CN108720923A - Calcaneus fracture closed reduction internal fixation auxiliary method based on digital 3D printing tool - Google Patents

Abstract

An auxiliary method for closed reduction and internal fixation of calcaneal fractures based on digital 3D printing tools, including: modeling, analyzing the condition; simulating fracture reduction; determining the position of the internal fixation device; after determining the fracture reduction, reset the position of the Kirschner wire; determining the fracture reduction Before, reset the position of the Kirschner wire; design the guide tool before the fracture reduction; design the fracture internal fixation into the guide plate; prepare all the guide tools by 3D printing, and conduct inspection.

Description

Auxiliary method for closed reduction and internal fixation of calcaneal fractures based on digital 3D printing tools

technical field

The invention relates to the field of 3D printing and fracture reduction and fixation, in particular to an auxiliary method for closed reduction and internal fixation of calcaneal fractures based on digital 3D printing tools.

Background technique

Closed reduction and internal fixation of fractures: refers to a surgical method of closed reduction and internal fixation of fractures. It is a combined process of closed reduction and internal fixation of fractures.

Closed reduction of a fracture: A surgical procedure that restores the correct anatomical relationship between the fracture pieces without incising or exposing the fractured area.

Internal fixation of fractures: A surgical method that connects the fracture fragments into a whole through internal fixation devices such as screws, steel plates, intramedullary nails, and steel wires, and helps the fractures to maintain a relatively fixed position and heal.

Design surgery with digital technology: analyze the patient's disease condition on the computer, and simulate the operation process on the computer with the help of 3D reconstruction, virtual calculation and other technologies to determine the best operation plan.

3D printing: It is a kind of additive manufacturing, a rapid prototyping technology. It is based on digital model files, using powdered metal or plastic and other bondable materials to construct objects by layer-by-layer printing. technology.

Calcaneal fracture is a very common and frequently-occurring disease. The most common treatment methods are divided into two types: open reduction and internal fixation and closed reduction and internal fixation.

Among them, closed reduction and internal fixation has many advantages. For example, it can effectively avoid surgical incisions caused by open reduction and internal fixation, which are prone to complications such as nonunion, necrosis, and infection. However, closed reduction and internal fixation still requires the use of small The incision is made to expose the subtalar joint, and a lot of intraoperative X-ray fluoroscopy is required. What is even more troublesome is that closed reduction requires extremely high technical requirements for the surgeon, which can easily lead to unsatisfactory reduction, unsatisfactory fixation, and long operation time , trauma and other adverse consequences.

At present, the basic steps, corresponding characteristics and disadvantages of calcaneal fracture closed reduction and internal fixation are as follows:

These shortcomings have become urgent problems to be solved. With the continuous development of digital technology and 3D printing (additive manufacturing) technology, our team invented a new surgical idea for closed reduction and internal fixation of calcaneal fractures.

solved:

1. Before the operation, the details of the calcaneal fracture cannot be intuitively understood;

2. Before the operation, it is impossible to intuitively and repeatedly carry out surgical planning and simulated surgery, so as to determine the operation plan of calcaneal fracture closed reduction and internal fixation;

3. Before the operation, the type and model of the internal fixation device cannot be completely determined;

4. During the operation, a small incision is still required to expose the subtalar articular surface;

5. During the operation, the fracture of the calcaneus must be confirmed through real-time observation (such as: subtalar joint micro-incision, repeated intraoperative X-ray fluoroscopy, etc.);

6. During the operation, repeated attempts are required to obtain a satisfactory reset;

7. During the operation, the installation position of the internal fixation device is not accurate;

8. During the operation, multiple temporary fixations are required, or internal fixation devices need to be installed repeatedly;

9. During the operation, the internal fixation device must be installed after repeated intraoperative X-ray fluoroscopy guidance or verification. And other issues.

Contents of the invention

In order to solve the above-mentioned problems in the prior art, the object of the present invention is to provide an auxiliary method for closed reduction and internal fixation of calcaneal fractures based on digital 3D printing tools. The fracture surgery plan is designed through virtual technology, and 3D printing tools will be assisted to help the whole operation process to be carried out according to the preoperative design plan, so as to ensure personalized and precise medical treatment.

