CN112914676A - Combined elbow joint osteotomy orthopedic guide plate and manufacturing method thereof - Google Patents
Combined elbow joint osteotomy orthopedic guide plate and manufacturing method thereof Download PDFInfo
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Abstract
The invention discloses a combined elbow joint osteotomy orthopedic guide plate and a manufacturing method thereof, wherein the combined elbow joint osteotomy orthopedic guide plate is prepared by the manufacturing method, the finished product of the combined elbow joint osteotomy orthopedic guide plate comprises a proximal end guide plate, a middle end guide plate and a distal end guide plate, one end of the middle end guide plate is connected with the proximal end guide plate, and the other end of the middle end guide plate is connected with the distal end guide plate and mutually forms an osteotomy groove. The invention establishes three-dimensional anatomical model measurement individualized data through the computer to determine parameters such as the osteotomy angle, the osteotomy plane, the rotation angle and the like for elbow varus deformity correction, can accurately measure and analyze the elbow joint deformity by the aid of the computer, and ensures the accuracy and precision of the design of the osteotomy orthopedic operation scheme.
Description
Technical Field
The invention relates to the field of orthopedic aid design and processing, in particular to a combined elbow joint osteotomy orthopedic guide plate and a manufacturing method thereof.
Background
Elbow varus deformity is commonly seen in children and is one of the long-term complications of supracondylar fracture of humerus, and the incidence rate of the elbow varus deformity is reported in documents to be 30-57%. The elbow varus deformity is mainly characterized by the change of the carrying angle of the affected side, and the severe elbow varus deformity easily causes the limited motion of the elbow joint, the unstable joint, the delayed ulnar nerve paralysis and the like. No matter what treatment method is adopted to treat supracondylar fracture of humerus, the possibility of concurrent elbow varus deformity exists, which is one of the problems widely concerned by scholars at home and abroad. The likelihood of a plastic re-correction of the varus deformity is not great for the distal humeral epiphysis, and therefore orthopaedic surgery is often used for patients with varus angles greater than 20 °, particularly with elbow joint mobility disorders. In many cases, patients with minor varus deformities and no significant elbow dysfunction are often left to receive surgical treatment to improve the appearance of the affected limb.
The current common operation method for correcting elbow varus deformity is a distal humerus lateral wedge osteotomy, the operation focus is to correct coronal varus deformity, and the internal rotation deformity in a horizontal plane and the hyperextension deformity in a sagittal plane are often ignored, so that the operation effect is not ideal. In addition, although some operators subjectively want to perform three-dimensional correction, the individual difference of the malformation degree of each child patient is large, which brings great challenges to orthopedic surgeons, and the operators are difficult to accurately control the correction angle of each dimension in the operation, often need to repeatedly debug in the operation or only determine the correction degree according to the general appearance, and finally have great errors with preoperative planning, resulting in unsatisfactory operation effect.
With the development of digital medicine, computer aided design and 3D printing technology bring great help to orthopedics clinics. At present, 3D printing can be applied to aspects such as preoperative planning of orthopedics department, surgical navigation template manufacturing and personalized internal fixation implantation, wherein the surgical navigation template is widely applied. Therefore, a method for assisting accurate osteotomy with strong practicability and easy popularization and use is urgently needed clinically.
Disclosure of Invention
The invention aims to provide a combined elbow joint osteotomy orthopedic guide plate and a manufacturing method thereof, which can accurately measure and analyze elbow joint deformity by using the assistance of a computer, ensure the accuracy and precision of the design of an osteotomy orthopedic operation scheme and solve the technical problems mentioned in the background technology.
The purpose of the invention is realized by the following technical scheme:
a method for manufacturing a combined elbow joint osteotomy orthopedic guide plate comprises the following steps:
s1, carrying out CT or MRI scanning on the upper limbs of the patient to obtain tomography data of the affected and healthy elbow joints, carrying out image segmentation and reconstruction by using medical image three-dimensional reconstruction software, constructing a lesion model and a normal elbow joint model, and repairing to form a digital three-dimensional model of the lesion model and the normal elbow joint model;
s2, measuring anatomical structure parameters of a pathological change model of the patient and a digital three-dimensional model of a normal elbow joint, calculating an osteotomy orthopedic angle and an osteotomy position according to the anatomical structure parameters in combination with preoperative imaging and clinical examination data, judging the type of elbow joint deformity, and drawing an osteotomy line;
s3, designing an osteotomy plane at the osteotomy position of the lesion model according to the calculated angle of osteotomy correction, simulating osteotomy by using a cutting command in three-dimensional software according to the osteotomy plane, and separating a part needing to be cut.
