CN117197363B - Hip-protecting evaluation system for hip joint developmental diseases and storage medium thereof - Google Patents
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Abstract
The invention belongs to the technical field of medical software, and particularly relates to a hip protection evaluation system for hip joint developmental diseases and a storage medium thereof. The evaluation system of the present invention includes: the three-dimensional modeling module is used for carrying out pelvis and femur segmentation according to the medical image, reconstructing a three-dimensional model, fitting the femur head into a sphere, and determining a rotation center to obtain a three-dimensional hip joint model; the registration module is used for registering the three-dimensional hip joint model obtained by the three-dimensional modeling module by adopting rigid transformation with the medical images acquired under different real positions of the patient as references; the impact evaluation module is used for simulating the movement of the hip joint, judging whether the hip joint is impacted in the movement by adopting a contact detection algorithm, and recording the body position and the impact position when the impact occurs and the movement state of the hip joint when the impact occurs. The invention can accurately evaluate the collision condition of hip joint movement of patients with hip joint developmental diseases before and after operation, is beneficial to doctors to adjust operation plans, and has good application prospect.
Description
Technical Field
The invention belongs to the technical field of medical software, and particularly relates to a hip protection evaluation system for hip joint developmental diseases and a storage medium thereof.
Background
Hip developmental diseases, including developmental hip dysplasia (DDH) and the like are important causes of disability in teenagers and adults, hip protection therapy can correct hip dysplasia before the disease progresses to the end stage, and with the popularization of early screening, more and more patients have an opportunity to receive hip protection therapy. Periacetabular osteotomies (PAOs), femoral osteotomies, head and neck shaping, etc. are important hip-protection surgical treatments. Many such patients have intra-and extra-articular impacts pre-operatively, and accurate quantitative assessment of the impact prior to treatment helps to actually address clinical symptoms such as pain, limited function, etc. in patients.
The osteotomy orthopedic operation corrects the hip joint deformity by changing the position and angle of the acetabulum in three-dimensional space through osteotomy, displacement and rotation. Traditional surgical planning and postoperative effect evaluation are mainly based on X-ray measurement of LCEA angles and Tonnis angles, and the coverage of the acetabulum outside and above is evaluated on a two-dimensional level. The osteotomy orthopedic operation changes the relation between the acetabulum and the femur in the three-dimensional space, and the influence of the osteotomy orthopedic operation on the three-dimensional layer coverage of the hip joint is considered. However, there are few and controversial studies on the related exploratory.
With the popularization of the technology in recent years, the operation amount is increased, and the challenges faced by the original osteotomy orthopedic operation principle are increasingly highlighted: the osteotomy such as PAO changes the space structure of the original hip joint, the situation that the anterior ilium moves downwards, the acetabulum is sunken inwards and the like possibly occurs after operation, the risk of intra-articular and extra-articular impact is theoretically increased, the extra-articular impact can obviously limit the mobility of the joint after operation, the postoperative pain is caused, and the function of the hip joint is affected. Previous studies (1, clin Orthop Relat Res. 2022 Sep 1;480 (9): 1694-1703. Doi:10.1097/CORR.0000000000002199. Epub 2022 Apr 6. PMID: 35384868; PMCID: PMC9384945.;2, clin Orthop Relat Res. 2013May;471 (5): 1602-14. Doi: 10.1007/s11999-013-2799-8. Epub 2013 Jan 25. PMID: 23354462; PMCID: PMC 3613512.) have shown that osteotomy has the risk of causing joint impact.
Currently, although some prior art techniques exist that can be modeled from CT images of the hip joint (e.g., CN202310630508.9, a type of hip-preserving surgical treatment system and device based on CJFH typing), techniques for pre-and post-operative evaluation using the built models are still relatively lacking and are only directed to a single disease. The difficulty is that the pelvic posture can change for different types of diseases, different patients and in different postures (e.g. the posture of the pelvis in sitting and standing positions of the same patient is different). This may result in a different three-dimensional structural pose of the hip joint, which may further affect the mobility of the hip joint, affecting the hip joint impact. Thus, existing such modeling systems and methods fail to accurately assess hip impact conditions, and thus fail to provide accurate pre-and post-operative assessment of osteotomy orthopedic procedures.
Disclosure of Invention
Aiming at the problems in the prior art, the invention provides a hip protection evaluation system for hip joint developmental diseases and a storage medium thereof.
