CN102349843B - Method for preparing individually-customized pelvic tumor prosthesis - Google Patents
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Abstract
The invention relates to a method for preparing individually-customized pelvic tumor prosthesis. The method comprises the following steps of: reconstructing three-dimensional models of pelvises and tumors according to two-dimensional images of captive tests (CT), magnatic resonance imaging (MRI) and the like of patients before operations, demarcating a tumor excision boundary according to a tumor therapeutic principle, and determining a plane and an angle of pelvic osteotomy; and reconstructing the three-dimensional models of amputated pelvic defect parts by comparing with normal pelvises, designing and producing individually-customized prosthesis, and performing surface modification on a contacting section of a prosthesis material and bones to fulfill the aim of combining the prosthesis material and the bones stably. The pelvic tumor prosthesis designed by the method can be customized individually aiming at the tumor excision range of different patients to retain bone mass as far as possible while the tumors are excised completely, and can be matched with the original pelvic excision parts accurately to realize accurate pelvic reconstruction operations; bone integration is formed between the prosthesis and the bones to ensure the long-term stability of the prosthesis; and hip joints of the prosthesis are designed by super-radium acetabuli, so the prosthesis is stable and has a motion function.
Description
Technical field
The invention belongs to pelvic tumor resection and rebuild field, be specifically related to the preparation method of individuation customization pelvic tumor prosthese.
Background technology
Pelvis is predilection site good, malignant tumor, and especially II district pathological changes (primary pelvic tumors around acetabular) is the most common.Because the anatomical structure of pelvis is complicated, so the tumor resection at this position and reconstruction are all very difficult.Pelvic tumor resection method depends on growth site and the scope of tumor.Pelvis is positioned at the hinge position of trunk and lower limb, and to supporting trunk, keep stablizing significant, so after pelvis excision, in order to preserve the function of limbs, reconstruction is necessary.
After pelvic tumor resection, method for reconstructing comprises: the structural reconstruction of allograph bone, saddle prosthese (Saddle prosthese) are rebuild, adjustable semi-pelvis prosthesis is rebuild, the technology such as prosthese of support reconstruction, integration technology, compound reconstruction and the computer-aided design of the autologous bone composite bone cement of deactivation.Although distinct methods cuts both ways, compare with pelvis amputation or the spacious art of putting, really can obtain good function result.Wherein, prosthese is rebuild can provide postoperative at once stable to patient, and operative doctor can have more selection to adjust leeway in operation implementation process, thus prosthese to rebuild be comparatively generally acknowledged Therapeutic Method at present, be widely used clinically.
Although the method that pelvis prosthesis is rebuild is at present more, but still undesirable.One of major reason is wherein exactly that prosthese does not mate, and standardization prosthese can not be accomplished individuation customization, after the more pelvic tumor resection that is therefore not suitable for making a variation, rebuilds.Individuation prosthetic designs is current developing direction.Wherein, to take the Vitallium prosthese of computer-aided design processing be representative to the semi-pelvis prosthesis of customization.But due to this prosthese do not carry out osteotomy surface stress analysis, excision and prosthese install can not exact matching etc. problem, its clinical effectiveness is dissatisfied, complication is high, function result is poor.In addition, this prosthese manufacturing cost is higher, and the cycle is longer, and in art, the Unpredictability of tumor resection has limited the use of this prosthese sometimes.
In sum, pelvic tumor resection changes greatly, so reconstruction mode needs individuation to consider.The individuation measure prostheses of exact matching will become the ideal chose that pelvic tumor resection is rebuild.This desirable individuation customization pelvic tumor prosthese should possess following characteristics: 1) size of prosthese and immobile interface are determined according to the concrete tumor resection situation of patient, and can with the position exact matching of original pelvic tumor resection; 2) in when operation, can computer secondary navigation system realize the accurate installation of prosthese; 3) the cross section part that prosthese contacts with bone can reach bone and integrate; 4) the cross section part that prosthese contacts with bone meets stress dispersion principle, is beneficial to the mechanotransduction of bone-material interface; 5) hip joint of prosthese part should be stablized, and has again motor function; 6) prosthetic material should have good biocompatibility, has again enough mechanical strengths and anti-fatigue ability.
In order to reach above requirement, individuation customization pelvis prosthesis becomes the new direction of research gradually.Titanium alloy is bio-inert material, and existing enough mechanical strengths and anti-fatigue ability, have again good biocompatibility, therefore becomes the preferred material of processing prosthese.Along with the fast development of the auxiliary precision processing technology of digitizing technique and modern computer, the individuation prosthese that the pelvis defect area of at short notice patient being estimated is carried out accurate three-dimensional Model Reconstruction and manufactured and designed exact matching has become possibility.