S4, after the simulation osteotomy is completed, removing bone blocks needing to be resected, resetting the resected elbow joint, enabling the upper and lower osteotomy surfaces to be jointed, correcting the internal rotation angle, measuring anatomical structure parameters, taking the healthy side model mirror image as reference and verifying the postoperative correction effect, and enabling the elbow joint deformity to be recovered to be normal;
s5, importing the lesion model into computer aided design software, selecting the corresponding bone cutting area surface according to the operation approach, stretching the bone cutting area surface into a bone cutting guide plate body, and designing a bone cutting guide groove and a Kirschner wire positioning guide hole according to the determined bone cutting position and the Kirschner wire insertion position; then, a postoperative model which is simulated by the operation is introduced, the proximal guide plate and the distal guide plate are reset by referring to the postoperative model, and the internal rotation angle positioning columns and the positioning holes on the proximal guide plate and the distal guide plate are designed according to the reset condition, so that the design of the osteotomy orthopedic guide plate is completed.
S6, importing a source file of the osteotomy orthopedic guide plate model into 3D printing software, placing a spatial position, adding support to the suspended structure, and performing layered slicing processing to obtain two-dimensional information data;
s7, generating a scanning path by using the two-dimensional information data, importing the scanning path into 3D printing equipment, setting process parameters, and printing the osteotomy orthopedic guide plate;
s8, grinding the sand-blasting bone-cutting orthopedic guide plate to obtain a finished product of the bone-cutting orthopedic guide plate;
the specific process of judging the elbow joint deformity type comprises the steps of defining the longitudinal axis of a humerus as an arm axis, defining the long axis of an ulna as a forearm axis, forming an outward-opening included angle between the arm axis and the extension line of the forearm axis at the elbow, enabling the included angle to range from 165 degrees to 170 degrees, enabling a carrying angle to be 10 degrees to 15 degrees, enabling a male to be 10 degrees and a female to be 15 degrees, judging that the elbow is inverted when the carrying angle is reduced, and judging that the elbow is inverted when the carrying angle is increased.
Further, the repairing process of the lesion model and the normal elbow joint model in step S1 includes denoising, smoothing and hole filling.
Furthermore, the tomography CT or MRI scanning data is stored in a DICOM image format, and the thickness of the layer is 0.625-1.5 mm.
Further, the lesion model and the digitized three-dimensional model of the normal elbow joint in step S2 include, but are not limited to, length, arm axis, forearm axis, carrying angle, and internal rotation angle.
Further, the procedure of resetting the truncated elbow joint in step S4 is to remove the bone pieces to be cut, reset the truncated elbow joint using the movement and rotation commands, fit the upper and lower osteotomy surfaces, correct the internal rotation angle, and measure the length of the upper limb, the elbow, the forearm axis, the carrying angle, and the internal rotation angle.
Further, the specific process of generating the osteotomy orthopedic guide plate model in step S5 is to determine the osteotomy position and the kirschner wire needle insertion position on the post-operation model, determine the positions of the osteotomy guide groove and the kirschner wire positioning guide hole, reset the proximal end guide plate and the distal end guide plate with reference to the post-operation model, and design the internal rotation angle positioning columns and the positioning holes on the proximal end guide plate and the distal end guide plate according to the reset condition, thereby completing the design of the osteotomy orthopedic guide plate model.
The combined elbow joint osteotomy orthopedic guide plate is prepared by the manufacturing method of the combined elbow joint osteotomy orthopedic guide plate, the finished product of the combined elbow joint osteotomy orthopedic guide plate comprises a near-end guide plate, a middle-end guide plate and a far-end guide plate, one end of the middle-end guide plate is connected with the near-end guide plate, and the other end of the middle-end guide plate is connected with the far-end guide plate and mutually forms an osteotomy groove.