A hip protection assessment system for a hip developmental disorder, comprising:
the three-dimensional modeling module is used for carrying out pelvis and femur segmentation according to the medical image, reconstructing a three-dimensional model, fitting the femur head into a sphere, and determining a rotation center to finally obtain a three-dimensional hip joint model;
the registration module is used for registering the three-dimensional hip joint model obtained by the three-dimensional modeling module by adopting rigid transformation with the medical images acquired under different real positions of the patient as references;
the impact evaluation module is used for simulating the movement of the hip joint of the patient before or after the operation, judging whether the hip joint is impacted in the movement by adopting a contact detection algorithm, and recording the body position and the impact position of the impact and the movement state of the hip joint of the impact.
Preferably, the medical image is selected from a CT image, an X-ray image or an MRI image.
Preferably, the movement of the hip joint comprises at least one of the following movement patterns: the compound movement of the hip joint on XYZ three axes, hip adduction, hip abduction, hip flexion and extension, hip internal rotation and hip external rotation.
Preferably, the contact detection algorithm specifically includes:
establishing a coordinate system in a three-dimensional space, and determining the coordinates of osseous surface points of the three-dimensional hip joint model with the accuracy of 1 mm;
calculating the distance between the bone surfaces of different structures in real time, wherein the distance changes during hip joint motion simulation;
and judging that the collision occurs when the distance between the femur structure and the osseous surface of the pelvis structure is smaller than a predefined threshold value.
Preferably, the method further comprises:
and the operation planning module is used for simulating the rotation and displacement of the bone blocks according to the operation plan and converting the three-dimensional hip joint model into a three-dimensional hip joint model after operation.
Preferably, the surgical plan includes at least one of the following: bone cutting around acetabulum, femur head and neck shaping, femur rotation cutting.
Preferably, the method further comprises:
an acetabular coverage assessment module for assessing acetabular coverage in a three-dimensional hip joint model.
Preferably, the step of the acetabular coverage assessment module assessing acetabular coverage in a three-dimensional hip model comprises:
step a, defining a measurement standard on the three-dimensional hip joint model, and defining a coverage angle and a coverage area;
step b, performing spatial registration on the acetabulum and the femoral head by using a rigid body transformation method;
and c, carrying out quantitative evaluation on the registered three-dimensional hip joint model by applying a defined metric standard, wherein the content of the quantitative evaluation comprises: the percentage of the coverage area of the acetabulum, the coverage conditions of the front, the rear and the outer sides of the acetabulum, and the ASA and PSA angles of the sections;
and d, analyzing the acquired coverage measurement data by using a statistical method.
The present invention also provides a computer-readable storage medium having stored thereon: a computer program for implementing the above described hip joint developmental disease warranty hip assessment system.
The invention constructs a hip protection evaluation system for hip joint developmental diseases, and can analyze the collision conditions of the hip joint before and after the operation aiming at the patient with the hip joint developmental diseases. The invention has the beneficial effects that:
1. and judging the pelvis posture by adopting the true position medical image data, correcting the three-dimensional reconstruction pelvis posture as a standard, and performing operation planning, motion simulation and impact assessment by adopting the true position pelvis posture. The result is more accurate and is more close to the daily life needs of the patient.
2. In a preferred scheme, the invention provides an automatic impact detection method adopting an algorithm to replace manual judgment adopted in the prior art, and the method is more efficient and has the impact detection precision of 1mm.
In a word, the invention realizes a system and a method for more accurately evaluating the impact condition of the hip joint, and has good application prospect.
It should be apparent that, in light of the foregoing, various modifications, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims.
The above-described aspects of the present invention will be described in further detail below with reference to specific embodiments in the form of examples. It should not be understood that the scope of the above subject matter of the present invention is limited to the following examples only. All techniques implemented based on the above description of the invention are within the scope of the invention.
