CN212369125U - Computer-aided design individualized prosthesis for accurate resection of pelvic tumors - Google Patents

Abstract

The utility model belongs to the orthopedic ware field of bone surgery osteotomy, especially relate to individualized false body for accurate excision of computer-aided design pelvis tumour, including acetabular cup false body, ilium cross-section contact surface, ischium cross-section contact surface, pubic bone cross-section contact surface, extend ilium cross-section contact surface above the acetabular cup false body, ilium cross-section contact surface adopts the platelike structure that is provided with ke needle passageway to be fixed with the ilium face, and acetabular cup false body downwardly extending stretches out ischium cross-section and is fixed with ischium face, and it is fixed with pubic bone face that extend out pubic bone cross-section contact surface before the acetabular cup false body; the acetabulum cup prosthesis adopts a cylinder with an acetabulum cup groove, and the acetabulum cup groove adopts a cambered surface structure. The utility model has the advantages that: the method not only realizes accurate tumor resection, but also realizes the positioning of the personalized prosthesis, the prosthesis furthest retains the autogenous bone of a patient, not only increases the stability of the prosthesis, but also is beneficial to the rapid growth of the prosthesis and the bone interface, the function of the pelvis is furthest ensured, and the operation of the orthopedic tumor resection and prosthesis replacement operation is simplified.

Description

Computer-aided design individualized prosthesis for accurate resection of pelvic tumors

Technical Field

The utility model belongs to orthopedic equipment field is cut to the bone surgery, especially relates to accurate excision of computer-aided design pelvis tumour is with individualized false body.

Background

With the increasing rise of computer-aided orthopedics, 3D printing-assisted orthopedic precise surgery techniques are increasing, and the techniques are mainly applied to the aspects of fracture deformity healing, congenital bone deformity or dysplasia, joint replacement, bone tumor resection and the like, and due to the complexity of mechanisms and anatomical features of the pelvis, the resection of pelvic tumors is always difficult in orthopedic surgery, so that the complete resection of the tumors is ensured, and the postoperative mobility of patients needs to be recovered as much as possible, so that the requirements on the angle and direction of osteotomy are high, the range and the angle of osteotomy are not precise, which directly affects the functional recovery of the patients, and even leads to the failure of the whole surgery, and therefore, the precise angle and range of osteotomy are particularly important.

The tumor resection operation of the traditional method is only that a surgeon empirically resects a tumor according to preoperative CT and plain film and observation in the operation, for a patient needing joint replacement, only some conventional joint prostheses are used for replacement, the inclination angle of the acetabulum and the fit degree of the joint are required to be completed by the experience of medical workers, only whether the osteotomy range and the prosthesis position are accurate can be pre-judged, but clear reduction standards are lacked, the precision is not high, the tumor resection degree and the prosthesis position after the operation have certain deviation, taking the pelvic tumor to accumulate the tumor in the II area of the joint as an example, the recovery condition of the inclination angle and the anteversion angle of the acetabulum prosthesis is not optimistic only depending on two-dimensional perspective, the quantified osteotomy range and angle and the accurate replacement position of the prosthesis are not available in the operation, the prosthesis cannot reserve autologous bone of the patient to the maximum extent, and the prosthesis stability is not high, the prosthesis grows slowly into the bone interface. Some students use 3D printing technology to print the pelvis with tumors before operation, simulate the operation on a model in advance, and select a more appropriate internal fixing device to improve the accuracy of the operation, but the method does not overcome the defect of two-dimensional perspective estimation of the orthopedic condition in the operation.

SUMMERY OF THE UTILITY MODEL

In order to solve the problems that the bone cutting amount can not be accurately measured in the traditional operation technology, the space angle of the position of the prosthesis can not be controlled, and the X-ray exposure times in the operation are more, the utility model provides a computer-aided design pelvis tumor accurate resection guide plate, a personalized prosthesis and a manufacturing method thereof, wherein the method takes the opposite side or normal structure and functional parameters as the standard, if the hip joint does not need to be replaced, the prosthesis at the tumor position can be directly designed according to the mechanical property of the pelvis, such as the tumor invasion joint surface or the joint load area, when the acetabulum needs to be designed on the personalized prosthesis, when the opposite side acetabulum is normal, the acetabulum of the prosthesis can be designed according to the inclination angle and the; when the contralateral acetabulum is abnormal, the prosthesis is designed according to the normal angle and the original height of the prosthesis at the affected side, the position of the fixing nail of the prosthesis and the position and the direction of the osteotome are determined, and the repair of precise structure and function can be completed without perspective in the operation.

The utility model discloses not only realize not only accurate excision tumour but also realize the location of individualized false body, the function of pelvis has been guaranteed to the at utmost simultaneously, simplifies the operation of bone tumour excision and false body replacement operation, improves the operation precision, is favorable to having realized accurate tumour excision, false body design and preparation, and false body maximum remains patient's autologous bone not only increases false body stability, also helps the quick growth of false body and skeleton interface to go into.