Furthermore, the near-end guide plate comprises a near-end plate body, a near-end kirschner wire positioning column, near-end reserved grooves, internal rotation angle positioning columns and near-end osteotomy guide walls, the near-end osteotomy guide walls are installed at the bottom end of the near-end plate body, the number of the near-end reserved grooves is 2, the 2 near-end reserved grooves are formed in two ends of the near-end osteotomy guide walls, the internal rotation angle positioning columns are installed on extension parts at two ends of the near-end osteotomy guide walls, and the near-end kirschner wire positioning columns are installed on the near-end plate body;
the far-end guide plate comprises a far-end plate body, far-end reserved grooves, far-end Kirschner wire positioning columns, internal rotation angle positioning holes and far-end osteotomy guide walls, the far-end osteotomy guide walls are installed at the top end of the far-end plate body, the number of the far-end reserved grooves is 2, the 2 far-end reserved grooves are formed in two ends of the near-far-end osteotomy guide walls, the internal rotation angle positioning holes are installed in extension parts at two ends of the far-end osteotomy guide walls and are matched with the internal rotation angle positioning columns, and the far-end Kirschner wire positioning columns are installed on the far-end plate body;
the middle-end guide plate comprises a middle-end plate body, a middle-end special-shaped structure body, an airfoil-shaped structure boss and a middle-section guide plate Kirschner wire positioning hole, the number of the middle-end special-shaped structure body is 2, the middle-end special-shaped structure body is arranged at two ends of the middle-end plate body, the airfoil-shaped structure boss is arranged on the middle-end special-shaped structure body, the near-end reserved groove reaches the far-end reserved groove which is matched with the airfoil-shaped structure boss.
Further, the finished product of the combined elbow joint osteotomy orthopedic guide plate is a high polymer material guide plate.
Further, the finished product of the combined elbow joint osteotomy orthopedic guide plate is a biological ceramic guide plate.
The invention has the beneficial effects that:
the invention establishes a three-dimensional anatomical model through a computer to measure individualized data so as to determine parameters such as an osteotomy angle, an osteotomy plane, a rotation angle and the like for correcting the elbow varus deformity, so that the severity of the elbow joint deformity of different individuals can be known, and the anatomical morphology of the surgical site of a patient is counted; the computer-aided preoperative surgical simulation can visually evaluate the surgical effect, so that the orthopedic effect is the best, and the complication incidence rate is reduced.
The intraoperative osteotomy orthopedic operation guide plate is simple and convenient to apply, can finish accurate positioning and orientation of an operation area only by tightly attaching the template to a corresponding anatomical structure, has no special experience requirement, is valuable to young doctors in the aspect of operation training, can shorten the learning curve of the young doctors, saves the operation time and reduces the bleeding volume of patients; the invention realizes the analysis and the accurate correction of the elbow varus with the help of the computer-aided technology, the reverse engineering and the rapid prototyping technology, improves the accurate correction of the elbow varus deformity to the digital level, and has more accurate, more reliable and more excellent treatment effect.
Drawings
FIG. 1 is a flow chart of a method for manufacturing the combined elbow osteotomy orthopedic guide plate of the present invention;
FIG. 2 is a schematic view showing the overall structure of the combined elbow osteotomy orthopedic guide plate of the present invention;
FIG. 3 is a schematic view of the structure of the proximal guide of the present invention;
FIG. 4 is a schematic view of the construction of the distal guide plate of the present invention;
FIG. 5 is a schematic view of the end guide of the present invention;
FIG. 6 is a block diagram illustrating a first perspective view of the orthopedic guide plate for elbow joint osteotomy in accordance with the present invention;
FIG. 7 is a block diagram illustrating a second perspective view of the elbow osteotomy guide of the present invention in use;
in the figure, 1-a near end guide plate, 101-a near end plate body, 102-a near end kirschner wire positioning column, 103-a near end reserved groove, 104-an internal rotation angle positioning, 105-a near end osteotomy guide wall, 2-a middle end guide plate, 201-a middle end plate body, 202-a middle end special-shaped structure body, 203-an airfoil-shaped structure boss, 204-a middle section guide plate kirschner wire positioning hole, 3-a far end guide plate, 301-a far end plate body, 302-a far end reserved groove, 303-a far end kirschner wire positioning column, 304-an internal rotation angle positioning hole and 305-a far end osteotomy guide wall.
Detailed Description
The technical solutions of the present invention will be described clearly and completely with reference to the following embodiments, and it should be understood that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be obtained by a person skilled in the art without inventive effort based on the embodiments of the present invention, are within the scope of the present invention.