Drawings
FIG. 1 is an exemplary diagram of a three-dimensional hip joint model;
FIG. 2 is an exemplary diagram of placement of auxiliary dotted lines in a three-dimensional hip model;
FIG. 3 is an exemplary diagram of impact assessment in a three-dimensional hip model;
FIG. 4 is a diagram of an exemplary view of the results of impact assessment in a three-dimensional hip model;
FIG. 5 is an exemplary diagram showing hidden grid functionality when viewing results of impact assessment in a three-dimensional hip model;
FIG. 6 is an exemplary diagram of a three-dimensional hip model as modified by a surgical plan;
FIG. 7 is a schematic representation of a pre-operative acetabular coverage assessment result;
FIG. 8 is a schematic illustration of femoral head collision displacement detection results;
fig. 9 is a schematic diagram of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: a rotation neutral position, an adduction abduction neutral position, qu;
fig. 10 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: rotating the neutral position, adducting and abducting the neutral position, stretching the film;
FIG. 11 is a selection of the internal and external rotation axes of the femur, with the vertical line through the center of the femoral head selected as the internal and external rotation axes of the femur;
fig. 12 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: adduction and abduction neutral position, qu degrees, internal rotation hip joint;
fig. 13 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: an adduction abduction neutral position, qu °, an external rotation hip joint;
fig. 14 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: adduction abduction neutral position Qu °, internal rotation hip joint;
fig. 15 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: adduction abduction neutral position Qu °, supination of hip joint;
fig. 16 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: an adduction abduction neutral position, a buckling extension membrane neutral position and an external rotation hip joint;
fig. 17 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: an adduction abduction neutral position, a buckling extension membrane neutral position and an internal rotation hip joint;
fig. 18 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: the inner-retracting and outer-expanding neutral position stretches by 30 degrees, and the hip joint is externally rotated;
fig. 19 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: rotating the neutral position, buckling for 0 degrees, and abducting;
fig. 20 is a schematic view of a collision evaluation result during hip joint movement, and a specific movement mode is as follows: rotating the neutral position, buckling for 0 degrees and expanding inwards;
FIG. 21 is a comparison of three-dimensional hip models of cases before and after surgery, with the left view being pre-operative and the right view being post-operative;
FIG. 22 is a schematic illustration of the steps for converting a pre-operative three-dimensional hip model to a post-operative three-dimensional hip model;
fig. 23 is a schematic view of the results of the acetabular coverage assessment after surgery.
Detailed Description
It should be noted that, in the embodiments, algorithms of steps such as data acquisition, transmission, storage, and processing, which are not specifically described, and hardware structures, circuit connections, and the like, which are not specifically described may be implemented through the disclosure of the prior art.
Example 1 hip protection evaluation System for hip joint developmental diseases
The evaluation system of the present embodiment includes:
the three-dimensional modeling module is used for carrying out pelvis and femur segmentation according to the medical image, reconstructing a three-dimensional model, fitting the femur head into a sphere, and determining a rotation center to finally obtain a three-dimensional hip joint model;
the registration module is used for registering the three-dimensional hip joint model obtained by the three-dimensional modeling module by adopting rigid transformation with the medical images acquired under different real positions of the patient as references;
the operation planning module is used for simulating the rotation and displacement of the bone blocks according to the operation plan and converting the three-dimensional hip joint model into a three-dimensional hip joint model after operation;
the impact evaluation module is used for simulating the movement of the hip joint, judging whether the hip joint is impacted in the movement by adopting a contact detection algorithm, and recording the body position and the impact position when the impact occurs and the movement state of the hip joint when the impact occurs;
an acetabular coverage assessment module for assessing acetabular coverage in a three-dimensional hip joint model.
The step of the acetabular coverage assessment module assessing acetabular coverage in a three-dimensional hip model comprises:
step a, defining a measurement standard on the three-dimensional hip joint model, and defining a coverage angle and a coverage area;
step b, performing spatial registration on the acetabulum and the femoral head by using a rigid body transformation method;
step c, quantitatively evaluating the three-dimensional hip joint model after registration by applying a defined measurement standard, specifically evaluating the coverage area percentage of the acetabulum, the coverage conditions of the front, the rear and the outer sides of the acetabulum, and forming angles ASA (Anterior Sector Angle) and PSA (PosteriorSector Angle) on each section;
and d, analyzing the acquired coverage measurement data by using a statistical method.
The method for carrying out the pre-operation and post-operation hip joint impact conditions by adopting the system comprises the following steps:
step 1, performing pelvis and femur segmentation according to CT data, reconstructing a three-dimensional model, fitting a femoral head into a sphere, and determining a rotation center to finally obtain a three-dimensional hip joint model;
fig. 1 is an example of a three-dimensional hip joint model, where the data file in this embodiment is saved in stl format, and the specific operation in step 1 is as follows: after stl files are imported, the femur and the pelvis are in the same set, and default colors are the same, so that the femur and the pelvis are inconvenient to distinguish. By right clicking on the bone collection, different names of components are created and different colors are assigned to distinguish. And then selecting a required grid part through a grid tool in the function bar, and importing corresponding components. The components of the osteotomy are first created as shown in the figure, then the part of the osteotomy which the doctor wants to osteotomy is selected by a lasso tool in the function bar, and the part is divided into the osteotomy components and displayed in green. This step corresponds to the surgical cutting of the pelvic bone portion, facilitating subsequent adjustment of the angle of the cut portion.
