计算机辅助骨盆骨折微创内固定系统的研究

Traditional internal fixation has considerable damage to muscles and high risk of postoperative infection. With the help of surgical instruments and digital imaging technology, techniques of minimally invasive fixation to treat the pelvic fractures developed rapidly over the past decades. Lack of uniform technical standards and poor accuracy of screw placement, many complications were reported, even of paralysis and death. A high-precision and uniform standard for minimally invasive to treat the pelvic fractures is needed. In this study, we plan to load the CT datas of patients into Mimics software for three-dimensional reconstruction, then preserved as STL format, and loaded into UG imageware software to find out the best channel of screw trajectory. Several bony markers will be defined and used to improve the accuracy of screw placement. At last, a standardized software system based on three-dimensional reconstruction and reverse engineering will be builded. With the help of 3D-Pringter, we can perform the preoperative surgery to verify and optimize the system. This standardized system will help us to spread minimally invasive treatment of pelvic fractures , decrease complications and make more and more patients enjoy the benefit of those novel techniques.

闭合复位、微创内固定正日益成为治疗不稳定骨盆骨折的首选。但目前存在技术标准不统一、置钉准确度不佳等问题，导致一系列并发症的发生，严重者甚至瘫痪或死亡。一套高精确度、易学、统一的置钉标准及辅助置钉系统是目前迫切需要解决的问题。本研究在大量前期微创治疗骨盆骨折的工作基础上，利用患者术前CT 数据，导入Mimics 软件中建立三维模型，以STL 格式在UG imageware 内建立最佳置钉数字通道并进行有限元验证，找出骨性标记点，利用术中C型臂X线透视辅助下，结合自行开发的经皮固定导向装置，开展全新的骨盆骨折微创治疗。结合最新的3D打印技术，构建骨盆标本模拟手术，最终建立起一套标准化、程序化基于三维建模和逆向工程原理指导骨盆空心钉微创固定的智能系统，推动和规范骨盆骨折的微创治疗。

复杂骨盆骨折是最为严重且难以处理的创伤骨折类型，对于骨盆、髋臼骨折及复杂四肢关节内骨折的诊疗上，在当前骨科临床及科研工作中均存在较多的问题。本研究组在本课题开展期间，结合大量骨盆骨折等临床骨折病例成功治疗的基础上，提出了一整套基于患者术前CT 数据，建立数字化三维模型，结合最新3D软硬件设备，构建骨折实物标本，模拟术前手术操作，进行术前规划和术中比对的临床诊疗规范。结合最新数字医学技术，利用计算机在术前做出内植物规格选择及钉道设计，结合具体病例特征性解剖骨性标记点，利用术中C型臂X线透视辅助下与术前规划的模拟对照，开展全新的骨盆骨折等相应病例微创治疗，并推广应用于全身各部位复杂关节内骨折治疗。大量研究成果以中英文论文形式进行发表，申请相关专利并在国内外学术会议以发言交流形式进行有效推广。初步提出并建立了一套完整的标准化、程序化基于三维建模和逆向工程原理指导骨盆等复杂骨折微创手术固定的智能系统与规范，有效推动3D打印等数字骨科技术在临床骨折诊疗的广泛应用。