Example 1
Referring to fig. 1 to 7, the present embodiment provides a method for manufacturing a combined elbow joint osteotomy guide plate, which aims to solve complications such as osteotomy line deviation, orthopedic angle defect, and osteotomy plane contraposition imbalance during and after an orthopedic operation.
The method for manufacturing the osteotomy guide plate according to the present embodiment is described by taking the manufacturing of the osteotomy guide plate in the elbow inversion orthopedic surgery as an example. It should be emphasized that in other embodiments, the manufacturing process of the osteotomy guide plate used in the elbow inversion orthopedic surgery described in this embodiment is not limited to the manufacturing process of the osteotomy guide plate used in the elbow inversion orthopedic surgery, and the manufacturing process of the osteotomy guide plate used in other orthopedic surgeries can also be used.
A method for manufacturing a combined elbow joint osteotomy orthopedic guide plate comprises the following steps:
s1, carrying out CT or MRI scanning on the upper limbs of the patient to obtain tomography data of the affected and healthy elbow joints, carrying out image segmentation and reconstruction by using medical image three-dimensional reconstruction software, constructing a lesion model and a normal elbow joint model, and repairing to form a digital three-dimensional model of the lesion model and the normal elbow joint model;
specifically, the repairing process of the lesion model and the normal elbow joint model comprises denoising, fairing and hole filling;
the effect of this step is: the CT or MRI scanning data of the skeleton to be corrected is led into medical image three-dimensional reconstruction software for computer simulation modeling, so that the subsequent osteotomy line and osteotomy angle can be determined to have an accurate and reliable reference standard, and the high consistency of preoperative design, intraoperative operation and postoperative effect is ensured.
S2, measuring anatomical structure parameters of a pathological change model of the patient and a digital three-dimensional model of a normal elbow joint, calculating an osteotomy orthopedic angle and an osteotomy position according to the anatomical structure parameters in combination with preoperative imaging and clinical examination data, judging the type of elbow joint deformity, and drawing an osteotomy line;
specifically, the lesion model and the digitized three-dimensional model of the normal elbow joint in the step S2 include, but are not limited to, length, arm axis, forearm axis, carrying angle, and internal rotation angle;
the specific process of judging the elbow joint deformity type comprises the following steps of defining a longitudinal axis of a humerus as an arm axis, defining a long axis of an ulna as a forearm axis, forming an outward-opening included angle between the arm axis and an extension line of the forearm axis at an elbow, wherein the included angle ranges from 165 degrees to 170 degrees, a carrying angle ranges from 10 degrees to 15 degrees, a male is 10 degrees, a female is 15 degrees, elbow inversion is judged when the carrying angle is reduced, and elbow eversion is judged when the carrying angle is increased;
the effect of this step is: the current common operation method for correcting elbow varus deformity is a distal humerus lateral wedge osteotomy, the operation focus is to correct coronal varus deformity, and the internal rotation deformity in a horizontal plane and the hyperextension deformity in a sagittal plane are often ignored, so that the operation effect is not ideal. Anatomical structure parameters of the affected side model and the healthy side model are measured on a three-dimensional space coordinate through medical image reconstruction software, so that each measured anatomical structure parameter is more accurate, and a reliable reference datum is provided for calculating the malformation parameters of the affected side model.
S3, designing an osteotomy plane at the osteotomy position of the lesion model according to the calculated angle of osteotomy correction, simulating osteotomy by using a cutting command in three-dimensional software according to the osteotomy plane, and separating a part needing to be cut.
The effect of this step is: and determining the osteotomy position and the osteotomy angle according to the measured and calculated malformation parameters, simulating osteotomy according to the determined osteotomy position, separating the osteotomy block and retaining the skeleton, and facilitating the next operation simulation.
S4, after the simulation osteotomy is completed, removing bone blocks needing to be resected, resetting the resected elbow joint, enabling the upper and lower osteotomy surfaces to be jointed, correcting the internal rotation angle, measuring anatomical structure parameters, taking the healthy side model mirror image as reference and verifying the postoperative correction effect, and enabling the elbow joint deformity to be recovered to be normal;
specifically, in the step S4, the process of resetting the resected elbow joint includes removing the bone block to be resected, resetting the resected elbow joint by using the moving and rotating commands, fitting the upper and lower osteotomy surfaces, correcting the internal rotation angle, and measuring the length of the upper limb, the elbow of the arm, the forearm axis, the carrying angle and the internal rotation angle;
the effect of this step is: the operation simulation is carried out on the cut affected side model by referring to the healthy side mirror image model, the postoperative effect is measured and verified, and if the postoperative effect does not reach the expectation, the step can be repeatedly adjusted until the ideal correction result is achieved.
