigation guide plate, navigation angle device and Kirschner wire using the acetabular bone navigation guide plate of 3D printing design；
The navigation guide plate includes arc stiffening plate, column and arc spill locating slot, and it is recessed that the arc stiffening plate is located at arcOn the back of shape locating slot outer surface, the column is located on the left of inner arc at endpoint, the groove radian of the arc spill locating slotMatch with the mortar edge radian of acetabular bone；
The column quantity is two, and the column is provided with through-hole along central axes；The column is closely packed together with column, andColumn outer edge protrusion makes two columns integrally concave structure；
The Kirschner wire passes through column and hammers into limbus of acetabulum sclerotin；
The arc stiffening plate, column and arc spill locating slot are integrally formed using 3D printing；
The navigation angle device includes the first navigation bar, connecting rod, the second guide rod, adjusting rod and lever；
It is described first navigation bar, connecting rod, the second guide rod endpoint be mutually sequentially connected, it is described first navigation bar led with secondIt is parallel to each other to bar, the connecting rod and the angle of the first navigation bar and the second guide rod are 45 degree to 75 degree；
There are two the second through-holes for the top setting of the first navigation bar, and the diameter of second through-hole is identical as column diameter,And the concave structure between the circumferential size and column of the first navigation bar matches；
The adjusting rod is perpendicularly fixed on the second guide rod, and strip aperture is provided on the adjusting rod；
The lever includes strip circular arc handle and connection handle；The strip circular arc handle is covered in acetabular bone polishing and bores handleOn, and bore handle radian with acetabular bone polishing and match；The strip circular arc handle and the first navigation bar, the second guide rod are mutualIn parallel；Described connection handle one end is fixed on strip circular arc handle, and the connection handle other end is provided with bolt；
The bolt of the lever passes through the aperture of adjusting rod and tightens fixation；
In concave structure between first navigation bar insertion column of the navigation angle device.
Further, the first navigation bar, connecting rod, the second guide rod and the adjusting rod of the navigation angle device are beaten using 3DIntegrated printing shaping is printed, integrally printing is formed the lever using 3D printing.
Further, acetabular bone navigation guide plate is using in phthalein amine in poly- 12, polypropylene, polyether-ether-ketone, poly- carbonic acid vinegarAny one print.
It is a kind of using 3D printing design acetabular bone navigation guide plate the preparation method comprises the following steps:
Step 1: according to pre-operative patients CT three-dimensional data, specific acetabulum and angle of splay degree are measured；
Step 2: according to patient's CT scan image, the three-dimensional bones of the body mortar mortar snap type of patient is established using three-dimensional reverse modeling software,And acetabular bone axis is determined according to acetabulum and angle of splay degree；
Step 3: according to three-dimensional bones of the body mortar mortar nest modelling acetabular bone border template --- arc spill locating slot, and guarantee arcSpill locating slot blocks fixation at acetabular bone edge；
Step 4: arc stiffening plate and column, the central axis of the column through-hole and trouble are designed according to arc spill locating slotPerson's acetabular bone axis is parallel；
Step 5: navigation guide plate mathematical model is formed according to the design parameter of arc spill locating slot, arc stiffening plate and columnFile；
Step 6: 3D printer carries out 1:1 printing according to the digital model file of navigation guide plate, closes to produce for the full bones of the bodySave the navigation guide plate of replacement operation；
Step 7: navigation angle device is printed using 3D printer.
Further, after establishing out three-dimensional bones of the body mortar mortar snap type using three-dimensional reverse modeling software, model net is recycledLattice repair software and carry out repair process to the three-dimensional bones of the body mortar mortar snap type established by three-dimensional reverse modeling software, to remove three-dimensionalWedge angle, burr in bones of the body mortar mortar snap type.
Further, three-dimensional reverse modeling software is Mimics medicine reverse modeling software, and model meshes repair softwareEntitled GeomagicStudio, the entitled 3-matic of threedimensional model design software.