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5、Bell?RS，Davis?AM，Wunder?JS，Buconjic?T，McGoveran?B，Gross?AE.Allograft?reconstruction?of?the?acetabulum?after?resection?of?stage-IIB?sarcoma.Intermediate-term?results.J?Bone?Joint?Surg?Am.1997?Nov；79(11)：1663-74
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Summary of the invention
The object of the present invention is to provide a kind of pelvic tumor for different excision extensions, realize the preparation method that customizes pelvic tumor prosthese with the individuation of former pelvis cut portion position exact matching.
For achieving the above object, the technical solution used in the present invention is:
1) pelvis and tumor resection position reconstructing three-dimensional model
According to CT before operation in patients and MRI scanning two dimensional image, carry out the reconstructing three-dimensional model of pelvis and tumor, by tumor therapeutics principle, on threedimensional model, delimit tumor resection border, determine plane and the angle of pelvic osteotomy, and utilize plane and the angle of pelvis FEM mechanics analysis correction pelvic osteotomy;
2) design of measure prostheses
According to offside normal pelvis, after the defect that is pelvis to tumor resection position threedimensional model is revised, data are converted to industrial computer Aided Design and manufacture the data that software can be identified, carry out the design of individuation measure prostheses, the position angle of planning fixed form and acetabular bone;
3) processing of measure prostheses
The data drawing input numerical control machining center of measure prostheses is processed to preparation, obtain individuation customization pelvic tumor prosthese.
Described CT or MRI scanning bed thickness are 1-2mm.
Described by tumor therapeutics principle on threedimensional model, delimit tumor resection border and utilize mimics or the dividing function of simpleware software by pelvic tumor amputation region disconnecting.
Described step 2) the position angle of planning fixed form and acetabular bone adopts screw fixation method, and according to the direction in the angle planning nail road in cross section, screw adopts the os integumentale screw of diameter 7-9mm; Determine position and the angle of acetabular bone, acetabular bone adopts super radial design; Corresponding bulb adopts the standard bulb of diameter 28mm.
Described step 3) prosthese processing is carried out to the surperficial cross section part contacting with bone and adopt sandblast technology to make rough surface, surface roughness Ra is 5-15 μ m.
Described prosthetic material adopts medical titanium alloy Ti-6A1-4V to make or low bullet titanium alloy material is made.
The individuation customization pelvic tumor prosthese tool of making by design preparation method of the present invention has the following advantages: 1) size of prosthese and immobile interface can be determined according to the concrete tumor resection situation of patient, and can with the position exact matching of original pelvic tumor resection, realize the individuation customization of prosthese, can change flexibly for pelvic tumor resection variation feature greatly the design of prosthese; 2) threedimensional model of tumor resection planning and prosthese all can import computer assisted navigation system in the preoperative, when operation, can realize by navigation the accurate installation of prosthese; 3) the cross section part that prosthese contacts with bone meets stress dispersion principle, is beneficial to the mechanotransduction of bone-material interface; 4) artificial hip joint of prosthese can keep stable, has again good motor function; 5) the cross section part that prosthese contacts with bone can reach bone and integrate; 6) titanium alloy is as prosthetic material, and existing good biocompatibility, has again enough mechanical strengths and anti-fatigue ability.
Accompanying drawing explanation
Fig. 1 is the lateral side view of the embodiment of the present invention;
The specific embodiment
Below in conjunction with accompanying drawing, the present invention is described in further detail.
Referring to Fig. 1, preparation method of the present invention is as follows:
1) pelvis and tumor resection position reconstructing three-dimensional model
The reconstructing three-dimensional model that carries out pelvis and tumor according to two dimensional images such as CT before operation in patients and MRI scannings, scanning bed thickness is 1-2mm; By tumor therapeutics principle, on threedimensional model, delimit tumor resection border 1, determine plane and the angle of pelvic osteotomy, utilize the dividing function of software (as mimics or simpleware software) by pelvic tumor amputation region disconnecting; Utilize pelvis FEM mechanics analysis technology to be revised plane and the angle of pelvic osteotomy, make it meet stress dispersion principle, avoid rebuilding rear prosthese-synosteosis interfacial stress and concentrate, to reach the object of stable bond.The Cross section Design of prosthese is corresponding with above-mentioned cross section.
2) design of measure prostheses
According to offside normal pelvis, after tumor resection position threedimensional model (being the defect of pelvis) is revised, data are converted to industrial computer Aided Design and manufacture software (as UG, Solideworks etc.) data that can identify, carry out the design of individuation measure prostheses, for different patients' different osteotomy scopes, each cross section 1 of prosthese, external form and size are variable, are Individual design.Adopt screw fixation method, according to the direction in the angle planning nail road 2 in cross section, screw adopts the os integumentale screw of diameter 7-9mm; The nail direction in road 2 and the quantity of hold-down screw are determined according to concrete osteotomy scope, are all variable, are Individual design.Determine position and the angle of acetabular bone 3, acetabular bone 3 adopts super radial design, can guarantee the stable of hip joint, can have good motor function again; Corresponding bulb adopts the standard bulb of diameter 28mm, is convenient to the installation of assembly type artificial hip joint femoral part.