The technical scheme of the utility model: the individualized prosthesis for precise pelvic tumor resection is designed by aid of a computer, and is characterized by comprising an acetabular cup prosthesis, an ilium cross section contact surface, an ischium cross section contact surface and a pubis cross section contact surface, wherein the ilium cross section contact surface extends out of the upper part of the acetabular cup prosthesis, is fixed with the ilium surface by adopting a plate-shaped structure provided with a kirschner wire channel, extends out of the lower part of the acetabular cup prosthesis and is fixed with the ischium surface, and the pubis cross section contact surface extends out of the front part of the acetabular cup prosthesis and is fixed with the pubis surface;

the acetabulum cup prosthesis adopts a column provided with an acetabulum cup groove, the acetabulum cup groove adopts a cambered surface structure, the bottom of the acetabulum cup is provided with screw holes, and the contact surface of the ischium section is also provided with screw holes;

preferably, the number of the screw holes at the bottom of the acetabular cup is 3, and the number of the screw holes at the contact surface of the ischial section is 2;

preferably, the ilium section contact surface, the ischium section contact surface, the pubis section contact surface and the pelvis contact surface all adopt net structures;

preferably, the iliac section interface, the ischial section interface, the pubic section interface and the pelvic interface all have maximum length and width values of 91.5mm 31.19, 46.64 mm 25.34mm, 20.34 mm 11.76 mm;

preferably, the mesh structure adopts a polygonal mesh.

Preferably, the number of the kirschner wire channels is 6.

The utility model has the advantages that: the method not only realizes accurate tumor resection, but also realizes the positioning of the personalized prosthesis, the prosthesis reserves the autogenous bone of the patient to the maximum extent, not only increases the stability of the prosthesis, but also is beneficial to the rapid growth of the prosthesis and the bone interface. Meanwhile, the functions of the pelvis are ensured to the maximum extent, the operation of orthopedic tumor excision and prosthesis replacement operations is simplified, and the operation accuracy is improved.

Drawings

Fig. 1 is a schematic diagram of the present invention reconstructing a three-dimensional pelvic tumor model by three-dimensional software;

FIG. 2 is a schematic diagram of the present invention for determining tumor location via CT and three-dimensional models of the pelvis;

FIG. 3 is a schematic diagram of the tumor range determination osteotomy location in the three-dimensional model of the present invention;

FIG. 4 is a schematic view of the present invention in designing an acetabulum on a personalized prosthesis at an osteotomy position of a pelvic model;

FIG. 5 is a schematic view of the lead-in prosthesis of the present invention determining the position and direction of screw insertion and the length of the screw;

FIG. 6 is a schematic view of the present invention in the position of the prosthetic screw and the K-wire matching;

FIG. 7 is a schematic view of the guide plate design of the present invention;

fig. 8 is a schematic view of the present invention in determining the position of the prosthesis based on the positioning of the k-wire and the osteotomy plane.

Fig. 9 is a schematic view of the pelvic prosthesis of the present invention, as seen from the acetabular cup prosthesis;

FIG. 10 is a rear view of FIG. 9;

fig. 11 is a left side view of fig. 9.

In the figure, 1, pelvis prosthesis, 2, acetabulum cup prosthesis, 3, ilium cross section contact surface, 4, ischium cross section contact surface, 5, pubic cross section contact surface, 6, kirschner wire channel, 7, acetabulum cup groove, 8, screw hole, 9, grid structure, 10, ilium, 11, ischium, 12, pubis, 13 and pelvis model.

Detailed Description

An embodiment of the present invention will be described with reference to the accompanying drawings.

Example 1

The method for manufacturing the personalized prosthesis for the precise resection of the pelvic tumor through computer-aided design comprises the following steps:

step 1, collecting tomography CT data of the complete pelvis of a patient, storing the data in a DICOM image format, and establishing a three-dimensional pelvis tumor model through three-dimensional reconstruction software;

step 2, determining the three-dimensional range and the tumor position of the pelvis on the three-dimensional pelvis tumor model; (see fig. 2)

Step 3, determining the bone cutting position and angle on the three-dimensional pelvis tumor model, and performing bone cutting treatment on the tumor;

step 4, drawing a pelvis prosthesis completely matched with an osteotomy surface in the three-dimensional pelvis tumor model after the osteotomy treatment, correcting the model after the osteotomy, and simulating an implanted screw model to determine the pelvis prosthesis and a screw fixing position;

and 5, simulating an implanted kirschner wire model in the three-dimensional pelvic tumor model after the osteotomy treatment to determine the fixing position of the kirschner wire.