Compared with prior art, the invention has the following advantages:
The navigation guide plate of design using when be fixed at limbus of acetabulum, do not need to remove in acetabular bone bruting process, pass through navigation angleDegree device can more accurately readily polish to acetabular bone, so that acetabular component placed angle accuracy is more smart than traditional technologyIt is quasi-.
The use of navigation guide plate of the present invention, compared to conventional template, due to eliminating the fixation point to acetabular boneThe related links such as punching, axis location punching and the removal of template, are effectively reduced operating time and reduce amount of bleeding.
Conventional template punching range includes in acetabular bone edge and mortar nest, and the sclerotin thickness at acetabular bone different location have it is thinThere is the sclerotin thinner thickness in thickness, especially mortar nest, hole depth needs accurate perception in drill process, otherwise easily occurs perforating etc. and askTopic.
Navigation guide plate of the present invention is stuck on limbus of acetabulum by groove, and is passed through column through-hole by Kirschner wire and fixedIn on limbus of acetabulum 12 to 1 o ' clock orientations (at acetabular notch for 6 directions), due to the limbus of acetabulum in 12 points to 1 directionsThe problems such as sclerotin thickness is larger, is not in sclerotin perforation.
Detailed description of the invention
Fig. 1 is a kind of navigation guide plate overlooking structure diagram of acetabular bone navigation guide plate using 3D printing design；
Fig. 2 is a kind of navigation guide plate side dimensional structure diagram of acetabular bone navigation guide plate using 3D printing design；
Fig. 3 is a kind of navigation guide plate inner arc side dimensional structure diagram of acetabular bone navigation guide plate using 3D printing design；
Fig. 4 is a kind of navigation angle device planar structure schematic diagram of acetabular bone navigation guide plate using 3D printing design；
Fig. 5 is a kind of navigation angle device schematic perspective view of acetabular bone navigation guide plate using 3D printing design；
In figure: 1 arc spill locating slot, 2 arc stiffening plates, 3 columns, 4 through-holes, the groove of 5 arc spill locating slots, 6 firstNavigate bar, 7 connecting rods, 8 second guide rods, 9 adjusting rods, 10 levers, 11 bolts, 12 second through-holes.
Specific embodiment
The present invention is described in further detail with preferred embodiment with reference to the accompanying drawing.
The technology of the present invention thinking is directed to general technology defect existing for traditional acetabulum navigation template --- in surgical procedure firstAcetabulum navigation template is fixed in acetabular fossa, then positions and punches, then remove acetabulum navigation template, it is last targetedCarry out acetabular bone polishing.
For prior art defect, proposes not need to be positioned in a kind of surgical procedure, punch, the programs such as template removes, and the acetabular bone navigation guide plate of the precision of procedure efficiency and prosthetic hip acetabulum installation can be effectively improved.