S5, importing the lesion model into computer aided design software, selecting the corresponding bone cutting area surface according to the operation approach, stretching the bone cutting area surface into a bone cutting guide plate body, and designing a bone cutting guide groove and a Kirschner wire positioning guide hole according to the determined bone cutting position and the Kirschner wire insertion position; then, a postoperative model which is simulated by the operation is introduced, the proximal guide plate and the distal guide plate are reset by referring to the postoperative model, and the internal rotation angle positioning columns and the positioning holes on the proximal guide plate and the distal guide plate are designed according to the reset condition, so that the design of the osteotomy orthopedic guide plate is completed.
Specifically, the specific process of designing the osteotomy orthopedic guide plate model in step S5 is to design the osteotomy guide groove and the kirschner wire positioning guide hole according to the determined osteotomy position and the kirschner wire insertion position on the preoperative model, then reset the proximal and distal end guide plates with reference to the postoperative model, and design the internal rotation angle positioning columns and the positioning holes on the proximal and distal end guide plates according to the reset condition, thereby completing the design of the osteotomy orthopedic guide plate model.
The effect of this step is: the postoperative model that obtains through the operation simulation, select corresponding skeleton surface drawing to the baffle body, make cut the accurate laminating of bone baffle in the skeleton surface and realize accurate location, and set up according to the good osteotomy face of confirming and cut the bone guide way, be used for the guide and restrict pendulum saw and remove the orbit, so that the pendulum saw removes the accurate cutting with predetermined bone position of cutting in cutting the bone inslot, according to the safe needle insertion position design ke shi needle location guide post of confirming, be used for the operation in-process to squeeze into according to predetermined needle insertion position and fix the ke shi needle, prevent to cut the bone baffle and slide in the use.
S6, importing a source file of the osteotomy orthopedic guide plate model into 3D printing software, placing a spatial position, adding support to the suspended structure, and performing layered slicing processing to obtain two-dimensional information data;
the effect of this step is: and cutting the osteotomy orthopedic guide plate model into a plurality of slices along the vertical direction to obtain layered slice information, and generating two-dimensional information data which can be recognized by a 3D printer and printed layer by layer.
S7, generating a scanning path by using the two-dimensional information data, importing the scanning path into 3D printing equipment, setting process parameters, and printing the osteotomy orthopedic guide plate;
the effect of this step is: the bone cutting orthopedic guide plate model is printed and molded by adopting a 3D printing technology, so that the solid bone cutting orthopedic guide plate is obtained, and compared with the traditional molding mode, the bone cutting orthopedic guide plate has the advantages of high processing efficiency and high precision, the processed bone cutting orthopedic guide plate has high strength, uniform internal tissue stress and lower probability of fracture.
S8, grinding the sand-blasting bone-cutting orthopedic guide plate to obtain a finished product of the bone-cutting orthopedic guide plate;
the effect of this step is: through the orthopedic baffle of osteotomy of 3D printing shaping, there are some supporting materials of remaining on the baffle surface, need carry out aftertreatment work such as polishing, sandblast.
Furthermore, the tomography CT or MRI scanning data is stored in a DICOM image format, and the thickness of the layer is 0.625-1.5 mm.
The effect of this step is: the key of the three-dimensional reconstruction of the medical image is the layer thickness interlayer spacing of scanning data such as CT, MRI and the like, the reconstruction precision is worse when the numerical value is larger, the reconstruction precision is better when the numerical value is smaller, and the effect of 0.625 mm-1.5 mm is optimal.
The invention establishes a three-dimensional anatomical model through a computer to measure individualized data so as to determine parameters such as an osteotomy angle, an osteotomy plane, a rotation angle and the like for correcting the elbow varus deformity, so that the severity of the elbow joint deformity of different individuals can be known, and the anatomical morphology of the surgical site of a patient is counted; the computer-aided preoperative surgical simulation can visually evaluate the surgical effect, so that the orthopedic effect is the best, and the complication incidence rate is reduced.