To achieve the above object, the technical solution of the present invention is:

An auxiliary method for closed reduction and internal fixation of calcaneal fractures based on digital 3D printing tools. It includes two parts: preoperative computer design and guidance tool production and operation implementation. Among them, the specific steps of preoperative computer design and guidance tool production are:

Step 1. Modeling and analyzing the condition:

Import the CT data of the patient's calcaneal fracture before operation into the computer, and reconstruct it through software to obtain a "three-dimensional fracture digital model" and analyze the condition;

Step 2. Simulate fracture reduction:

The "three-dimensional calcaneal fracture digital model" is implemented on the computer with Magics software to implement "fracture block reduction"

Step 3. Determine the position of the internal fixation device:

The installation of the internal fixation device is simulated in the "Digital Model of Calcaneal Fracture after Reduction" by the computer, and the verification is repeated until the computer simulation operation is completed;

Step 4. After confirming the fracture reduction, reset the position of the Kirschner wire:

Insert reset Kirschner wires into the "digital model of calcaneal fracture after reduction", the main purpose of which is to make several pointing objects that form a rigid connection with the fracture block, and the temporary fixation plays a marking role;

Step 5. Before determining the fracture reduction, reset the position of the Kirschner wire:

Restore the fracture fragments in the "Digital Model of Calcaneal Fracture after Reduction" that have been connected with the reset Kirschner wire according to the position in the "Digital Model of Calcaneal Fracture" in step 1, and maintain the reset Kirschner wire and the corresponding fracture. The relative position of the block remains unchanged, and the orientation of Kirschner wire placement before fracture reduction is obtained;

Step 6. Design the guide tool before fracture reduction:

On the computer, design the "pre-reduction guiding tool", which can only be combined with the calcaneus around the calcaneus through a unique orientation, and only the unique orientation can be combined with the "reduction Kirschner wire before fracture reduction";

Step 7. Design the guide plate for placing the fracture internal fixation;

On the computer, design the "guide tool for placing the fracture internal fixation device", which can only be combined with the "reduction Kirschner wire after fracture reduction" through a unique orientation, and only the unique orientation can be combined with the "internal fixation device";

Step 8. Prepare all guide tools by 3D printing and inspect them:

Prepare all the above-mentioned guiding tools by 3D printing, and inspect them. If they are qualified, they will be sterilized and set aside, and then the actual operation will be carried out according to the model designed above.

Further, in said step 1, the CT data is in DICOM format, and the software is Mimisc software.

Compared with the prior art, the beneficial effects of the present invention are:

The method of the present invention designs a fracture surgery plan through virtual technology, and with the assistance of 3D printing tools, helps the whole operation process to be carried out according to the preoperative design plan, thereby ensuring personalized and precise medical treatment, thereby solving a series of deficiencies in the current operation, reducing Operating time, reducing trauma and complications, reducing intraoperative X-ray perspective, and helping to protect doctors and patients.

In general, it is to make the surgical process faster, more accurate and safer:

1. Before the operation, you can intuitively understand the detailed situation of the fracture of the calcaneus, and know the situation of the fracture well;

2. Before operation, operation planning and operation simulation can be carried out intuitively and repeatedly, so as to determine the operation plan of calcaneal fracture closed reduction and internal fixation;

3. Before operation, the type and model of internal fixation can be basically determined;

4. During the operation, it is no longer necessary to make a small incision to expose the subtalar articular surface;

5. During the operation, through the guidance of the guide plate, the fracture reduction can be completed in one step according to the preoperative plan;

6. During the operation, through the guidance of the guide plate, the internal fixation device can be accurately installed according to the preoperative plan;

7. During the operation, through the guidance of the guide plate, the internal fixation device can be installed in one step according to the preoperative plan;

8. During the operation, the use of intraoperative X-ray fluoroscopy is reduced or even unnecessary;

Reduce operating time, reduce surgical injuries, reduce complications, and reduce the X-ray radiation dose of medical staff.

Description of drawings

Fig. 1 is a schematic diagram of internal fixation in the method of the present invention.

Figure 2 is a schematic diagram of the combination of Kirschner wires and fitted armor in the method of the present invention.

Fig. 3 is a structural schematic diagram of the fitted armor of the present invention after wearing.

Fig. 4 is a schematic structural view of the guiding tool before fracture reduction of the present invention.

Fig. 5 is a side view of the guide tool before fracture reduction of the present invention.

Detailed ways

The technical solution of the present invention will be further described in detail below in conjunction with the accompanying drawings and specific embodiments:

As shown in Figure 1-5,

An auxiliary method for closed reduction and internal fixation of calcaneal fractures based on digital 3D printing tools. It includes two parts: preoperative computer design and guidance tool production and operation implementation. Among them, the specific steps of preoperative computer design and guidance tool production are:

Step 1. Modeling and analyzing the condition:

Import the CT data of the patient's calcaneal fracture before operation into the computer, and reconstruct it through software to obtain a "three-dimensional fracture digital model" and analyze the condition;

Step 2. Simulate fracture reduction:

The "three-dimensional calcaneal fracture digital model" is implemented on the computer with Magics software to implement "fracture block reduction"

Step 3. Determine the position of the internal fixation device:

The installation of the internal fixation device is simulated in the "Digital Model of Calcaneal Fracture after Reduction" by the computer, and the verification is repeated until the computer simulation operation is completed;