Step 2, registering by using the X-ray images acquired under different real positions of the patient as a reference and adopting rigid transformation, wherein the three-dimensional model is a three-dimensional hip joint model obtained by the three-dimensional modeling module; rigid body transformations spatially align medical images of two or more different modalities by registration point translation and rotation operations without changing the internal structure of the images.
In registration, auxiliary dotted lines are required to be arranged in the three-dimensional hip joint model, and the system of the embodiment can quickly create and display the rotation center of the femoral head, the hip stretching rotation axis, the adduction and abduction rotation axis and the internal rotation and external rotation axis. As shown in fig. 2, clicking creates an auxiliary line, inputting initial coordinates and end coordinates of the auxiliary line in a pop-up box (or directly clicking an arrow, and then selecting a node in a grid), clicking determines, and then creating a corresponding auxiliary line. After the creation is completed, clicking and extending the hip flexion rotation axis, and selecting the line segment just created to complete the creation of the rotation axis, wherein the rest reference point line creation methods are the same as the above.
Step 3, performing preoperative evaluation, namely evaluating acetabular coverage in the three-dimensional hip joint model by utilizing an acetabular coverage evaluation module, simulating movement of the hip joint by utilizing an impact evaluation module, judging whether the hip joint is impacted in movement by adopting a contact detection algorithm, and recording the body position and the impact position when the impact occurs and the movement state of the hip joint when the impact occurs; the movement of the hip joint comprises at least one of the following movement modes: the compound movement of the hip joint on XYZ three axes, hip adduction, hip abduction, hip flexion and extension, hip internal rotation and hip external rotation.
Specifically, the contact detection algorithm specifically includes:
establishing a coordinate system in a three-dimensional space, and determining the coordinates of osseous surface points of the three-dimensional hip joint model with the accuracy of 1 mm;
calculating the distance between the bone surfaces of different structures in real time, wherein the distance changes during hip joint motion simulation;
and judging that the collision occurs when the distance between the femur structure and the osseous surface of the pelvis structure is smaller than a predefined threshold value.
An example of step 3 is shown in fig. 3, in which the impact evaluation module is clicked in the system software, the selection detection range is displayed in the left box, the triangle button is clicked, the drop-down text box is popped up, the content to be detected is selected, the detection content can be selected by clicking and determining, and the detection is completed. Clicking on the results view may then view the rotational collision model corresponding to the bone (e.g., as shown in fig. 4) in a display box and display the angle. While the collision location is given a different color identification. The user can hide the grid function from view more fully through the display of the function bar, as shown in FIG. 5.
And 4, simulating the rotation and displacement of the bone block according to the operation plan, and converting the three-dimensional hip joint model into a three-dimensional hip joint model after operation.
An example of step 4 is shown in fig. 6, where the surgeon needs to make a positional adjustment of the cut-out pelvic bone region and then fix it with steel nails. In the system of this embodiment, the operation planning module in the menu bar is clicked, and the selection set (the components divided by the division set module), the selection reference line (the rotation point and the axis divided by the auxiliary point line module) and the translational rotation set are displayed on the left side, respectively. And sequentially selecting the contents in the three options to adjust the position of the bone model. As shown in figure 6, the osteotomy part and the hip extending and bending rotation shaft are sequentially selected, the rotation is selected, the rotation angle is input, and the rotation operation on the osteotomy part can be completed by clicking the application.
And then performing postoperative evaluation again according to the method of the step 3.
The doctor can repeatedly adjust the operation plan with the evaluation result and evaluate again until the best evaluation result is achieved, and then the final operation plan is determined.