The intraoperative osteotomy orthopedic operation guide plate is simple and convenient to apply, can finish accurate positioning and orientation of an operation area only by tightly attaching the template to a corresponding anatomical structure, has no special experience requirement, is valuable to young doctors in the aspect of operation training, can shorten the learning curve of the young doctors, saves the operation time and reduces the bleeding volume of patients; the invention realizes the analysis and the accurate correction of the elbow varus with the help of the computer-aided technology, the reverse engineering and the rapid prototyping technology, improves the accurate correction of the elbow varus deformity to the digital level, and has more accurate, more reliable and more excellent treatment effect.
Example 2
The combined elbow joint osteotomy orthopedic guide plate is prepared by the manufacturing method of the combined elbow joint osteotomy orthopedic guide plate, the finished product of the combined elbow joint osteotomy orthopedic guide plate comprises a near-end guide plate 1, a middle-end guide plate 2 and a far-end guide plate 3, one end of the middle-end guide plate 2 is connected with the near-end guide plate 1, and the other end of the middle-end guide plate 2 is connected with the far-end guide plate 3 and mutually forms an osteotomy groove.
Further, the proximal guide plate 1 includes a proximal end plate body 101, a proximal k-wire positioning column 102, proximal reserved grooves 103, internal rotation angle positioning columns 104 and proximal osteotomy guide walls 105, the proximal osteotomy guide walls 105 are installed at the bottom end of the proximal end plate body 101, the number of the proximal reserved grooves 103 is 2, 2 of the proximal reserved grooves 103 are opened at two ends of the proximal osteotomy guide walls 105, the internal rotation angle positioning columns 104 are installed at extensions of two ends of the proximal osteotomy guide walls 105, and the proximal k-wire positioning columns 102 are installed on the proximal end plate body 101;
the distal guide plate 3 comprises a distal plate body 301, a distal reserved groove 302, a distal k-wire positioning post 303, internal rotation angle positioning holes 304 and a distal osteotomy guiding wall 305, wherein the distal osteotomy guiding wall 305 is installed at the top end of the distal plate body 301, the number of the distal reserved grooves 302 is 2, 2 distal reserved grooves 103 are opened at two ends of the proximal osteotomy guiding wall 305, the internal rotation angle positioning holes 304 are installed on the extension parts at two ends of the distal osteotomy guiding wall 305 and are matched with the internal rotation angle positioning posts 104, and the distal k-wire positioning post 303 is installed on the distal plate body 301;
the middle-end guide plate 2 comprises a middle-end plate body 201, a middle-end special-shaped structural body 202, an airfoil-shaped structural boss 203 and a middle-section guide plate Kirschner wire positioning hole 204, the number of the middle-end special-shaped structural bodies 202 is 2, the middle-end special-shaped structural bodies 202 are arranged at two ends of the middle-end plate body 201, the airfoil-shaped structural boss 203 is arranged on the middle-end special-shaped structural body 202, and the near-end reserved groove 103 and the far-end reserved groove 103 are matched with the airfoil-shaped structural boss 203.
Further, the finished product of the combined elbow joint osteotomy orthopedic guide plate is a high polymer material guide plate.
Further, the finished product of the combined elbow joint osteotomy orthopedic guide plate is a biological ceramic guide plate.
The high polymer material guide plate and the biological ceramic guide plate are both novel biodegradable materials and are made of starch in renewable plant resources. It should be noted that these materials are used in this embodiment not only because of their advantages of good biodegradability and biocompatibility, but also because of their advantages of easy availability, low cost, good processability, high strength, etc. It should be emphasized that in other embodiments, the material is not limited to the materials described in this embodiment, but may be other types of materials as long as they have good biocompatibility and high mechanical properties and can meet the performance requirements of the osteotomy orthopedic guide plate in osteotomy.
