髋臼前柱骨折顺行拉力螺钉内固定的数字化基础与相关研究

Minimally invasive treatment of acetabular fractures especially acetabular anterior column fractures has obvious advantages, such as percutaneous screw fixation has the advantages of reducing the operation incision, reduce intraoperative hemorrhage and reduce the incidence of incision related complications etc.. However, anatomical structure is very complex in the pelvis, the interpretation of X-ray images and screw placement is quite challenging, to make the screws completely safe and accurate fracture reduction and, must be familiar with different range perspective image. Although the application of 3D computer navigation reduces these operation difficulty, but the two-dimensional X-ray image is still the basic method of screw placement assisted doctor working in the Department of orthopedics. Realization of the anterior column and displayed in real channel by individual image information of patients in the preoperative planning optimal screw placement in nail path and operation is the difficult problem to solve. Retrograde lag screw fixation due to the pubic tubercle at the same side of the screw, the superficial location, relatively easy; direct screw entry point located at the acetabular and the gluteus medius muscle attachment sites, and the surrounding structure is more complex, so the accuracy of screw placement requires high. This project will be of human anatomy, modern imaging, 3D printing, combination of computational medicine, and Department of orthopedics, analysis and optimization of direct acetabular anterior column screw nail, establish personalized acetabular anterior column antegrade screws fixation screw channel guide optimal, and the design of percutaneous antegrade acetabular anterior column screw fixed guide for clinical application. The method aims to provide a personalized, this kind of surgery is relatively accurate.

微创治疗髋臼骨折特别是髋臼前柱骨折具有明显优势，可以缩小手术切口、减少术中出血以及降低切口相关并发症发生率等优点。但是，骨盆内的解剖结构非常复杂，解读透视图像以及螺钉置入相对困难，虽然三维计算机导航的应用减少了此类手术的难度，但是二维透视图像依旧是骨科医生置入螺钉的基本辅助方法。实现术中显示髋臼前柱真实通道及通过患者的个体化影像信息在术前规划螺钉置入的最优钉道并实施手术是当前难以解决的问题。逆行拉力螺钉固定由于在同侧的耻骨结节处进钉，位置表浅，相对容易；顺行螺钉进钉点位于髋臼上方、臀中肌附着处，且周围结构较为复杂，因此对螺钉置入的准确性要求较高。本项目将人体解剖学、现代影像学、3D打印、计算医学和骨科学相结合，分析、优化顺行髋臼前柱螺钉钉道，建立个性化髋臼前柱顺行螺钉固定最优钉道导板，并设计经皮顺行髋臼前柱螺钉固定导向器，应用于临床，旨在为此类手术提供一种个性化、相对精确的方法。

目前对复杂髋臼骨折的手术入路各家报道不一，主要有单一非扩展的入路、前后联合入路及扩展的髂腹股入路。近年来，随着暴露、复位及内固定技术的进步，越来越多的学者选择单一的非扩展的入路治疗复杂的髋臼骨折。单一入路对前柱骨折只能通过间接复位和拉力螺钉内固定技术，髋臼前柱拉力螺钉内固定技术, 分顺行与逆行2种途径, 顺行是指螺钉自髂翼后外侧髋臼上方顺行向前内下方打入髋臼前柱, 而逆行与顺行相反, 自耻骨向后外上方打入髋臼前柱。逆行髋臼前柱拉力螺钉入钉点位置表浅, 方向容易掌握，手术操作步骤简单。顺行髋臼前柱由于置钉时入钉点位置深, 不容易显露, 且进针方向不容易变动, 螺钉过长易损伤股动静脉和股神经，手术操作现对困难。数字化三维重建和逆向工程技术的出现与不断发展为现代骨科手术提供了新的辅助手段，根据CT数据重建的三维模型可以直观、深入观察手术部位结构特点，可以对手术区的结构进行数字化分析，这样不仅可以提高内固定装置放置的精确度，而且可提高手术的安全性，而基于该技术的导航模板的出现更是为提高手术精度创造了可能。智能化手术设备是推动微创手术发展和普及的核心装备之一，该类设备的研发日益凸显生命科学与信息科学等相关学科的广泛交叉、相互渗透、优化融合的发展态势。但目前已得到应用的骨科手术机器人其基本原理大体相同，需要医院另外购置手术室配套CT设备，术前需要患者通过CT采集数据后进行手术规划，增加了患者的射线暴露量。本项目将人体解剖学、现代影像学、快速成形、计算机辅助骨科手术相结合，分析、优化顺行髋臼前柱螺钉钉道，建立个性化髋臼前柱顺行螺钉固定最优骨性通道，同时设计骨性通道导航导板加以验证，并设计无遮挡骨科手术机器人辅助髋臼前柱顺行螺钉固定，基于正侧位X线片结合红外数字导航原理，快速精准实时规划手术通道，通过控制软件驱动六轴协作机器人到达指定位置，形成入针/入钻平台，旨在为此类手术提供一种个性化、相对精确的方法。

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