The particular technique details of technical solution of the present invention is as follows:
It is a kind of to include navigation guide plate, navigation angle device and Kirschner wire using the acetabular bone navigation guide plate of 3D printing design；
As shown in Figure 1 to Figure 3, the navigation guide plate includes arc stiffening plate 2, column 3 and arc spill locating slot 1, the arcShape stiffening plate 2 is located on 1 outer surface back of arc spill locating slot, and the column 3 is located on the left of inner arc at endpoint, the arc5 radian of groove of spill locating slot and the mortar edge radian of acetabular bone match；
3 quantity of column be two, 3 central axes of column be parallel to each other, the column 3 is provided with directly along central axesDiameter 2mm through-hole 4,4 quantity of through-hole are two, and the column 3 is closely packed together with column 3, and 3 outer edge protrusion of column makesThe whole concave structure of two columns；
The Kirschner wire passes through column and hammers into limbus of acetabulum sclerotin；
The arc stiffening plate 2, column 3 and arc spill locating slot 1 are integrally formed using 3D printing；
As shown in Fig. 4 to Fig. 5, the navigation angle device include first navigation bar 6, connecting rod 7, the second guide rod 8, adjusting rod 9,Lever 10, bolt 11, the second through-hole 12；
The first navigation bar 6 is provided with the second through-hole of diameter 2mm 12 along central axes, and quantity is two, the first navigation bar6, connecting rod 7, the second guide rod 8 endpoint be mutually sequentially connected, it is described first navigation bar 6 be parallel to each other with the second guide rod 8,The angle of the connecting rod 7 and the first navigation bar 6 and the second guide rod 8 is 45 degree to 75 degree；
There are two the second through-hole 12, the diameters and 3 diameter of column of second through-hole 12 for the top setting of the first navigation bar 6It is identical, and the concave structure between the circumferential size and column of the first navigation bar 6 matches；
The adjusting rod 9 is perpendicularly fixed on the second guide rod 8, is provided with strip aperture on the adjusting rod 9；
The lever 10 includes strip circular arc handle and connection handle；The strip circular arc handle is covered in acetabular bone polishing and bores handOn handle, and handle radian is bored with acetabular bone polishing and is matched；The strip circular arc handle of the lever 10 and the first navigation bar 6, theTwo guide rods 8 are parallel to each other；Described connection handle one end is fixed on strip circular arc handle, and the connection handle other end is provided withBolt 11, and by the fixation position of bolt adjusting connection handle and adjusting rod, so that navigation angle device be made to adapt to different stylesAcetabular bone milling tools, and guarantee acetabular bone grinding accuracy.
The bolt 11 of the lever 10 passes through the aperture of adjusting rod 9 and tightens fixation；
In concave structure between first navigation bar insertion column of the navigation angle device.
The first navigation bar 6, connecting rod 7, the second guide rod 8 and the adjusting rod 9 of the navigation angle device use 3D printing oneBody printing shaping, using 3D printing, integrally printing is formed the lever 10.
The diameter of the first navigation bar 6 is identical as 3 diameter of column, the concave structure of the first navigation bar 6 and column 3It can mutual joint match.
Acetabular bone navigation guide plate is using any one in phthalein amine in poly- 12, polypropylene, polyether-ether-ketone, poly- carbonic acid vinegarIt prints.
With the following method, prepare acetabular bone navigation guide plate, it is specific the preparation method is as follows:
Step 1: according to pre-operative patients CT three-dimensional data, specific acetabulum and angle of splay degree are measured；
Step 2: according to patient's CT scan image, the three-dimensional bones of the body mortar mortar snap type of patient is established using three-dimensional reverse modeling software,And acetabular bone axis is determined according to acetabulum and angle of splay degree；
Step 3: according to three-dimensional bones of the body mortar mortar nest modelling acetabular bone border template --- arc spill locating slot, and guarantee arcSpill locating slot blocks fixation at acetabular bone edge；
Step 4: arc stiffening plate and column, the central axis of the column through-hole and trouble are designed according to arc spill locating slotPerson's acetabular bone axis is parallel；
Step 5: navigation guide plate mathematical model is formed according to the design parameter of arc spill locating slot, arc stiffening plate and columnFile；
Step 6: 3D printer carries out 1:1 printing according to the digital model file of navigation guide plate, closes to produce for the full bones of the bodySave the navigation guide plate of replacement operation；
Step 7: navigation angle device is printed using 3D printer.
After establishing out three-dimensional bones of the body mortar mortar snap type using three-dimensional reverse modeling software, model meshes is recycled to repair softwareRepair process is carried out to the three-dimensional bones of the body mortar mortar snap type established by three-dimensional reverse modeling software, to remove three-dimensional bones of the body mortar mortar snapWedge angle, burr in type.
Three-dimensional reverse modeling software is Mimics medicine reverse modeling software, and model meshes repair the entitled of softwareGeomagicStudio, the entitled 3-matic of threedimensional model design software.
