CN117197363B - A hip preservation assessment system for developmental diseases of the hip joint and its storage medium - Google Patents

Abstract

The invention belongs to the technical field of medical software, and specifically relates to a hip preservation assessment system for developmental diseases of the hip joint and its storage medium. The evaluation system of the present invention includes: a three-dimensional modeling module for segmenting the pelvis and femur based on medical images, reconstructing the three-dimensional model, fitting the femoral head into a sphere, determining the center of rotation, and obtaining a three-dimensional hip joint model; and a registration module for Based on the medical images collected in different real positions of the patient, rigid body transformation is used to register the three-dimensional hip joint model obtained by the three-dimensional modeling module; the impact assessment module is used to simulate the movement of the hip joint and uses a contact detection algorithm to determine Whether there is an impact on the hip joint during exercise, record the body position when the impact occurs, the location where the impact occurs, and the motion status of the hip joint when the impact occurs. The invention can accurately assess the impact of hip joint motion before and after surgery in patients with hip joint developmental diseases, helps doctors adjust surgical plans, and has good application prospects.

Description

A hip preservation assessment system for developmental diseases of the hip joint and its storage medium

Technical field

The invention belongs to the technical field of medical software, and specifically relates to a hip preservation assessment system for developmental diseases of the hip joint and its storage medium.

Background technique

Developmental diseases of the hip joint, including developmental dysplasia of the hip (DDH), are an important cause of disability in adolescents and adults. Hip-preserving treatment can correct developmental deformities of the hip joint before the disease progresses to the terminal stage. With the advent of early screening, With its popularity, more and more patients have the opportunity to receive hip-preserving treatment. Periacetabular osteotomy (PAO), femoral osteotomy, and head and neck plasty are all important hip-preserving surgical treatments. However, many of these patients have intra-articular and extra-articular impingement in the hip joint before surgery. Accurate and quantitative assessment of the impact before treatment can help effectively solve the patient's pain, functional limitations and other clinical symptoms.

Osteotomy and orthopedic surgery changes the position and angle of the acetabulum in three-dimensional space through osteotomy, displacement and rotation to correct hip joint deformity. Traditional surgical planning and postoperative effect evaluation are mainly based on X-ray measurement of the LCEA angle and Tonnis angle, and evaluate the lateral and superior coverage of the acetabulum at a two-dimensional level. However, osteotomy and orthopedic surgery changes the relationship between the acetabulum and femur in the three-dimensional space, and its impact on the three-dimensional coverage of the hip joint should also be considered. However, relevant exploratory research is currently sparse and controversial.

In recent years, with the promotion of this technology, the number of surgeries has increased, and the challenges faced by the original osteotomy and orthopedic surgery principles have become increasingly prominent: PAO and other osteotomies and orthopedics have changed the original hip joint space structure, and sub-anterior inferior iliac spine surgery may occur after surgery. Movement, acetabular invagination, etc. theoretically increase the risk of intra-articular and extra-articular impact, and extra-articular impact will significantly limit postoperative joint mobility, lead to postoperative pain, and affect hip joint function. Previous research (1. Clin Orthop Relat Res. 2022 Sep1;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: PMC3613512.) The results suggest that osteotomy and orthopedic surgery may cause joint impingement. .

At present, although there are some existing technologies that can be used to model based on CT images of the hip joint (such as CN202310630508.9 A hip-preserving surgical treatment system and device based on CJFH classification), it is difficult to use the constructed model to conduct pre-operative and surgical procedures. Post-assessment technology is still lacking and only targets a single disease. The difficulty is that the pelvic posture will change for different types of diseases, different patients, and in different positions (for example, the same patient has different pelvic postures in sitting and standing positions). This may lead to different three-dimensional structural postures of the hip joint, which will further affect hip joint mobility and hip joint impact. Therefore, these existing modeling systems and methods cannot accurately assess hip impingement and thus cannot provide accurate pre- and post-operative assessments for osteotomy and orthopedic surgeries.

Contents of the invention

In view of the problems of the prior art, the present invention provides a hip preservation assessment system for developmental diseases of the hip joint and its storage medium.

A hip-preserving assessment system for developmental diseases of the hip, including:

The three-dimensional modeling module is used to segment the pelvis and femur based on medical images, reconstruct the three-dimensional model, fit the femoral head into a sphere, determine the center of rotation, and finally obtain a three-dimensional hip joint model;

The registration module is used to register the three-dimensional hip joint model obtained by the three-dimensional modeling module using rigid body transformation based on the medical images collected in different real positions of the patient;

The impact assessment module is used to simulate the movement of the patient's hip joint before or after surgery, uses a contact detection algorithm to determine whether the hip joint has an impact during movement, and records the body position at the time of the impact, the location of the impact, and the hip joint at the time of the impact. Movement state.