Step 6, designing and manufacturing an operation guide plate according to the shape of the side surface of the operation approach of the original affected side model and by combining the osteotomy position, the Kirschner wire position and the angle;

and 7, performing operation simulation by using the guide plate, determining structural parameters and fixed positions of the pelvic prosthesis, the screws and the kirschner wires, and designing and manufacturing the prosthesis.

The individualized prosthesis for precise pelvic tumor resection is designed by aid of a computer and comprises an acetabular cup prosthesis, an ilium cross section contact surface, an ischium cross section contact surface and a pubis cross section contact surface, wherein the ilium cross section contact surface extends out of the upper part of the acetabular cup prosthesis and is fixed with the ilium surface by adopting a plate-shaped structure provided with a kirschner wire channel, the ischium cross section extends out of the lower part of the acetabular cup prosthesis and is fixed with the ischium surface, and the pubis cross section contact surface extends out of the front part of the acetabular cup prosthesis and is fixed with the pubis surface;

the acetabulum cup prosthesis adopts a column with an acetabulum cup groove, the acetabulum cup groove adopts a cambered surface structure, the bottom of the acetabulum cup is provided with screw holes, and the contact surface of the ischium section is also provided with screw holes.

Example 2

The method for manufacturing the personalized prosthesis for the precise resection of the pelvic tumor through computer-aided design comprises the following steps:

step 1, collecting tomography CT data of the complete pelvis of a patient, storing the data in a DICOM image format, and establishing a three-dimensional pelvis tumor model through three-dimensional reconstruction software;

step 2, determining the three-dimensional range and the tumor position of the pelvis on the three-dimensional pelvis tumor model; (see fig. 2)

In step 2, the three-dimensional range and the tumor position of the pelvis are determined on the three-dimensional pelvis tumor model: comprehensively judging the tumor position according to nuclear magnetic resonance, CT and X-ray films, marking in the three-dimensional model, marking the contour line of the tumor, the boundary of the outer edge of the tumor and the boundary of the outer edge of the pelvis on the nuclear magnetic resonance or CT, and determining the three-dimensional range and the tumor position of the pelvis.

Step 3, determining the bone cutting position and angle on the three-dimensional pelvis tumor model, and performing bone cutting treatment on the tumor;

step 3, determining the osteotomy position and angle on the three-dimensional pelvic tumor model: according to the outer margin of the tumor, the osteotomy model is introduced into the three-dimensional pelvic tumor model, and the osteotomy is determined to be positioned to completely resect the tumor, wherein the osteotomy range is maintained at least 10mm beyond the outer margin of the tumor; according to the specific shape of the tumor, whether the osteotome needs to change the osteotomy with a plurality of angles is determined, and the specific osteotomy direction and the osteotomy angle of the osteotome are determined.

Step 4, drawing a pelvis prosthesis completely matched with the osteotomy surface in the three-dimensional pelvis tumor model after the osteotomy treatment in the osteotomy step 4, and performing the orthopedic specific steps on the model after the osteotomy: the three-dimensional pelvis tumor model after the osteotomy treatment is reshaped by taking the contralateral mirror image model as a reference; the contact surface of the pelvis prosthesis and the osteotomy surface adopts a bone trabecula structure, the prosthesis contact surface is completely matched with the osteotomy surface of the pelvis, the pelvis prosthesis and the osteotomy surface can be used for recovering the muscle position in the muscle attachment point reserved hole surgery, the screw model simulates implantation to determine the prosthesis and screw fixing positions, and simultaneously, the prosthesis and screw model structural parameters are measured;

taking the contralateral mirror model as a reference specifically means that: the acetabulum of the opposite side is normal, and the correction can be carried out according to the inclination angle and the acetabulum height of the acetabulum of the opposite side; when the contralateral acetabulum is abnormal, the orthopedic treatment is carried out according to the anatomical structure parameters of bones and joints.

The bone model is used for orthopedic correction, and a pelvis prosthesis and a screw fixing position are determined by simulating an implanted screw model;

and 5, simulating an implanted kirschner wire model in the three-dimensional pelvic tumor model after the osteotomy treatment to determine the fixing position of the kirschner wire.

Step 6, designing and manufacturing an operation guide plate according to the shape of the side surface of the operation approach of the original affected side model and by combining the osteotomy position, the Kirschner wire position and the angle;

and 7, performing operation simulation by using the guide plate, determining structural parameters and fixed positions of the pelvic prosthesis, the screws and the kirschner wires, and designing and manufacturing the prosthesis.