Step 4. After confirming the fracture reduction, reset the position of the Kirschner wire:

Insert reset Kirschner wires into the "digital model of calcaneal fracture after reduction", the main purpose of which is to make several pointing objects that form a rigid connection with the fracture block, and the temporary fixation plays a marking role;

Step 5. Before determining the fracture reduction, reset the position of the Kirschner wire:

Restore the fracture fragments in the "Digital Model of Calcaneal Fracture after Reduction" that have been connected with the reset Kirschner wire according to the position in the "Digital Model of Calcaneal Fracture" in step 1, and maintain the reset Kirschner wire and the corresponding fracture. The relative position of the block remains unchanged, and the orientation of Kirschner wire placement before fracture reduction is obtained;

Step 6. Design the guide tool before fracture reduction:

On the computer, design the "pre-reduction guiding tool", which can only be combined with the calcaneus around the calcaneus through a unique orientation, and only the unique orientation can be combined with the "reduction Kirschner wire before fracture reduction";

Step 7. Design the guide plate for implantation of fracture internal fixation:

On the computer, design the "guide tool for placing the fracture internal fixation device", which can only be combined with the "reduction Kirschner wire after fracture reduction" through a unique orientation, and only the unique orientation can be combined with the "internal fixation device";

Step 8. Prepare all guide tools by 3D printing and inspect them:

Prepare all the above-mentioned guiding tools by 3D printing, and inspect them. If they are qualified, they will be sterilized and set aside, and then the actual operation will be carried out according to the model designed above.

Further, in said step 1, the CT data is in DICOM format, and the software is Mimisc software.

Experimental example 1:

Part 1 Preoperative computer design and guidance tool making

1. Modeling and analyzing the condition:

The CT data (DICOM format) of the patient's preoperative calcaneal fracture was imported into the computer, and the "three-dimensional fracture digital model" of the calcaneal fracture was obtained after reconstruction by Mimisc software, so as to fully understand the fracture situation and analyze the condition. Fracture, calcaneus varus 18°, Bohler angle reduced to 11°, subtalar articular surface and calcaneocuboid joint uneven.

2. Simulated fracture reduction:

Save the "three-dimensional fracture digital model" in SLT format, use Magics software to analyze the condition, and implement "fracture block reduction" on the computer. After the reduction, the calcaneus varus is corrected, the Bohler angle returns to 32°, and the subtalar Both the articular surface and the heel-cuboid joint were restored to smoothness.

3. Determine the position of internal fixation:

On the computer, the installation of the internal fixation device was simulated in the "digital model of the fracture after reduction". After repeated verification, it was found that three internal fixation devices were needed, each with a cortical bone screw with a length of 36 mm and a diameter of 5 mm from outside to inside. Fix the subtalar joint horizontally through the two layers of cortex from the anterior subtalar articular surface, and use a hollow nail with a length of 76mm and a diameter of 6.5mm to the calcaneocuboid joint from directly behind the calcaneus tubercle, and use a hollow nail from below the calcaneus tubercle. A hollow nail with a length of 56 mm and a diameter of 6.5 mm is attached to the subtalar joint.

4. After confirming the fracture reduction, reset the position of the Kirschner wire:

On the computer, insert the reset Kirschner wire into the "digital model of the fracture after reduction". After repeated attempts, it was found that a 3.0 wire was placed in the posterior inferior aspect of the calcaneal tubercle, the talus-loaded talus process of the calcaneus, and the outer side of the subtalar articular surface. The Kirschner wires are suitable, and these 3 Kirschner wires form a rigid connection with the corresponding fracture fragments, which can be used not only to hold the fracture fragments for reduction, but also to guide the orientation of the fracture fragments.

5. Before determining the fracture reduction, reset the position of the Kirschner wire:

On the computer, the fracture fragments in the "digital fracture model after reduction" that have been placed in the reset Kirschner wires are restored according to the pre-fracture positions, and the relative positions of the reset Kirschner wires and the corresponding fracture fragments are kept unchanged, and the fracture reduction is obtained. Orientation of anterior reset Kirschner wire placement

6. Design reset Kirschner wire implantation guide plate:

On the computer, design the reset Kirschner wire implant guide plate, which is designed to be armor-shaped, and can only be combined with the patient’s right ankle in a unique orientation, and the reset Kirschner wire can only pass through the guide plate through the calcaneus in the only orientation The posteroinferior part of the tubercle, the calcaneus-loaded talus process, and the medial subtalar articular surface enter the corresponding fracture fragments laterally.

When the design is satisfactory, the reset Kirschner wire implantation guide plate is made by 3D printing, and after repeated inspection, it is sterilized and ready for use.

7. Design the guide plate for internal fixation implantation:

On the computer, design an "internal fixation guide plate", which can only be combined with a unique orientation to reset the Kirschner wire, and has 3 guide parts with unique orientations to guide the placement of 1 cortical bone screw and 2 hollow nails. Insert.