The combined elbow joint osteotomy orthopedic guide plate comprises the following use steps: (1) assembling and fitting the proximal guide plate 1, the middle guide plate 2 and the distal guide plate 3 on the distal humerus of the affected side of the patient; (2) the near-end guide plate 1 positioned above and the far-end guide plate 3 positioned below are driven into a Kirschner wire through a Kirschner wire positioning column on the guide plate to be fixed, so that the guide plates are prevented from sliding; (3) performing wedge-shaped osteotomy along the osteotomy groove by using an osteotomy tool, and removing the wedge-shaped osteotomy block and the middle guide plate together after the osteotomy is completed; (4) the proximal end distal osteotomy surface is closed, and the distal end of the humerus is rotated to ensure that the internal rotation angle positioning hole on the distal end guide plate 3 is superposed with the internal rotation angle positioning column on the proximal end guide plate, so that the correction of the internal rotation angle of the elbow joint is completed.
The foregoing is illustrative of the preferred embodiments of this invention, and it is to be understood that the invention is not limited to the precise form disclosed herein and that various other combinations, modifications, and environments may be resorted to, falling within the scope of the concept as disclosed herein, either as described above or as apparent to those skilled in the relevant art. And that modifications and variations may be effected by those skilled in the art without departing from the spirit and scope of the invention as defined by the appended claims.
Claims (10)
1. The manufacturing method of the combined elbow joint osteotomy orthopedic guide plate is characterized in that: the method comprises the following steps:
s1, carrying out CT or MRI scanning on the upper limbs of the patient to obtain tomography data of the affected and healthy elbow joints, carrying out image segmentation and reconstruction by using medical image three-dimensional reconstruction software, constructing a lesion model and a normal elbow joint model, and repairing to form a digital three-dimensional model of the lesion model and the normal elbow joint model;
s2, measuring anatomical structure parameters of a pathological change model of the patient and a digital three-dimensional model of a normal elbow joint, calculating an osteotomy orthopedic angle and an osteotomy position according to the anatomical structure parameters in combination with preoperative imaging and clinical examination data, judging the type of elbow joint deformity, and drawing an osteotomy line;
s3, designing an osteotomy plane at the osteotomy position of the lesion model according to the calculated angle of osteotomy correction, simulating osteotomy by using a cutting command in three-dimensional software according to the osteotomy plane, and separating a part needing to be cut.
S4, after the simulation osteotomy is completed, removing bone blocks needing to be resected, resetting the resected elbow joint, enabling the upper and lower osteotomy surfaces to be jointed, correcting the internal rotation angle, measuring anatomical structure parameters, taking the healthy side model mirror image as reference and verifying the postoperative correction effect, and enabling the elbow joint deformity to be recovered to be normal;
s5, importing the lesion model into computer aided design software, selecting the corresponding bone cutting area surface according to the operation approach, stretching the bone cutting area surface into a bone cutting guide plate body, and designing a bone cutting guide groove and a Kirschner wire positioning guide hole according to the determined bone cutting position and the Kirschner wire insertion position; then, introducing a postoperative model with a well simulated operation, resetting the near-end guide plate and the far-end guide plate by referring to the postoperative model, and designing internal rotation angle positioning columns and positioning holes on the near-end guide plate and the far-end guide plate according to the reset condition to complete the design of the osteotomy orthopedic guide plate;
s6, importing a source file of the osteotomy orthopedic guide plate model into 3D printing software, placing a spatial position, adding support to the suspended structure, and performing layered slicing processing to obtain two-dimensional information data;
s7, generating a scanning path by using the two-dimensional information data, importing the scanning path into 3D printing equipment, setting process parameters, and printing the osteotomy orthopedic guide plate;
s8, grinding the sand-blasting bone-cutting orthopedic guide plate to obtain a finished product of the bone-cutting orthopedic guide plate;
the specific process of judging the elbow joint deformity type comprises the steps of defining the longitudinal axis of a humerus as an arm axis, defining the long axis of an ulna as a forearm axis, forming an outward-opening included angle between the arm axis and the extension line of the forearm axis at the elbow, enabling the included angle to range from 165 degrees to 170 degrees, enabling a carrying angle to be 10 degrees to 15 degrees, enabling a male to be 10 degrees and a female to be 15 degrees, judging that the elbow is inverted when the carrying angle is reduced, and judging that the elbow is inverted when the carrying angle is increased.
2. The method for making a combined elbow joint osteotomy orthopedic guide plate of claim 1, wherein: the repairing process of the lesion model and the normal elbow joint model in the step S1 includes denoising, smoothing and hole filling.
3. The method for making a combined elbow joint osteotomy orthopedic guide plate of claim 1, wherein: the tomography CT or MRI scanning data is stored in a DICOM image format, and the thickness of the layer is 0.625-1.5 mm.