The individual prosthesis for precisely excising the pelvic tumor is designed by the aid of a computer, and is a pelvic prosthesis 1, wherein the pelvic prosthesis 1 comprises an acetabular cup prosthesis 2, an ilium cross-section contact surface 3, an ischium cross-section contact surface 4 and a pubis cross-section contact surface 5, the ilium cross-section contact surface 2 extends out of the upper part of the acetabular cup prosthesis, the ilium cross-section contact surface 2 is fixed with the ilium surface by adopting a plate-shaped structure provided with a kirschner wire channel 6, the lower part of the acetabular cup prosthesis 2 extends out of the ischium cross section 4 to be fixed with the ischium surface, and the pubis cross-section contact surface 5 extends out; the contact surface 3 of iliac section, the contact surface 4 of ischium section, and the contact surface 5 of pubic section are respectively bonded with ilia 10, ischium 11, and pubic bone 12 (see fig. 9-11)

The acetabulum cup prosthesis 2 adopts a cylinder provided with an acetabulum cup groove 7, the acetabulum cup groove 7 adopts a cambered surface structure and is a hemispherical or stepped cambered surface, the bottom of the acetabulum cup is provided with screw holes 8, and the contact surface of the ischium section is also provided with the screw holes 8;

the number of screw holes 8 at the bottom of the acetabular cup is 3, and the number of screw holes at the contact surface of the ischium section is 2;

the contact surface of the ilium section, the contact surface of the ischium section, the contact surface of the pubis section and the pelvis contact surface all adopt a net structure;

the contact surface of the ilium section 3, the ischium section 4, the pubis section 5 and the pelvis are all in a net structure; the friction force of the contact surface is increased, so that the fitting is better, the stability of the prosthesis is increased, and the rapid bone ingrowth of the prosthesis and the bone interface is promoted.

Example 3

The method for manufacturing the personalized prosthesis for the precise resection of the pelvic tumor through computer-aided design comprises the following steps:

step 1, collecting tomography CT data of the complete pelvis of a patient, storing the data in a DICOM image format, and establishing a three-dimensional pelvis tumor model through three-dimensional reconstruction software;

step 2, determining the three-dimensional range and the tumor position of the pelvis on the three-dimensional pelvis tumor model; (see fig. 2)

In step 2, the three-dimensional range and the tumor position of the pelvis are determined on the three-dimensional pelvis tumor model: comprehensively judging the tumor position according to nuclear magnetic resonance, CT and X-ray films, marking in the three-dimensional model, marking the contour line of the tumor, the boundary of the outer edge of the tumor and the boundary of the outer edge of the pelvis on the nuclear magnetic resonance or CT, and determining the three-dimensional range and the tumor position of the pelvis.

Step 3, determining the bone cutting position and angle on the three-dimensional pelvis tumor model, and performing bone cutting treatment on the tumor;

step 3, determining the osteotomy position and angle on the three-dimensional pelvic tumor model: according to the outer margin of the tumor, the osteotomy model is introduced into the three-dimensional pelvic tumor model, and the osteotomy is determined to be positioned to completely resect the tumor, wherein the osteotomy range is maintained at least 10mm beyond the outer margin of the tumor; according to the specific shape of the tumor, whether the osteotome needs to change the osteotomy with a plurality of angles is determined, and the specific osteotomy direction and the osteotomy angle of the osteotome are determined.

Step 4, drawing a pelvis prosthesis completely matched with the osteotomy surface in the three-dimensional pelvis tumor model after the osteotomy treatment in the osteotomy step 4, and performing the orthopedic specific steps on the model after the osteotomy: the three-dimensional pelvis tumor model after the osteotomy treatment is reshaped by taking the contralateral mirror image model as a reference; the contact surface of the pelvis prosthesis and the osteotomy surface adopts a bone trabecula structure, the prosthesis contact surface is completely matched with the osteotomy surface of the pelvis, the pelvis prosthesis and the osteotomy surface can be used for recovering the muscle position in the muscle attachment point reserved hole surgery, the screw model simulates implantation to determine the prosthesis and screw fixing positions, and meanwhile, the pelvis prosthesis and screw model structural parameters are measured;

the measurement of the structural parameters of the pelvic prosthesis and the screw model comprises the following steps:

step A, introducing a pelvic prosthesis into software, and determining the screw feeding position and direction of a screw according to the positions of the pelvic prosthesis and the osteotomy surface;

step B, measuring the length of the pelvis prosthesis and each screw model on the pelvis prosthesis;

taking the contralateral mirror model as a reference specifically means that: the acetabulum of the opposite side is normal, and the correction can be carried out according to the inclination angle and the acetabulum height of the acetabulum of the opposite side; when the contralateral acetabulum is abnormal, the orthopedic treatment is carried out according to the anatomical structure parameters of bones and joints.