When the design is satisfactory, the internal fixation implant guide plate is made by 3D printing, and after repeated inspection, it is sterilized and ready for use.

Implementation of the second part of the operation

8. Install the guide plate to guide the insertion and reset of the Kirschner wire:

Install the armor-style reset Kirschner wire implantation guide plate to the right ankle of the patient. At this time, there is one and only one posture that can make the guide plate installed in place. Then, through the three guide holes with depth-limiting function, three pieces of 3.0 g Wire implantation

9. Remove the guide plate and use Kirschner wire to reduce the fracture:

Remove the "Kirschner wire implantation guide plate", keep the reset Kirschner wire, and then reset according to the preoperative plan

10. Install the fracture fixation into the guide plate, use it to guide the fracture reduction, and use it to temporarily maintain the fracture reduction position:

Install the "Fracture Fixation Guide" and perform reduction according to the preoperative plan. Using the uniqueness of the relative position between the "Fracture Fixation Guide" and the "Reposition Kirschner Wire", the fracture block is accurately reset and temporarily maintained for fracture reduction. Location

11. Guided installation of cortical bone screws and hollow nails:

According to the guidance of the guide plate, guide the installation of 1 cortical bone screw (fixing the subtalar joint, diameter 5mm, length 36mm) and 2 hollow screws (one for the calcaneus joint, diameter 6.5mm, length 76mm; the other for the Subtalar joint, diameter 6.5mm, length 56mm).

The guide part of the cortical bone screw is designed with double sleeves. First, the small sleeve is used to guide the drill to complete the drilling, and then the large sleeve is used to guide the installation of the cortical bone screw.

The guide part of the hollow nail is also designed with double sleeves, first use the small sleeve to guide the implantation of the guide pin, and then use the large sleeve to guide the installation of the hollow nail.

12. Remove the guide plate and Kirschner wire to complete the operation:

After checking the fracture and internal fixation position under the C-arm, the guide plate and Kirschner wires were removed, the surgical incision was flushed, the skin was sutured, and the pressure was bandaged to complete the operation.

The above is only a specific implementation of the present invention, but the scope of protection of the present invention is not limited thereto, and any changes or replacements that do not come to mind through creative work shall be covered within the scope of protection of the present invention. Therefore, the protection scope of the present invention should be determined by the protection scope defined in the claims.

Claims (2)

1. fixing householder method in the fracture of calcaneus closed reduction based on digitlization 3D printing tool, which is characterized in that including such as Lower step：

Step 1: modeling, analysing patient's condition：

The preoperative fracture of calcaneus CT data of patient are imported into computer, " 3 D stereo fracture number is obtained after being rebuild by software Change model ", and analysing patient's condition；

Step 2: the simulation reduction of the fracture：

By " 3 D stereo fracture of calcaneus digital model ", Magics software implementations " fracture block reset " are used on computers

Step 3: determining the position of inner fixing device：

By the installation of " the fracture of calcaneus digital model after reset " of computer inner simulation inner fixing device, verify repeatedly, Until completing Surgery simulation；

Step 4: after determining the reduction of the fracture, the position of Kirschner wire is resetted：

" the fracture of calcaneus digital model after reset " inner insertion is resetted into Kirschner wire, main purpose is to make several and fracture Block forms rigidly connected direction object, is fixed temporarily and plays the role of label；

Step 5: before determining the reduction of the fracture, the position of Kirschner wire is resetted：

By " the fracture of calcaneus digital model after reset " of having connected reset Kirschner wire inner each sclerite by step 1 Position in " 3 D stereo fracture of calcaneus digital model " is restored, and is maintained to reset Kirschner wire and is corresponded to the opposite of sclerite Position is constant, resets the orientation that Kirschner wire is placed in before obtaining the reduction of the fracture；

Step 6: steering tool before the design reduction of the fracture：

On computers, design " steering tool before resetting ", which can only be incorporated in calcaneum week by unique orientation It encloses, and only unique orientation is combined with " the reset Kirschner wire before the reduction of the fracture "；

Step 7: design fracture inside-fixture is placed in guide plate：

On computers, " fracture inside-fixture merging steering tool " is designed, which can only pass through unique orientation knot It closes " the reset Kirschner wire after the reduction of the fracture ", and only unique orientation is combined with " inner fixing device "；

Step 8: all steering tools are prepared by 3D printing, and test：

Above-mentioned all steering tools are prepared by 3D printing, and are tested, if qualified, are carried out disinfection, it is spare, Later practical operation is carried out according to the model of above-mentioned design.

2. according to the method described in claim 1, it is characterized in that, in the step 1, CT data are DICOM format, software For Mimisc softwares.