Preferably, the medical image is selected from CT images, X-ray images or MRI images.

Preferably, the movement of the hip joint includes at least one of the following movement modes: compound movement of the hip joint on the XYZ three axes, hip joint adduction, hip abduction, hip joint flexion and extension, hip joint internal rotation, hip joint External rotation of joints.

Preferably, the contact detection algorithm specifically includes:

Establish a coordinate system in the three-dimensional space and determine the coordinates of the bony surface points of the three-dimensional hip joint model with an accuracy of 1mm;

The distance between the bony surfaces of different structures is calculated in real time, and the distance changes when the hip joint motion is simulated;

When the distance between the bony surfaces of the femoral structure and the pelvic structure is less than a predefined threshold, it is determined that an impact has occurred.

Preferably, it also includes:

The surgical planning module is used to simulate the rotation and displacement of the bone block according to the surgical plan, and convert the three-dimensional hip joint model into a post-operative three-dimensional hip joint model.

Preferably, the surgical plan includes at least one of the following surgeries: periacetabular osteotomy, femoral head and neck shaping, and femoral derotation osteotomy.

Preferably, it also includes:

Acetabular coverage assessment module for evaluating acetabular coverage in 3D hip models.

Preferably, the step of the acetabular coverage assessment module evaluating the acetabular coverage in the three-dimensional hip joint model includes:

Step a, define a metric on the three-dimensional hip joint model, and define the coverage angle and coverage area;

Step b, use the rigid body transformation method to spatially register the acetabulum and femoral head;

Step c: Apply defined metrics to perform quantitative evaluation on the registered three-dimensional hip joint model. The quantitative evaluation includes: percentage of acetabular coverage area, front, rear, and lateral coverage of acetabulum, and ASA of each section. , PSA angle;

Step d: Use statistical methods to analyze the obtained coverage metric data.

The present invention also provides a computer-readable storage medium on which is stored a computer program for implementing the above hip preservation assessment system for developmental diseases of the hip joint.

The present invention constructs a hip preservation assessment system for developmental diseases of the hip joint, which can analyze hip joint impact conditions before and after surgery for patients with developmental diseases of the hip joint. The beneficial effects of the present invention are:

1. Use real-body medical image data to determine the pelvic posture and use it as a standard to correct the three-dimensional reconstructed pelvic posture. Use the real-body pelvic posture for surgical planning, motion simulation, and impact assessment. Make the results more accurate and closer to the daily needs of patients.

2. In the preferred solution, the present invention provides an algorithm to automatically detect impacts to replace the manual judgment used in the prior art, which is more efficient and the impact detection accuracy reaches 1 mm.

In short, the present invention realizes a system and method that can more accurately assess hip joint impact conditions, and has good application prospects.

Obviously, according to the above content of the present invention, according to the common technical knowledge and common means in the field, without departing from the above basic technical idea of the present invention, various other forms of modifications, replacements or changes can also be made.

The above contents of the present invention will be further described in detail below through specific implementation methods in the form of examples. However, this should not be understood to mean that the scope of the above subject matter of the present invention is limited to the following examples. All technologies implemented based on the above contents of the present invention belong to the scope of the present invention.

Description of drawings

Figure 1 is an example diagram of a three-dimensional hip joint model;

Figure 2 is an example of setting auxiliary points and lines in a three-dimensional hip joint model;

Figure 3 is an example of impact assessment in a three-dimensional hip joint model;

Figure 4 is an example of viewing the results of impact assessment in a three-dimensional hip joint model;

Figure 5 is an example of showing and hiding the grid function when viewing the results of impact assessment in a three-dimensional hip joint model;

Figure 6 is an example of a three-dimensional hip joint model changing through surgical planning;

Figure 7 is a schematic diagram of the acetabular coverage assessment results before surgery;

Figure 8 is a schematic diagram of the femoral head collision displacement detection results;

Figure 9 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement modes are: rotation in neutral position, adduction and abduction in neutral position, and flexion;

Figure 10 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement modes are: rotation in neutral position, adduction and abduction in neutral position, and extension;

Figure 11 shows the selection of the axis of internal rotation and external rotation. The vertical line passing through the center of the femoral head is selected as the axis of internal rotation and external rotation of the femur;

Figure 12 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in neutral position, flexion of 90°, and internal rotation of the hip joint;

Figure 13 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in neutral position, flexion of 90°, and external rotation of the hip joint;

Figure 14 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in neutral position, flexion of 120°, and internal rotation of the hip joint;

Figure 15 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in neutral position, flexion of 120°, and external rotation of the hip joint;

Figure 16 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in the neutral position, flexion and extension in the neutral position, and external rotation of the hip joint;

