中国组织工程研究

中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (15): 2297-2302.doi: 10.3969/j.issn.2095-4344.2579

• 人工假体 artificial prosthesis •    下一篇

建立下肢形态学数据库为匹配术后即装假肢提供参考

伍笑棋，李  顶，黄学成，黄文华   

  1. 南方医科大学人体解剖教研室，广东省广州市   510515
  • 收稿日期:2019-07-16 修回日期:2019-07-18 接受日期:2019-09-17 出版日期:2020-05-28 发布日期:2020-03-19
  • 通讯作者: 黄文华，博士，博士生导师，教授，南方医科大学人体解剖教研室，广东省广州市 510515
  • 作者简介:伍笑棋，男，1996年生，江苏省常州市人，汉族，南方医科大学在读博士，主要从事康复医学、外科学方面的研究。
  • 基金资助:
    国家重点研发计划(2017YFC1103400)；广东省科技计划项目(2016B090917001)；广东省科技计划项目(2017B090912006)；深圳市医疗卫生“三名工程”高层次医学团队(SZSM201612019)；佛山市科技计划(2017AG100243)

Establishing morphological database of lower limbs for providing appropriate clinical postoperative prosthesis socket

Wu Xiaoqi, Li Ding, Huang Xuecheng, Huang Wenhua   

  1. Department of Human Anatomy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • Received:2019-07-16 Revised:2019-07-18 Accepted:2019-09-17 Online:2020-05-28 Published:2020-03-19
  • Contact: Huang Wenhua, MD, Doctoral supervisor, Professor, Department of Human Anatomy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • About author:Wu Xiaoqi, Doctoral candidate, Department of Human Anatomy, Southern Medical University, Guangzhou 510515, Guangdong Province, China
  • Supported by:
    the National Key Research and Development Plan, No. 2017YFC1103400; the Guangdong Science and Technology Plan Project, No. 2016B090917001; the Science and Technology Program of Guangdong Province, No. 2017B090912006; the High-Level Medical Team of Shenzhen Medical and Health “Three Famous Project”, No. SZSM201612019; the Science and Technology Plan of Foshan City, No. 2017AG100243

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摘要：

文题释义：
术后假肢：现代截肢康复的方法包括手术后安装临时假体，即在完成截肢手术后，医生为患者佩戴合适的临时假体。
大腿影像数据：研究采集的大腿数据包括膝上缘周径、膝上缘5 cm处周径、膝上缘10 cm处周径和膝上缘15 cm处周径，将大腿MRI数据导入3D重建软件，得到大腿截肢范围段表面积、体积。
大腿截肢范围段：为膝关节间隙上10-25 cm。

背景：目前假肢的制作是通过取型、修型、成型3个步骤完成的，由于修型过程是人工完成，与临床技师的经验技术密切相关，制作出来的假肢不美观，接受腔与残肢很难做到全接触。

目的：收集健康志愿者大腿MRI影像数据，评估成人大腿截肢范围段(膝关节间隙上10-25 cm)的对称性；将MRI影像数据建立成数据库，为下肢截肢患者匹配合适的术后即装假肢提供参考数据。

方法：招募40名健康志愿者，采集基本信息：年龄、身高、体质量、膝上缘周径、膝上缘5 cm处周径、膝上缘10 cm处周径和膝上缘15 cm处周径。所有志愿者对试验方案均知情同意，且得到医院伦理委员会批准。对大腿截肢范围进行三维重建，以模型的表面积、体积为参数，对每一例志愿者大腿进行解剖测量，利用三维逆向工程软件对测量结果进行3D偏差分析，完成大腿形态对称性的定量化和可视化分析。

结果与结论：①同体分析：同一个体左右大腿截肢范围段表面积之间的最大百分差异比不超过0.56%(P=0.109)；左右大腿截肢范围段体积之间最大百分差异比不超过1.19%(P=0.182)；三维偏差分析结果显示，最大平均负偏差为-1.47 mm，最大平均正偏差为1.14 mm。40例受试者的3D偏差分布78.02%在2 mm以内，20.97%在2.1-3.0 mm，仅1.01%大于3 mm。②异体分析：三维偏差分析结果显示，最大平均负偏差为-1.97 mm，而最大平均正偏差为1.89 mm。③提示成人双侧大腿截肢范围具有高度的解剖学对称性；当2名成人的膝上缘周径、膝上缘5 cm处周径、膝上缘10 cm周径和膝上缘15 cm处周径分别都相差在2 cm以内时，则认为这2名成人双侧大腿截肢范围段表面轮廓具有高度相似性，与性别、身高和体质量无关。

ORCID: 0000-0001-6838-3042(伍笑棋)

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 假肢接受腔, 大腿形态学, 三维重建, 偏差分析, 数据库, 康复研究

Abstract:

BACKGROUND: At present, the prosthesis is made by three steps: taking, trimming and shaping. Because the process of trimming is manual, it is closely related to the experience and technology of clinical technicians. If the prosthesis is not beautiful, it is difficult to make full contact between the receiving cavity and the residual limb.

OBJECTIVE: To collect MRI data of thigh in healthy volunteers, evaluate the anatomical symmetry of thigh amputation range (10-25 cm above knee joint space), and establish MRI data as a database so as to provide reference data for patients with lower limb amputation to match the appropriate prosthesis after operation.

METHODS: Totally 40 healthy volunteers were recruited and basic information was collected, including age, height, weight, the circumference of the knee, the circumference of the knee at 5 cm, the circumference of the knee at 10 cm, and the circumference of the knee at 15 cm. All volunteers signed the informed consent. This study was approved by the Hospital Ethics Committee. Three-dimensional reconstruction was carried out in thigh amputation range. Taking the surface area and volume of the model as parameters, the thighs of each volunteer were anatomically measured. Three-dimensional reverse engineering software was used to analyze the three-dimensional deviation of the measurement results so as to conduct quantification and visualization of the thigh symmetry.

RESULTS AND CONCLUSION: (1) Self symmetric analysis: Regarding the surface area, the maximal percent difference between the left and right thigh amputation was no more than 0.56% (P=0.109). Regarding the volume, the maximal percent difference between the left and right thigh amputation was no more than 1.19% (P=0.182). Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -1.47 mm, while the maximal mean positive deviation was 1.14 mm. Moreover, the three-dimensional deviation distribution of 40 subjects was within 2 mm (78.02%), between 2.1 and 3.0 mm (20.97%), and more than 3 mm (1.01%). (2) Allogeneic symmetric analysis: Results of the three-dimensional deviation analyses showed that the maximal mean negative deviation was -1.97 mm, while the maximal mean positive deviation was 1.89 mm. (3) The results confirmed that adult bilateral thigh amputation range has a high degree of anatomical symmetry. When differences between two adults’ right thighs are no more than 2 cm in the circumference of the knee, the circumference of the knee at 5 cm, the circumference of the knee at 10 cm, and the circumference of the knee at 15 cm, their surface profiles of thigh amputation ranges are considered to be highly similar, but are not associated with gender, height and weight.

Key words: prosthetic socket, thigh morphology, three-dimensional reconstruction, deviation analysis, database, rehabilitation research

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