One of the diseases evaluated by the method of this example is shown in fig. 7-23. Wherein, fig. 7 is a schematic view of the evaluation result of the acetabular covering before the operation, fig. 8 is a schematic view of the detection result of the femoral head collision displacement, fig. 9-20 are schematic views of the evaluation result of the collision in the hip joint movement process, and the detected movement comprises:
1. a rotated neutral position, an adduction abduction neutral position, qu (fig. 9);
2. rotating the neutral position, adducting and abducting the neutral position, stretching the film (FIG. 10);
3. selecting an internal rotation and external rotation axis, and selecting a vertical line passing through the center of the femoral head as the internal rotation axis and the external rotation axis of the femur (figure 11);
4. adduction abduction neutral position, qu °, internal rotation hip joint (fig. 12);
5. adduction abduction neutral position, qu °, supination hip joint (fig. 13);
6. adduction abduction neutral position Qu °, internal rotation hip joint (fig. 14);
7. adduction abduction neutral position Qu °, supination hip joint (fig. 15);
8. an adduction abduction neutral position, a flexion and extension membrane neutral position, and an external rotation hip joint (figure 16);
9. an adduction abduction neutral position, a flexion-extension neutral position, an internal rotation hip joint (fig. 17);
10. the adduction abduction neutral position, extension by 30 °, external rotation hip joint (fig. 18);
11. rotating the neutral position, buckling 0 °, abduction (fig. 19);
12. the neutral position was rotated, flexed 0 °, and deployed (fig. 20).
Fig. 21 is a comparison of three-dimensional hip models before and after surgery on a case, wherein the left image is before surgery and the right image is after surgery. Fig. 22 is a schematic diagram of a step of converting a preoperative three-dimensional hip model into a post-operative three-dimensional hip model.
Fig. 23 is a schematic view of the results of the post-operative acetabular coverage assessment.
It can be seen that the present embodiment does allow for evaluation of collision and acetabular coverage of the hip joint motion before and after surgery, thereby assisting the doctor in performing adjustments of the surgical plan.
According to the embodiment, the hip protection evaluation system for the hip joint developmental diseases can accurately evaluate collision conditions and acetabulum coverage conditions of hip joint movements of patients with the hip joint developmental diseases before and after operation, is beneficial to a doctor to adjust an operation plan, and has a good application prospect.
Claims (7)
1. A hip protection assessment system for a developmental disorder of a hip, comprising:
the three-dimensional modeling module is used for carrying out pelvis and femur segmentation according to the medical image, reconstructing a three-dimensional model, fitting the femur head into a sphere, and determining a rotation center to finally obtain a three-dimensional hip joint model;
the registration module is used for registering the three-dimensional hip joint model obtained by the three-dimensional modeling module by adopting rigid transformation with the medical images acquired under different real positions of the patient as references;
the impact evaluation module is used for simulating the movement of the hip joint of the patient before or after the operation, judging whether the hip joint is impacted in the movement by adopting a contact detection algorithm, and recording the body position and the impact position of the impact and the movement state of the hip joint of the impact;
an acetabular coverage assessment module for assessing acetabular coverage in the three-dimensional hip joint model;
the step of the acetabular coverage assessment module assessing acetabular coverage in a three-dimensional hip model comprises:
step a, defining a measurement standard on the three-dimensional hip joint model, and defining a coverage angle and a coverage area;
step b, performing spatial registration on the acetabulum and the femoral head by using a rigid body transformation method;
and c, carrying out quantitative evaluation on the registered three-dimensional hip joint model by applying a defined metric standard, wherein the content of the quantitative evaluation comprises: the percentage of the coverage area of the acetabulum, the coverage conditions of the front, the rear and the outer sides of the acetabulum, and the ASA and PSA angles of the sections;
and d, analyzing the acquired coverage measurement data by using a statistical method.
2. The hip protection evaluation system according to claim 1, wherein: the medical image is selected from a CT image, an X-ray image or an MRI image.
3. The hip joint developmental disease protection hip assessment system according to claim 1, wherein the movement of the hip joint comprises at least one of the following movements: the compound movement of the hip joint on XYZ three axes, hip adduction, hip abduction, hip flexion and extension, hip internal rotation and hip external rotation.
4. The hip protection evaluation system according to claim 1, wherein the contact detection algorithm specifically comprises:
establishing a coordinate system in a three-dimensional space, and determining the coordinates of osseous surface points of the three-dimensional hip joint model with the accuracy of 1 mm;
calculating the distance between the bone surfaces of different structures in real time, wherein the distance changes during hip joint motion simulation;
and judging that the collision occurs when the distance between the femur structure and the osseous surface of the pelvis structure is smaller than a predefined threshold value.
5. The hip protection evaluation system according to claim 1, further comprising:
and the operation planning module is used for simulating the rotation and displacement of the bone blocks according to the operation plan and converting the three-dimensional hip joint model into a three-dimensional hip joint model after operation.
6. The hip protection evaluation system according to claim 5, wherein: the surgical plan includes at least one of the following: bone cutting around acetabulum, femur head and neck shaping, femur rotation cutting.
7. A computer-readable storage medium having stored thereon: a computer program for implementing a hip protection assessment system according to any one of claims 1 to 6.
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