Figure 17 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in the neutral position, flexion and extension in the neutral position, and internal rotation of the hip joint;

Figure 18 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: adduction and abduction in neutral position, extension of 30°, and external rotation of the hip joint;

Figure 19 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement methods are: rotation neutral position, flexion 0°, abduction;

Figure 20 is a schematic diagram of the collision assessment results during hip joint movement. The specific movement modes are: rotation neutral position, flexion 0°, and adduction;

Figure 21 is a comparison of the three-dimensional hip joint models of the case before and after surgery, where the left picture is before surgery and the right picture is after surgery;

Figure 22 is a schematic diagram of the steps for converting a pre-operative three-dimensional hip joint model into a post-operative three-dimensional hip joint model;

Figure 23 is a schematic diagram of the acetabular coverage assessment results after surgery.

Detailed ways

It should be noted that the algorithms for data collection, transmission, storage, and processing steps that are not specified in the embodiments, as well as the hardware structures, circuit connections, etc. that are not specified in the embodiments can all be implemented by what has been disclosed in the prior art.

Example 1 Hip Preservation Assessment System for Developmental Diseases of the Hip Joint

The evaluation system of this embodiment includes:

The three-dimensional modeling module is used to segment the pelvis and femur based on medical images, reconstruct the three-dimensional model, fit the femoral head into a sphere, determine the center of rotation, and finally obtain a three-dimensional hip joint model;

The registration module is used to register the three-dimensional hip joint model obtained by the three-dimensional modeling module using rigid body transformation based on the medical images collected in different real positions of the patient;

The surgical planning module is used to simulate the rotation and displacement of the bone block according to the surgical plan, and convert the three-dimensional hip joint model into a post-operative three-dimensional hip joint model;

The impact assessment module is used to simulate the movement of the hip joint, uses a contact detection algorithm to determine whether the hip joint is impacted during movement, and records the body position at the time of the impact, the location of the impact, and the motion status of the hip joint at the time of the impact;

Acetabular coverage assessment module for evaluating acetabular coverage in 3D hip models.

The steps for the acetabular coverage assessment module to evaluate the acetabular coverage in the three-dimensional hip joint model include:

Step a, define a metric on the three-dimensional hip joint model, and define the coverage angle and coverage area;

Step b, use the rigid body transformation method to spatially register the acetabulum and femoral head;

Step c: Use defined metrics to perform quantitative evaluation on the registered three-dimensional hip joint model. Specifically, evaluate the percentage of acetabular coverage, the front, rear, and lateral coverage of the acetabulum, and the ASA (Anterior Sector Angle) of each section. , PSA (PosteriorSector Angle) angle;

Step d: Use statistical methods to analyze the obtained coverage metric data.

Methods for pre- and post-operative hip impingement using the system described above include the following steps:

Step 1: Segment the pelvis and femur based on CT data, reconstruct the three-dimensional model, fit the femoral head into a sphere, determine the center of rotation, and finally obtain a three-dimensional hip joint model;

Figure 1 is an example of a three-dimensional hip joint model. The data file in this embodiment is saved in stl format. The specific operation of step 1 is: after the stl file is imported, the femur and pelvis are in the same set, and the default colors are the same, which is inconvenient distinguish. By right-clicking on the bone collection, create components with different names and assign different colors to distinguish them. Then use the grid tool in the function bar to select the required grid part and import the corresponding components. As shown in the figure, first create the osteotomy component, and then use the lasso tool in the function bar to select the part where the doctor wants to osteotomy, and divide this part into the osteotomy component, which is displayed in green. This step is equivalent to cutting the pelvic bone during surgery, making it easier to adjust the angle of the cutting part later.

Step 2: Based on the X-ray images collected in different real positions of the patient, rigid body transformation is used for registration. The three-dimensional hip joint model obtained by the three-dimensional modeling module; rigid body transformation is to make the two hip joint models through translation and rotation operations of the registration points. Or multiple medical images of different modalities are spatially aligned without changing the internal structure of the image.

During registration, auxiliary points and lines need to be set in the three-dimensional hip joint model. The system in this embodiment can quickly create and display the femoral head rotation center, hip extension and hip flexion rotation axis, adduction and abduction rotation axis, and internal rotation and external rotation rotation axis. . As shown in Figure 2, click Create auxiliary line, enter the initial coordinates and end coordinates of the auxiliary line in the pop-up box (or click the arrow directly, and then select the node in the grid), click OK to create the corresponding auxiliary line. After the creation is completed, click on the hip extension and hip flexion rotation axis and select the line segment just created to complete the creation of the rotation axis. The other reference point lines are created in the same way as above.

