股骨头坏死区三维数字化模型建立及体积估算

引用本文：刘宏滨，赵汉青，史跃，侯利军, 王中勋.股骨头坏死区三维数字化模型建立及体积估算[J].中国组织工程研究，2016，20(44):6629-6635.

文章快速阅读：

刘宏滨，男，1965年生，江苏省徐州市人，1989年解放军第二军医大学毕业，硕士，主任医师，主要从事骨病微创治疗方面的研究。

(2016)44-06629-07

稿件接受：2016-08-12

文题释义：

股骨头坏死三维数字模型建立：多层螺旋CT三维重组技术既能将连续的图像进行多模式的三维重建，又能立体再现股骨头坏死区域，设计最佳髓芯减压通道，模拟髓芯减压手术，使术者在术中可参照最佳的模拟减压路径实施髓芯减压手术，对股骨头缺血性坏死的临床治疗具有指导意义。

股骨头坏死区体积估算：在CT多平面重建图像的横断面、矢状面和冠状面上对坏死区的最大直径进行测量，估算坏死区域的体积，对坏死区域进行量化，为术前取备植骨开辟一条新的途径。

背景：髓芯减压联合自体骨移植被广泛应用于修复早期股骨头缺血性坏死，研究者报道采用该项手术治疗成功率差别较大，其原因可能在于穿刺定位不准确以及反复穿刺造成二次损伤有关。

目的：通过Mimics软件重建股骨头坏死三维模型，立体再现坏死区病灶，实现对股骨头坏死区域的测量和体积估算。

方法：应用多层螺旋CT Syngommvvp VE23A工作站，联合Inspace软件和NeuroDSA软件进行影像重组，将DICOM格式的髋关节CT数据导入Mimics 13.0软件系统，利用Mimics SimuIation计算机软件三维重建股骨头坏死区域，真实再现股骨头的完整形态、坏死区的范围以及坏死区域的立体结构，实现对股骨头坏死区域的测量和体积估算。设计最佳髓芯减压通道，模拟髓芯减压手术，使术者在术中可参照最佳的模拟减压路径实施髓芯减压手术。

结果与结论：①36例48髋股骨头缺血性坏死患者中Ⅰ期8髋，占17%；Ⅱ期28髋，占58%；Ⅲ期12髋，占25%；②Ⅰ期股骨头坏死区的体积为(1 475.)mm3，Ⅱ期为(4 571.77±2 344.55)mm3，Ⅲ期为(4 836.46±2 969.33)mm3；③以坏死区域球体的半径为参数在Mimics SimuIation计算机软件模块中模拟髓芯减压术，完全剜除坏死区病灶；④通过Mimics软件模拟髓芯减压，可以使术者在术前更清楚的了解坏死灶信息及空间的立体结构，于Mimics三维视图上虚拟精准髓芯减压路径，为进一步实现实体手术提供理论基础。

骨科植入物；数字化骨科；股骨头坏死；坏死区体积；计算；成像；三维重建；髓芯减压；自体骨移植

主题词：

股骨头坏死；成像，三维；减压；组织工程

南京军区医学科技创新课题(2011MB007)

BACKGROUND:Core decompression and autogenous bone grafts are widely used in treatment of early avascular necrosis of femoral to the report, the success rate of this therapy has obvious difference; the reasons may be related to inaccurate puncture location and secondary damnification of repeated puncture.

OBJECTIVE:To reconstruct three-dimensional model of femoral head necrosis by Mimics software for reappearance of lesions in the necrotic area to realize measurement of necrotic area of the femoral head and estimation of its volume.

METHODS:We restructured images by using multi-slice spiral CT Syngommvvp VE23A workstation, Inspace software and NeuroDSA CT data in DICOM format were imported into Mimics 13.0 software area of the femoral head was reconstructed with Mimics SimuIation software to truly reproduce the integrated form, scope and stereochemical structure of the necrotic area so as to achieve the measurement of the necrotic area of the femoral head and the volume designed the best core decompression channel, simulated core decompression surgery, so that the patients could refer to the best simulated decompression path in the operation of core decompression.

RESULTS AND CONCLUSION:(1) Among 36 patients (48 hips) with avascular necrosis of femoral head, there were phase I in 8 hips, accounting for 17%, phase II in 28 hips, accounting for 58%, and phase III in 12 hips, accounting for 25%.(2) The volume of necrotic area was (1 475.)mm3in the phase I, (4 571.77±2 344.55)mm3in the phase II, and (4 836.46±2 969.33)mm3in the phase III.(3) We simulated the core decompression based on the radius of the sphere of the necrotic area as parameter in the Mimics Simulation software module, and then completely cleared the necrotic area.(4) Surgery can more clearly understand information and stereochemical structure of the necrotic area with Mimics software to simulate the core is the theoretical basis of operation.

Subject headings:Femur Head Necrosis; Imaging, Three-Dimensional; Decompression; Tissue Engineering

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