4. The method for making a combined elbow joint osteotomy orthopedic guide plate of claim 1, wherein: the lesion model and the digitized three-dimensional model of the normal elbow joint in step S2 include, but are not limited to, length, arm axis, forearm axis, carry angle, and pronation angle.
5. The method for making a combined elbow joint osteotomy orthopedic guide plate of claim 1, wherein: the procedure of resetting the truncated elbow joint in step S4 is to remove the bone pieces to be cut, reset the truncated elbow joint using the movement and rotation commands, fit the upper and lower osteotomy surfaces, correct the internal rotation angle, and then measure the length of the upper limb, the elbow, the forearm axis, the carrying angle, and the internal rotation angle.
6. The method for making a combined elbow joint osteotomy orthopedic guide plate of claim 1, wherein: the specific process of designing the osteotomy orthopedic guide plate model in the step S5 is to design an osteotomy guide groove and a kirschner wire positioning guide hole according to the determined osteotomy position and the kirschner wire insertion position on the preoperative model, then reset the proximal end guide plate and the distal end guide plate with reference to the postoperative model, and design internal rotation angle positioning columns and positioning holes on the proximal end guide plate and the distal end guide plate according to the reset condition, thereby completing the design of the osteotomy orthopedic guide plate model.
7. A combined elbow joint osteotomy orthopedic guide plate, characterized in that it is prepared by the method for manufacturing the combined elbow joint osteotomy orthopedic guide plate according to any one of claims 1-6, the finished product of the combined elbow joint osteotomy orthopedic guide plate comprises a proximal guide plate (1), a middle guide plate (2) and a distal guide plate (3), one end of the middle guide plate (2) is connected with the proximal guide plate (1), the other end of the middle guide plate (2) is connected with the distal guide plate (3), and the middle guide plate and the distal guide plate mutually form a osteotomy groove.
8. The combination elbow osteotomy orthopedic guide plate of claim 7, wherein: the near-end guide plate (1) comprises a near-end plate body (101), a near-end Kirschner wire positioning column (102), near-end reserved grooves (103), internal rotation angle positioning columns (104) and a near-end osteotomy guiding wall (105), wherein the near-end osteotomy guiding wall (105) is installed at the bottom end of the near-end plate body (101), the number of the near-end reserved grooves (103) is 2, the 2 near-end reserved grooves (103) are arranged at two ends of the near-end osteotomy guiding wall (105), the internal rotation angle positioning columns (104) are installed at extending parts at two ends of the near-end osteotomy guiding wall (105), and the near-end Kirschner wire positioning columns (102) are installed on the near-end plate body (101);
the far-end guide plate (3) comprises a far-end plate body (301), far-end reserved grooves (302), far-end Kirschner wire positioning columns (303), internal rotation angle positioning holes (304) and far-end osteotomy guide walls (305), wherein the far-end osteotomy guide walls (305) are installed at the top end of the far-end plate body (301), the number of the far-end reserved grooves (302) is 2, 2 far-end reserved grooves (103) are arranged at two ends of the near-far-end osteotomy guide walls (305), the internal rotation angle positioning holes (304) are installed at extension parts at two ends of the far-end osteotomy guide walls (305) and matched with the internal rotation angle positioning columns (104), and the far-end Kirschner wire positioning columns (303) are installed on the far-end plate body (301);
the middle-end guide plate (2) comprises a middle-end plate body (201), a middle-end special-shaped structural body (202), an airfoil-shaped structural boss (203) and a middle-section guide plate Kirschner wire positioning hole (204), wherein the number of the middle-end special-shaped structural body (202) is 2, the middle-end special-shaped structural body (202) is arranged at two ends of the middle-end plate body (201), the airfoil-shaped structural boss (203) is arranged on the middle-end special-shaped structural body (202), and the near-end reserved groove (103) and the far-end reserved groove (103) are matched with the airfoil-shaped structural boss (203).
9. The combination elbow osteotomy orthopedic guide plate of claim 8, wherein: the finished product of the combined elbow joint osteotomy orthopedic guide plate is a high polymer material guide plate.
10. The combination elbow osteotomy orthopedic guide plate of claim 8, wherein: the finished product of the combined elbow joint osteotomy orthopedic guide plate is a biological ceramic guide plate.
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