Step 3: Perform preoperative assessment, use the acetabular coverage assessment module to evaluate the acetabulum coverage in the three-dimensional hip joint model, use the impact assessment module to simulate the movement of the hip joint, and use the contact detection algorithm to determine whether the hip joint is impacted during movement. Record the body position when the impact occurs, the location where the impact occurs, and the motion state of the hip joint when the impact occurs; the movement of the hip joint includes at least one of the following movement modes: compound movement of the hip joint on the XYZ three axes, hip joint movement, Adduction, hip abduction, hip flexion and extension, hip internal rotation, hip external rotation.

Specifically, the contact detection algorithm includes:

Establish a coordinate system in the three-dimensional space and determine the coordinates of the bony surface points of the three-dimensional hip joint model with an accuracy of 1mm;

The distance between the bony surfaces of different structures is calculated in real time, and the distance changes when the hip joint motion is simulated;

When the distance between the bony surfaces of the femoral structure and the pelvic structure is less than a predefined threshold, it is determined that an impact has occurred.

An example of step 3 is shown in Figure 3. Click the impact assessment module in the system software. Select the detection range is displayed in the left box. Click the triangle button to pop up the drop-down text box. Select the content to be detected and click OK to select the detection content. , complete the detection. Click the result view to view the rotation collision model corresponding to the bone in the display box (an example is shown in Figure 4), and display the angle. At the same time, the collision positions are marked with different colors. Users can view the collision location more comprehensively through the show/hide grid function of the function bar, as shown in Figure 5.

Step 4: Simulate the rotation and displacement of the bone block according to the surgical plan, and convert the three-dimensional hip joint model into a post-operative three-dimensional hip joint model.

An example of step 4 is shown in Figure 6. During the operation, the doctor needs to adjust the position of the harvested pelvic region and then fix it with steel nails. In the system of this embodiment, click on the surgical planning module in the menu bar. The left side displays the selection set (components divided by the dividing set module), the selection reference line (the rotation point and axis divided by the auxiliary point and line module) and Translation and rotation collection. Select the contents of the three options in turn to adjust the position of the bone model. As shown in Figure 6, select the osteotomy part, hip extension and hip flexion rotation axis in sequence, select rotation, enter the rotation angle, and click Apply to complete the rotation of the osteotomy part.

Then follow step 3 again for postoperative evaluation.

The doctor can repeatedly adjust the surgical plan and re-evaluate based on the evaluation results until the best evaluation results are achieved, and then determine the final surgical plan.

One of the cases evaluated by the method of this example is shown in Figure 7-23. Among them, Figure 7 is a schematic diagram of the acetabular coverage assessment results before surgery, Figure 8 is a schematic diagram of the femoral head collision displacement detection results, and Figure 9-20 is a schematic diagram of the collision assessment results during hip joint movement. The detected movements include:

1. Neutral position of rotation, neutral position of adduction and abduction, flexion (Figure 9);

2. Rotate to neutral position, adduct and abduct to neutral position, and extend (Figure 10);

3. Select the axis of internal rotation and external rotation. Select the vertical line passing through the center of the femoral head as the axis of internal rotation and external rotation of the femur (Figure 11);

4. Adduct and abduct in neutral position, flex 90°, and internally rotate the hip joint (Figure 12);

5. Adduct and abduct in neutral position, flex 90°, and externally rotate the hip joint (Figure 13);

6. Adduct and abduct in neutral position, flex 120°, and internally rotate the hip joint (Figure 14);

7. Adduct and abduct in the neutral position, flex 120°, and externally rotate the hip joint (Figure 15);

8. Adduct and abduct the neutral position, flex and extend the neutral position, and externally rotate the hip joint (Figure 16);

9. Neutral position of adduction and abduction, neutral position of flexion and extension, and internal rotation of the hip joint (Figure 17);

10. Adduct and abduct in neutral position, extend 30°, and externally rotate the hip joint (Figure 18);

11. Rotation neutral position, flexion 0°, abduction (Figure 19);

12. Rotation neutral position, flexion 0°, adduction (Figure 20).

Figure 21 is a comparison of the three-dimensional hip joint models of the case before and after surgery. The left picture is before surgery and the right picture is after surgery. Figure 22 is a schematic diagram of the steps of converting a pre-operative three-dimensional hip joint model into a post-operative three-dimensional hip joint model.

Figure 23 is a schematic diagram of the acetabular coverage assessment results after surgery.

It can be seen that this embodiment can indeed evaluate the impact of hip joint motion and acetabular coverage before and after surgery, thereby assisting the doctor in adjusting the surgical plan.

As can be seen from the above embodiments, the present invention provides a hip preservation assessment system for developmental hip diseases, which can accurately evaluate the impact of hip motion and acetabulum coverage in patients with developmental hip diseases before and after surgery. It helps doctors adjust surgical plans and has good application prospects.

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.