下肢矫形手术应用微机图像技术辅助设计的应用研究

1、下肢矫形手术应用微机图像技术辅助设计的应用研究         10-04-30 09:06:00     编辑：studa20                作者：唐述森韩桂全王金荣王韶峰代瑞珍 【摘要】  目的应用医学图像处理软件，在计算机屏幕上进行下肢矫形手术的设计，对手术后状况进行预测，并检验该软件的

2、临床应用效果。方法自主开发一套基于数字X线的矫形外科手术设计与预测模拟软件，并将该软件应用于下肢矫形手术的组织测量分析、手术方案设计与手术效果模拟。2001年1月2006年12月，共为28例下肢长骨畸形患者进行截骨矫形手术，患者分为实验组和对照组，分别使用计算机辅助法和传统手工方法设计手术方案。其他术前术后处理均按常规进行，两组患者无差别。术后拍摄患肢X线片与术前的设计方案进行比较，分别计算两种设计方法下手术效果与术前设计的符合程度，并进行统计学分析。结果该软件测量误差小，构建的骨切除量参数准确，模拟效果逼真。手术效果与设计方案的符合率明显优于传统方法设计组，统计学处理差别有显著性。结论在下肢

3、矫形手术前的病例分析中应用医学图像处理软件能够对骨组织同时进行测量分析和手术模拟设计，可进行手术模拟并设计切除骨量。系统操作方法易于为外科医生掌握使用，具有临床实用性。 【关键词】  矫形外科下肢畸形计算机辅助图像处理    Abstract: ObjectiveA DR-based medical image processing software was developed to design the orthopaedics operation of lower limbs on the computer screen.The software w

4、as designed for predicting the effect after diorthosis and the clinical effect of using the software during preoperative planning will be evaluated. MethodsA DR-based computer image processing software was developed for orthopedic planning and prediction of postoperative situation.The tissue measure

5、ment, operation planning and simulation of operation effect was carried out in limb deformity cases with the software on computer.From Jan 2001 to Dec 2006, 28 cases of lower limb long bone deformity were operated and followed up with completely data.All the 28cases were divided into control group a

6、nd experimental group, and different design methods were respectively performed in each group.The control group were treated by the traditional hand-made method and the experimental group were treated by the computer-assisted method.All treatment for two groups were same before and after the operati

7、on.After osteotomy, X-ray pictures were taken at operated limbs and compared with preoperative casts.Concordances between operation effect and preoperative cast were calculated and analyzed statistically.ResultsThe software runs smoothly and the error was tiny to ignore.Excision parameters provided

8、by computer were accurate and the preoperative cast was vivid.Both operation effect and coincidence were obviously more satisfactory in experimental group than in control group.And the difference was analyzed to be significant.ConclusionComputer image processing technique can be used to analyze the

9、bone tissue and design the operation method, and the quantity of bone resection also can be sure in the cases analysis before the operation.The method is easy to master and can be used widely in the clinical work.    Key  words：orthopedics;  limb deformity;  computer as

10、sisted;  image processing    目前临床上对于膝内翻/外翻等下肢长骨畸形，截骨矫形是常用的治疗方法。下肢矫形手术治疗效果的关键在于设计完善的手术方案，精确控制截骨部位、截骨角度与截骨量。但传统的诊断测量方法不够全面准确，术前无法模拟出术后的组织形态。本研究把先进的计算机图像处理技术应用于矫形外科领域来完成下肢长骨畸形的测量、手术设计、手术效果预测等，探索利用计算机图像处理技术辅助下肢矫形手术的定量诊断、设计预测。    1  手术方法1.1  硬件设备1.2  软件系统

11、    应用软件包括图像测量模块（包括任意图像面积、直线长度、曲线长度等的测量）、手术设计、切除/植入量构建等图像处理模块。全部操作过程采用人机对话和菜单选择方式完成，采用Visual C语言及Visual FoxPro数据库编程。1.3  患者资料    2001年1月2008年12月，来自本院资料完整的下肢长骨畸形手术患者共28例，年龄1354岁，平均34岁。其中股骨髁上截骨治疗膝屈曲畸形11例，膝内翻胫骨高位截骨术9例，膝外翻股骨远端截骨8例。患者随机分为实验组和对照组，分别使用计算机辅助法和传统手工方法设计手术方案。

12、其他术前术后处理均按常规进行，两组患者无差别。1.4  手术过程1.4.1  拍摄下肢全长X线片    患者站立于踏板上，面对投射板，双下肢标准中立位，患者保持不动，平移投射板，分23次拍摄下肢全长X线片，范围包括髋、膝、踝三个关节。将拍摄的影像信息转为数字信号输入到计算机中，拼接出完整的下肢影像。1.4.2  设计手术方案    实验组：首先绘制下肢力线，测量膝内外翻角度，按照畸形严重的部位不同，选择截骨部位，在膝关节平面上方或者下方量取约34 cm，做一条平行与关节面的直线，根据测定的内外翻的角度加过矫3°绘制另外一条截骨直线。三角形内所包含的楔形骨块即为应切除的骨质。利用软件的任意选区、定点旋转功能，模拟手术后下肢骨骼的形态，重新绘制下肢力线轴，观察形态是否满意。利用软件的测量工具，测量需要截骨的距离。对照组：在X线片上采用人工测量的方法测算需要截骨的距离。1.4.3  根据设计结果进行