The bone model is used for orthopedic correction, and a pelvis prosthesis and a screw fixing position are determined by simulating an implanted screw model;

step 5, simulating an implanted kirschner wire model in the three-dimensional pelvic tumor model after the osteotomy treatment to determine a kirschner wire fixing position;

in step 5, simulating an implanted kirschner wire model in the three-dimensional pelvic tumor model after the osteotomy treatment to determine the fixed position of the kirschner wire: implanting a kirschner wire model, determining the position of a kirschner wire channel, matching the position of the kirschner wire model with the position of a screw fixing model, and implanting at least two kirschner wire models to maintain the position stability of the three-dimensional space of the pelvic prosthesis.

Step 6, designing and manufacturing an operation guide plate according to the shape of the side surface of the operation approach of the original affected side model and by combining the osteotomy position, the Kirschner wire position and the angle;

in step 6, designing and manufacturing the surgical guide plate according to the shape of the surgical access side surface of the original affected side model by combining the osteotomy position, the Kirschner wire position and the angle: in order to ensure the intraoperative accurate positioning of the guide plate, at least two Kirschner wire channels are reserved on the guide plate except for a reserved osteotome guide channel in the surgical guide plate, namely, the guide plate provides an accurate implantation position of a personalized prosthesis when a subsequent guide plate is manufactured, and the reserved osteotome edge position of the guide plate needs to meet 1.1-1.3 times of the width of a blade and 1.4-1.6 times of the thickness of the blade; the diameter of the reserved Kirschner wire channel of the guide plate is 1.1-1.3 times of that of the application Kirschner wire; meanwhile, the guide plate knife edge and the Kirschner wire needle path have enough depth of 6-20 mm, so that the direction is ensured.

And 7, performing operation simulation by using the guide plate, determining structural parameters and fixed positions of the pelvic prosthesis, the screws and the kirschner wires, and designing and manufacturing the prosthesis.

The individualized prosthesis for precise pelvic tumor resection is designed by aid of a computer and comprises an acetabular cup prosthesis, an ilium cross section contact surface, an ischium cross section contact surface and a pubis cross section contact surface, wherein the ilium cross section contact surface extends out of the upper part of the acetabular cup prosthesis and is fixed with the ilium surface by adopting a plate-shaped structure provided with a kirschner wire channel, the ischium cross section extends out of the lower part of the acetabular cup prosthesis and is fixed with the ischium surface, and the pubis cross section contact surface extends out of the front part of the acetabular cup prosthesis and is fixed with the pubis surface; the number of the Kirschner wire channels is 6.

The acetabulum cup prosthesis adopts a column with an acetabulum cup groove, the acetabulum cup groove adopts a cambered surface structure, the bottom of the acetabulum cup is provided with screw holes, and the contact surface of the ischium section is also provided with screw holes;

the number of screw holes at the bottom of the acetabular cup is 3, and the number of screw holes at the contact surface of the ischium section is 2;

the contact surface of the ilium section, the contact surface of the ischium section, the contact surface of the pubis section and the pelvis contact surface all adopt a net structure;

example 4

The method for manufacturing the personalized prosthesis for the precise resection of the pelvic tumor through computer-aided design comprises the following steps:

step 1, collecting tomography CT data of the complete pelvis of a patient, storing the data in a DICOM image format, and establishing a three-dimensional pelvis tumor model through three-dimensional reconstruction software;

step 2, determining the three-dimensional range and the tumor position of the pelvis on the three-dimensional pelvis tumor model; (see fig. 2)

In step 2, the three-dimensional range and the tumor position of the pelvis are determined on the three-dimensional pelvis tumor model: comprehensively judging the tumor position according to nuclear magnetic resonance, CT and X-ray films, marking in the three-dimensional model, marking the contour line of the tumor, the boundary of the outer edge of the tumor and the boundary of the outer edge of the pelvis on the nuclear magnetic resonance or CT, and determining the three-dimensional range and the tumor position of the pelvis.

Step 3, determining the bone cutting position and angle on the three-dimensional pelvis tumor model, and performing bone cutting treatment on the tumor;

step 3, determining the osteotomy position and angle on the three-dimensional pelvic tumor model: according to the outer margin of the tumor, the osteotomy model is introduced into the three-dimensional pelvic tumor model, and the osteotomy is determined to be positioned to completely resect the tumor, wherein the osteotomy range is maintained at least 10mm beyond the outer margin of the tumor; according to the specific shape of the tumor, whether the osteotome needs to change the osteotomy with a plurality of angles is determined, and the specific osteotomy direction and the osteotomy angle of the osteotome are determined.

