Establishment and volume estimation of three-dimensional digital model of osteoarthrosis of the femoral head

doi:10.3969/j.issn.2095-4344.2016.44.013

Abstract

Abstract:

BACKGROUND: Core decompression and autogenous bone grafts are widely used in treatment of early avascular necrosis of femoral head. According 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 software. Hip CT data in DICOM format were imported into Mimics 13.0 software systems. Necrotic 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 estimation. We 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 (1 475.48±647.342) mm³ in the phase I, (4 571.77±2 344.55) mm³ in the phase II, and (4 836.46±2 969.33) mm³ in 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 decompression. It is the theoretical basis of operation.

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

Key words: Femur Head Necrosis, Imaging, Three-Dimensional, Decompression, Tissue Engineering

CLC Number:

R318

Liu Hong-bin, Zhao Han-qing, Shi Yue, Hou Li-jun, Wang Zhong-xun. Establishment and volume estimation of three-dimensional digital model of osteoarthrosis of the femoral head[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(44): 6629-6635.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入36例48髋股骨头缺血性坏死患者，全部进入结果分析，无脱落。 2.2 本组36例48髋股骨头缺血性坏死分期及三维表现 Ⅰ期8髋，占17%。多层面重建表现为坏死区局部骨小梁扭曲变形，“星芒状结构”明显增粗，可伴有骨质疏松；多层面容积重建显示股骨头解剖形态及大小正常。Ⅱ期28髋，占58%(其中Ⅱa期7例、Ⅱb期8例、Ⅱc期13例)。多层面重建示股骨头坏死区骨质疏松，皮质下可见小囊变，骨小梁“星芒状结构”消失，内有点片状密度增高影；多层面容积重建示股骨头解剖形态基本正常，坏死区可见低密度囊状影，关节间隙清楚；Ⅲ期12髋，占25%。多层面重建表现为股骨头关节面下有大小不等的囊状低密度区，边缘散在分布斑片状骨质硬化影，出现“新月”征象和轻度碎裂(图1)；多层面容积重建显示整个股骨头外形基本正常，坏死区域可见空腔状(图2)。 2.3 股骨头坏死区三维形态及体积的估算股骨头坏死区域三维形态为一个或多个近似球体(图3)。Ⅰ期股骨头坏死区的体积为(1 475.48±647.34) mm3，Ⅱ期股骨头坏死区的体积为(4 571.77±2 344.55) mm3，Ⅲ期股骨头坏死区体积为(4 836.46±2 969.33) mm3。 2.4 设计最佳减压通道进针点选择在患侧股骨大转子以下2 cm处，以不规则坏死区域球体的中心为髓芯减压通道的另一点，有多个坏死区的设计多条有共同起点减压通道(图4)。髓芯减压通道的长轴与股骨干纵轴的夹角为减压通道的仰视角，选取最佳仰视角；在矢状上面选取最佳减压通道的前倾角。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刮除坏死区病灶。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。 2.5 术后MR表现术后1，2，3个月MR示坏死侧髋关节积液分别为42，38，32髋；坏死区未见新生骨生长。术后6个月MR示坏死区髋关节积液12髋，坏死区可见新生骨生长。 2.6 不良事件术后3 d嘱患者下床进行非负重活动，术后1周出院，术后3个月避免负重。所有患者在住院治疗期间，未出现感染、骨折、脱位以及排斥反应等不良事件。"

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