Usage mode in the acetabular bone navigation specific art of guide plate of 3D printing design of the present invention are as follows:
Upper posterior margin of acetabulum is dissected and exposed using operative approach on the outside of hip joint after standard first, removes cartilago acetabularis broad-mouthed receptacle for holding liquid lip, it willArc navigation guide plate be placed on upper posterior margin of acetabulum bone face, and make navigate guide plate column be located at 12 points to 1 point of limbus of acetabulum itBetween position, two pieces of diameter 2mm Kirschner wires are each passed through column inner via hole simultaneously by (setting acetabular notch midpoint as 6 directions)It hammers into limbus of acetabulum sclerotin.
The second through-hole in first navigation bar of navigation angle device is inserted on the end of two pieces of Kirschner wires, makes to navigateProtractor slides into along Kirschner wire direction, and the end of navigation angle device is placed in the concave structure between column, by navigated angleThe lever of device is spent by being put on the handle of acetabular bone polishing file, adjusts the bolt on lever, makes handle and the boat angle of acetabular bone polishing fileThe the first navigation bar for spending device is parallel, then implements acetabular bone polishing and needs to adjust when polishing acetabular bone replaces different-diameter burr cutter headBolt on lever, the handle of acetabular bone polishing file and the first navigation bar of boat protractor are parallel when making to polish each time.
Accurate acetabular bone grinding angle axis has been obtained using three-dimensional reverse modeling software by patient CT data due to preoperativeLine, and outside the upright post translation to acetabular bone by navigating on guide plate, neither influence the essence that surgical procedure also ensures navigation angle deviceReally, it uses two pieces of Kirschner wire fixations in the stabilization on bone, increasing navigation guide plate on column through-hole, is allowed to not by surgical procedureAnd Body Position Change is displaced and influences navigation accuracy.The sliding groove on lever can be passed through when replacing the burr cutter head of different-diameterAnd bolt realizes fine tuning, the axis to guarantee acetabular bone polishing file is parallel with the first navigation bar of boat protractor to guarantee hour angle of polishingSpend accuracy.
Using acetabular bone of the present invention navigation guide plate in actual medical procedure, specific effect is as follows:
By in October, 2017 to the nearly use in 1 year of in August, 2018, first patients with total hip replacement totally 54 money is carried outMaterial, wherein the 3D printing technique design acetabular bone navigation guide plate auxiliary using technical solution of the present invention completes operation totally 28(3D assisted group), wherein male 11, women 17, average age (57.3 ± 18.5 years old), routine operation completes 26 (controlsGroup), wherein male 8, women 18, average age (61.6 ± 13.7 years old).To two groups of case average operative used times, average outBlood volume, acetabular component angle of splay, top rake index are recorded, and carry out statistics assessment.
Statistics assessment result is specific as follows:
3D assisted group: performing the operation average 87.6 ± 14.7 minutes used times, intraoperative blood loss about 267.7 ± 87.5ml, outside acetabular componentExhibition angle: 41.5 ± 3.5 °, top rake: 10.6 ± 2.7 °.
Routine operation group: performing the operation average 114.6 ± 20.7 minutes used times, intraoperative blood loss about 347.7 ± 65.4ml, acetabular boneProsthese angle of splay: 48.5 ± 7.8 °, top rake: 5.7 ± 4.7 °.
Analyze statistical framework, it is seen then that 3D assisted group case is substantially better than conventional hand in average operative used time, intraoperative blood lossArt group (p< 0.05), 3D assisted group acetabular component placed angle accuracy better than routine operation group (p< 0.05).
It can be seen that can be substantially using acetabular bone navigation guide plate before the 3D printing technique Design Technology of technical solution of the present inventionDegree improves the accuracy of acetabular bone burr and Using prosthesis, while can shorten the operation used time, reduces amount of bleeding, reduces operation simultaneouslySend out disease.