Step 4, drawing a pelvis prosthesis completely matched with the osteotomy surface in the three-dimensional pelvis tumor model after the osteotomy treatment in the osteotomy step 4, and performing the orthopedic specific steps on the model after the osteotomy: the three-dimensional pelvis tumor model after the osteotomy treatment is reshaped by taking the contralateral mirror image model as a reference; the contact surface of the pelvis prosthesis and the osteotomy surface adopts a bone trabecula structure, the prosthesis contact surface is completely matched with the osteotomy surface of the pelvis, the pelvis prosthesis and the osteotomy surface can be used for recovering the muscle position in the muscle attachment point reserved hole surgery, the screw model simulates implantation to determine the prosthesis and screw fixing positions, and meanwhile, the pelvis prosthesis and screw model structural parameters are measured;

the measurement of the structural parameters of the pelvic prosthesis and the screw model comprises the following steps:

step A, introducing a pelvic prosthesis into software, and determining the screw feeding position and direction of a screw according to the positions of the pelvic prosthesis and the osteotomy surface;

step B, measuring the length of the pelvis prosthesis and each screw model on the pelvis prosthesis;

taking the contralateral mirror model as a reference specifically means that: the acetabulum of the opposite side is normal, and the correction can be carried out according to the inclination angle and the acetabulum height of the acetabulum of the opposite side; when the contralateral acetabulum is abnormal, the orthopedic treatment is carried out according to the anatomical structure parameters of bones and joints.

The bone model is used for orthopedic correction, and a pelvis prosthesis and a screw fixing position are determined by simulating an implanted screw model;

step 5, simulating an implanted kirschner wire model in the three-dimensional pelvic tumor model after the osteotomy treatment to determine a kirschner wire fixing position;

in step 5, simulating an implanted kirschner wire model in the three-dimensional pelvic tumor model after the osteotomy treatment to determine the fixed position of the kirschner wire: implanting a kirschner wire model, determining the position of a kirschner wire channel, matching the position of the kirschner wire model with the position of a screw fixing model, and implanting at least two kirschner wire models to maintain the position stability of the three-dimensional space of the pelvic prosthesis.

Step 6, designing and manufacturing an operation guide plate according to the shape of the side surface of the operation approach of the original affected side model and by combining the osteotomy position, the Kirschner wire position and the angle;

in step 6, designing and manufacturing the surgical guide plate according to the shape of the surgical access side surface of the original affected side model by combining the osteotomy position, the Kirschner wire position and the angle: in order to ensure the intraoperative accurate positioning of the guide plate, at least two Kirschner wire channels are reserved on the guide plate except for a reserved osteotome guide channel in the surgical guide plate, namely, the guide plate provides an accurate implantation position of a personalized prosthesis when a subsequent guide plate is manufactured, and the reserved osteotome edge position of the guide plate needs to meet 1.1-1.3 times of the width of a blade and 1.4-1.6 times of the thickness of the blade; the diameter of the reserved Kirschner wire channel of the guide plate is 1.1-1.3 times of that of the application Kirschner wire; meanwhile, the guide plate knife edge and the Kirschner wire needle path have enough depth of 6-20 mm, so that the direction is ensured.

And 7, performing operation simulation by using the guide plate, determining structural parameters and fixed positions of the pelvic prosthesis, the screws and the kirschner wires, and designing and manufacturing the prosthesis.

Step 7, performing operation simulation by using the guide plate, and designing and manufacturing the prosthesis according to the structural parameters and the fixed positions of the pelvic prosthesis, the screws and the kirschner wires: matching the guide plate with the 3D printed pelvis model to determine the guide plate placement position; a kirschner wire is driven into the kirschner wire path to completely fix the guide plate, the angle of the knife edge is used for osteotomy, the guide plate is taken down after the osteotomy, the kirschner wire is used for fixing the pelvis prosthesis on the pelvis model for the osteotomy treatment according to the position of the kirschner wire, and the pelvis prosthesis has the function of accurate positioning; and finally, selecting screws according to the measured lengths of the screws, fixing the pelvic prosthesis, confirming that the pelvic prosthesis is completely matched with the osteotomy surface, determining the structural parameters and the fixing positions of the pelvic prosthesis, the screws and the kirschner wires, and designing and manufacturing the prosthesis.

The individualized prosthesis for precise pelvic tumor resection is designed by aid of a computer and comprises an acetabular cup prosthesis, an ilium cross section contact surface, an ischium cross section contact surface and a pubis cross section contact surface, wherein the ilium cross section contact surface extends out of the upper part of the acetabular cup prosthesis, is fixed with the ilium surface by adopting a plate-shaped structure provided with a kirschner wire channel, extends out of the lower part of the acetabular cup prosthesis and is fixed with the ischium surface, and the pubis cross section contact surface extends out of the front part of the acetabular cup prosthesis and is fixed with the pubis surface;

the acetabulum cup prosthesis adopts a column provided with an acetabulum cup groove, the acetabulum cup groove adopts a cambered surface structure, the bottom of the acetabulum cup is provided with screw holes, and the contact surface of the ischium section is also provided with screw holes;

the number of screw holes at the bottom of the acetabular cup is 3, and the number of screw holes at the contact surface of the ischium section is 2;

the contact surface of the ilium section 3, the ischium section 4, the pubis section 5 and the pelvis are all in a net structure; the friction force of the contact surface is increased, so that the fitting is better, the stability of the prosthesis is increased, and the rapid bone ingrowth of the prosthesis and the bone interface is promoted.