3) processing of measure prostheses
The data drawing input numerical control machining center of measure prostheses is processed to preparation, and material adopts medical titanium alloy; The prosthese processing is carried out to surface modification, and the cross section part that prosthese is contacted with bone adopts sandblast technology to make rough surface, and surface roughness (Ra) parameter reaches 5-15 μ m, makes bone and material be easy to reach bone and integrates, and is beneficial to the long-term stability of prosthese.
The present invention rebuilds and has relative adaptation disease for pelvic tumor resection, and its most significant advantage is to realize the individuation customization of tumor prosthese, to guarantee that the accurate and prosthese of tumor resection fills the accurate of vacation.Can obviously improve the shortcoming of existing pelvic tumor method for reconstructing, thereby perform the operation a kind of reliable method for reconstructing is provided for guarantor's limb of pelvic tumor.
Claims (6)
1. individuation customizes a preparation method for pelvic tumor prosthese, it is characterized in that:
1) pelvis and tumor resection position reconstructing three-dimensional model
According to CT before operation in patients and MRI scanning two dimensional image, carry out the reconstructing three-dimensional model of pelvis and tumor, by tumor therapeutics principle, on threedimensional model, delimit tumor resection border, determine plane and the angle of pelvic osteotomy, and utilize plane and the angle of pelvis FEM mechanics analysis correction pelvic osteotomy;
2) design of measure prostheses
According to offside normal pelvis, after the defect that is pelvis to tumor resection position threedimensional model is revised, data are converted to industrial computer Aided Design and manufacture the data that software can be identified, carry out the design of individuation measure prostheses, the position angle of planning fixed form and acetabular bone;
3) processing of measure prostheses
The data drawing input numerical control machining center of measure prostheses is processed to preparation, obtain individuation customization pelvic tumor prosthese.
2. the preparation method of individuation customization pelvic tumor prosthese according to claim 1, is characterized in that: described CT or MRI scanning bed thickness are 1-2mm.
3. the preparation method of individuation according to claim 1 customization pelvic tumor prosthese, is characterized in that: described by tumor therapeutics principle on threedimensional model, delimit tumor resection border and utilize mimics or the dividing function of simpleware software by pelvic tumor amputation region disconnecting.
4. individuation according to claim 1 customizes the preparation method of pelvic tumor prosthese, it is characterized in that: described step 2) the position angle of planning fixed form and acetabular bone adopts screw fixation method, according to the direction in the angle planning nail road in cross section, screw adopts the os integumentale screw of diameter 7-9mm; Determine position and the angle of acetabular bone, acetabular bone adopts super radial design; Corresponding bulb adopts the standard bulb of diameter 28mm.
5. individuation according to claim 1 customizes the preparation method of pelvic tumor prosthese, it is characterized in that: described step 3) prosthese processing is carried out to the surperficial cross section part contacting with bone and adopt sandblast technology to make rough surface, surface roughness Ra is 5-15 μ m.
6. the preparation method of individuation customization pelvic tumor prosthese according to claim 1, is characterized in that: described prosthetic material adopts medical titanium alloy Ti-6A1-4V to make or low bullet titanium alloy material is made.
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| CN106456331A (en) * | 2014-03-04 | 2017-02-22 | 皇家墨尔本理工大学 | A method for producing a customised orthopaedic implant |
| CN105105838B (en) * | 2015-07-27 | 2018-08-28 | 广州中国科学院先进技术研究所 | Personalized jaw surgical guide plate and its manufacturing method |
| CN105935320B (en) * | 2016-04-29 | 2018-07-20 | 南方医科大学第三附属医院 | Local tissue structures personalization after the excision of pelvis Malignant Tumors Around reconstructs the internal structure of an organization |
| CN107811729B (en) * | 2017-10-20 | 2019-04-30 | 赵德伟 | A method of preparing acetabular bone supplementary material |
| CN109106481B (en) * | 2018-09-18 | 2021-04-30 | 北京爱康宜诚医疗器材有限公司 | Method and device for determining acetabular bone defect degree |
| CN110008506B (en) * | 2019-02-22 | 2023-04-25 | 南京航空航天大学 | Bone tumor bionic repair method |
| CN110478090A (en) * | 2019-07-17 | 2019-11-22 | 天津市天津医院 | CAD pelvic tumor is precisely cut off with personalized prosthese and preparation method thereof |
| CN112932744A (en) * | 2019-12-10 | 2021-06-11 | 上海昕健医疗技术有限公司 | Personalized customized pelvic prosthesis and manufacturing method thereof |
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