The maximum length and width values of the contact surface 3 of the ilium section, the contact surface 4 of the ischium section, the contact surface 5 of the pubis section and the contact surface of the pelvis are respectively 91.5mm 31.19, 46.64 mm 25.34mm and 20.34 mm 11.76 mm;

the mesh structure adopts polygonal meshes. Such as quadrilateral, hexagonal, octagonal. Simple structure and easy realization.

Example 5

The method for manufacturing the pelvis tumor precise resection guide plate and the personalized prosthesis by computer-aided design comprises the following steps:

step 1, collecting tomography CT data of the complete pelvis of a patient, storing the data in a DICOM image format, and establishing a pelvis tumor model through three-dimensional reconstruction software; (see fig. 1) the three-dimensional pelvic tumor model includes a three-dimensional model of the side of the teratoma and a three-dimensional model of the contralateral counterpart.

Step 2, comprehensively judging the tumor position according to nuclear magnetic resonance, CT and X-ray films, marking the tumor position in a three-dimensional model, comprehensively judging the tumor position, marking the contour line of the tumor, particularly the boundary of the outer edge of the tumor, on the nuclear magnetic resonance or CT, and determining the three-dimensional range of the pelvis on the three-dimensional model; (see fig. 2)

Step 3, referring to the tumor range in the step 2, finally determining the osteotomy position and angle, mainly introducing an osteotomy knife model with the same thickness of the osteotomy knife planned in the operation into software according to the outer edge boundary of the tumor, and determining that the position of the osteotomy knife can completely cut the tumor, wherein the osteotomy range is maintained at least outside the outer edge boundary of the tumor by 10 mm; determining whether the osteotome needs to change the osteotomes at a plurality of angles according to the specific forms of the tumors, and determining the specific osteotome direction and osteotome angle of the osteotome; (see fig. 3)

Step 4, the pelvis tumor model is subjected to osteotomy, so that not only single-plane osteotomy can be realized, but also multiplanar malformed osteotomy can be performed, tumors invade articular surfaces or articular bearing areas, acetabulums need to be designed on personalized prostheses, if the acetabulums on the opposite side are normal,

the prosthetic acetabulum can be designed according to the inclination angle and the acetabulum height of the contralateral acetabulum; (see fig. 4)

Step 5, software draws the pelvis prosthesis completely inosculated with the osteotomy surface, the contact surface of the prosthesis and the osteotomy surface adopts a bone trabecular structure, the prosthesis contact surface is completely inosculated with the osteotomy surface of the pelvis, the pelvis prosthesis can be used for recovering the muscle position in the muscle attachment point reserved hole surgery, the screw model simulates implantation to determine the prosthesis and the screw fixing position, and simultaneously, the measurement of the structure parameters of the prosthesis and the screw model comprises the following steps: step A, introducing a prosthesis into software and determining the screw-in position and direction of a screw according to the positions of the prosthesis and the osteotomy surface; step B, measuring the length of each screw on the prosthesis; (see fig. 5)

Step 6, performing position matching by using a kirschner wire model with a reasonable size and screws fixed on the pelvis model, and reserving at least two kirschner wires to maintain the position stability of the three-dimensional space of the prosthesis in order to ensure that the prosthesis implantation position in the actual operation is the same as the position of the computer-aided simulation implantation fixation; (see fig. 6)

Step 7, designing and manufacturing an operation guide plate according to the shape of the side surface of the operation approach of the original affected side model by combining the osteotomy position, the Kirschner wire position and the angle, wherein a reserved osteotomy knife guide channel is removed from the operation guide plate, at least two Kirschner wire channels determined in the step 6 are reserved on the guide plate for ensuring the accurate intraoperative positioning of the guide plate, namely, the accurate implantation position of the personalized prosthesis is provided for the subsequent guide plate manufacturing, and the reserved osteotomy knife edge position of the guide plate needs to meet the requirements of 1.1-1.3 times of the blade width and 1.4-1.6 times of the blade thickness; the diameter of the reserved kirschner wire needle channel of the guide plate is 1.1-1.3 times of that of the kirschner wire; meanwhile, the guide plate knife edge and the Kirschner wire needle path have enough depth of 6-20 mm, so that the direction is ensured. (see fig. 7)

Step 8, performing operation simulation by using the guide plate, specifically, matching the guide plate with the 3D printed pelvis model to determine the placement position of the guide plate; a kirschner wire is driven into a kirschner wire needle path to completely fix a guide plate, a bone is cut at a knife edge position angle, the guide plate is taken down after the bone is cut, a locking hole in the prosthesis is fixed on a skeleton model according to the position of the kirschner wire, and the prosthesis plays a role in accurately positioning the guide plate; finally, the screw is selected according to the measured length of the screw, and the prosthesis is fixed. (see fig. 8)

The individual prosthesis for precisely excising the pelvic tumor is designed by the aid of a computer, and is a pelvic prosthesis 1, wherein the pelvic prosthesis 1 comprises an acetabular cup prosthesis 2, an ilium cross-section contact surface 3, an ischium cross-section contact surface 4 and a pubis cross-section contact surface 5, the ilium cross-section contact surface 2 extends out of the upper part of the acetabular cup prosthesis, the ilium cross-section contact surface 2 is fixed with the ilium surface by adopting a plate-shaped structure provided with a kirschner wire channel 6, the lower part of the acetabular cup prosthesis 2 extends out of the ischium cross section 4 to be fixed with the ischium surface, and the pubis cross-section contact surface 5 extends out; the contact surface 3 of iliac section, the contact surface 4 of ischium section, and the contact surface 5 of pubic section are respectively bonded with ilia 10, ischium 11, and pubic bone 12 (see fig. 9-11)

The acetabulum cup prosthesis 2 adopts a cylinder provided with an acetabulum cup groove 7, the acetabulum cup groove 7 adopts a cambered surface structure and is a hemispherical or stepped cambered surface, the bottom of the acetabulum cup is provided with screw holes 8, and the contact surface of the ischium section is also provided with the screw holes 8;

the number of screw holes 8 at the bottom of the acetabular cup is 3, and the number of screw holes at the contact surface of the ischium section is 2;

the contact surface of the iliac section, the contact surface of the ischium section, the contact surface of the pubis section and the contact surface of the pelvis all adopt a net structure;

the contact surface of the ilium section 3, the ischium section 4, the pubis section 5 and the pelvis are all in a net structure; the friction force of the contact surface is increased, so that the fitting is better, the stability of the prosthesis is increased, and the rapid bone ingrowth of the prosthesis and the bone interface is promoted.

The maximum length and width values of the contact surface 3 of the ilium section, the contact surface 4 of the ischium section, the contact surface 5 of the pubis section and the contact surface of the pelvis are respectively 91.5mm 31.19, 46.64 mm 25.34mm and 20.34 mm 11.76 mm;

the mesh structure adopts polygonal meshes. Such as quadrilateral, hexagonal, octagonal. Simple structure and easy realization.

Usually, the ischia and the pubis are not reserved in the acetabulum osteotomy of the pelvic tumor, and the prosthesis disclosed by the application furthest reserves the autogenous bone of a patient, not only increases the stability of the prosthesis, but also facilitates the rapid growth of the prosthesis and a bone interface. Meanwhile, the function of the pelvis is ensured to the maximum extent.

Claims (7)

1. Computer-aided design pelvis tumour accurate excision is with individualized false body, its characterized in that includes acetabular cup false body, ilium cross section contact surface, ischium cross section contact surface, pubic bone cross section contact surface, the ilium cross section contact surface extends above the acetabular cup false body, and ilium cross section contact surface adopts the platelike structure that is provided with the ke shi needle passageway to be fixed with the ilium face, the ischium cross section that extends below the acetabular cup false body is fixed with the ischium face, it is fixed with the pubic bone face that extends the pubic bone cross section contact surface before the acetabular cup false body.

2. The personalized prosthesis for precise resection of pelvic tumors through computer-aided design according to claim 1, wherein the acetabular cup prosthesis is a cylinder provided with an acetabular cup groove, the acetabular cup groove is a cambered surface structure, the bottom of the acetabular cup is provided with screw holes, and the contact surface of the ischial section is also provided with screw holes.

3. The personalized prosthesis for precise resection of pelvic tumors by computer-aided design according to claim 1, wherein the number of screw holes at the bottom of the acetabular cup is 3, and the number of screw holes at the contact surface of the ischial cross section is 2.

4. The personalized prosthesis for precise resection of pelvic tumor based on computer-aided design according to claim 1, wherein the iliac cross-section interface, the ischial cross-section interface, the pubic cross-section interface and the pelvic interface are all mesh structures.

5. The personalized prosthesis for computer-aided design of precise pelvic tumor resection according to claim 4, wherein the maximum length and width values of the iliac cross-section contact surface, the ischial cross-section contact surface, the pubic cross-section contact surface and the pelvic contact surface are 91.5mm 31.19, 46.64 mm 25.34mm and 20.34 mm 11.76mm respectively.

6. The personalized prosthesis for precise resection of pelvic tumors according to claim 4, wherein the mesh structure is a polygonal mesh.

7. The personalized prosthesis for precise resection of pelvic tumors by computer-aided design according to claim 6, wherein the number of said K-wire channels is 6.

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