交锁髓内钉定位方法的研究与实现
|
摘要
交锁髓内钉的出现并广泛使用是骨折治疗领域的最大进展之一,用它来固定股骨干骨折部位的方法,可以使得患者的恢复效果比用钢板固定等方式治疗的效果好许多。但由于手术过程中固定髓内钉是在骨腔内进行的,远端锁孔位置难以精确定位,而使得手术不得不长时间在X光照射下进行,这严重威胁了医生和患者的健康。
基于目前的手术方法存在上述缺点,本文提出用光电检测的方法来定位交锁髓内钉的远端锁孔,介绍了基于光斑重心的交锁髓内钉远端定位方法,通过计算交锁髓内钉变形前后其远端端面像的重心变化,计算出交锁髓内钉远端锁孔的实际变化,并建立了该定位系统。
论文介绍了交锁髓内钉远端定位检测系统的原理和组成,主要包括光纤图像传输系统的设计和交锁髓内钉定位支架装置的研制,软件方面阐述了基于重心的光斑中心定位算法,在此基础上用VC++对光斑中心位置进行精确测量。为了避免二值变换引起的毛刺,先使用改进的阈值变换,再使用一种直观的画圆的方法,把光斑框起来求重心位置。通过实验测量和数据分析得出,交锁髓内钉远端的位移与光斑重心的位移成一定的线性关系。根据这个线性关系和光斑重心的位移则可以推出骨腔中髓内钉的远端位移,进而可以锁钉。
最后进行实验验证,使交锁髓内钉远端受力产生形变,光斑位置即产生相应的移动,通过软件计算出光斑的位移量,根据已知的标定曲线即可以推出理论髓内钉远端形变量,并与实际的形变量作比较和分析。结果表明该系统定位锁孔误差小于0.1mm,满足系统指标要求,具有较高的稳定性。
The appearance of interlocking intramedullary nails and its widely use is one of the fastest developments in the field of in treatment of the fracture. The recuperate effect for the sufferer of using it in treatment of the femoral shaft fracture is better than others as armor plates and so on. But as the process of fixing locking intrameduallary nailing on operation is going inside the femur, it is hard to accurately make sure the position of distal lockhole, so the operation has to be processed under the X-ray for a long time and it is harmful to the doctor’s and the sufferer’s health deeply.
Because of the main defections which exist in fracture surgery nowadays, we present a novel distal location method of photoelectric detection technology and establish the system based on gravity center of light spot. The actual position of distal lockholes for interlocking intramedullary nails can be obtained through computing the change of gravity center of the light spot before and after deformation.
We describe the principle and component of the measurement system. In hard line, we mainly design on optical fiber image system and stent positioning system. The first object is to get the gravity center of light spot after image acquisition in software, so we exploit a real-time system based on VC++ to measure the gravity center of light spot. During image processing, a modified threshold transform of image is used to avoid the defect through the binary transform. A circle is drawn directly around the light spot to get the gravity center. In addition, a lot of measuring experiments are performed in the laboratory. We can draw the conclusion based on the experimental data which constitutes a certain linear relationship between the displacement of distal end and the displacement of light spot. According to this linear relationship and displacement of light spot, the remote displacement of interlocking intramedullary nails in femur can be obtained.
To subject to a test, we can get the precision of system by comparing and analyzing theoretical deformation and practical deformation of distal end for interlocking intramedullary nails. The quantitative analysis of the result shows that the absolute error of orientation can be less than 0.1mm. It can meet the requirement of the measuring system. The measurement system has higher stability.
基于目前的手术方法存在上述缺点,本文提出用光电检测的方法来定位交锁髓内钉的远端锁孔,介绍了基于光斑重心的交锁髓内钉远端定位方法,通过计算交锁髓内钉变形前后其远端端面像的重心变化,计算出交锁髓内钉远端锁孔的实际变化,并建立了该定位系统。
论文介绍了交锁髓内钉远端定位检测系统的原理和组成,主要包括光纤图像传输系统的设计和交锁髓内钉定位支架装置的研制,软件方面阐述了基于重心的光斑中心定位算法,在此基础上用VC++对光斑中心位置进行精确测量。为了避免二值变换引起的毛刺,先使用改进的阈值变换,再使用一种直观的画圆的方法,把光斑框起来求重心位置。通过实验测量和数据分析得出,交锁髓内钉远端的位移与光斑重心的位移成一定的线性关系。根据这个线性关系和光斑重心的位移则可以推出骨腔中髓内钉的远端位移,进而可以锁钉。
最后进行实验验证,使交锁髓内钉远端受力产生形变,光斑位置即产生相应的移动,通过软件计算出光斑的位移量,根据已知的标定曲线即可以推出理论髓内钉远端形变量,并与实际的形变量作比较和分析。结果表明该系统定位锁孔误差小于0.1mm,满足系统指标要求,具有较高的稳定性。
The appearance of interlocking intramedullary nails and its widely use is one of the fastest developments in the field of in treatment of the fracture. The recuperate effect for the sufferer of using it in treatment of the femoral shaft fracture is better than others as armor plates and so on. But as the process of fixing locking intrameduallary nailing on operation is going inside the femur, it is hard to accurately make sure the position of distal lockhole, so the operation has to be processed under the X-ray for a long time and it is harmful to the doctor’s and the sufferer’s health deeply.
Because of the main defections which exist in fracture surgery nowadays, we present a novel distal location method of photoelectric detection technology and establish the system based on gravity center of light spot. The actual position of distal lockholes for interlocking intramedullary nails can be obtained through computing the change of gravity center of the light spot before and after deformation.
We describe the principle and component of the measurement system. In hard line, we mainly design on optical fiber image system and stent positioning system. The first object is to get the gravity center of light spot after image acquisition in software, so we exploit a real-time system based on VC++ to measure the gravity center of light spot. During image processing, a modified threshold transform of image is used to avoid the defect through the binary transform. A circle is drawn directly around the light spot to get the gravity center. In addition, a lot of measuring experiments are performed in the laboratory. We can draw the conclusion based on the experimental data which constitutes a certain linear relationship between the displacement of distal end and the displacement of light spot. According to this linear relationship and displacement of light spot, the remote displacement of interlocking intramedullary nails in femur can be obtained.
To subject to a test, we can get the precision of system by comparing and analyzing theoretical deformation and practical deformation of distal end for interlocking intramedullary nails. The quantitative analysis of the result shows that the absolute error of orientation can be less than 0.1mm. It can meet the requirement of the measuring system. The measurement system has higher stability.
引文
[1] Karrezis LA, Miles AW.“Biological”internal fixation of long bone fractures: a biomech- anical study of a“noncontact”plate system. Injury, 1998, 29(9):689.
[2]吴贵亮,姚士军,郭贺荣.交锁髓内钉与加压钢板治疗股骨干骨折临床疗效比较.中国矫形外科杂志,2003,14(7):1004~1005.
[3] Klemm KW,Borner M. Interlocking nailing of complex fractures of the femur and tibia.Clin Orthop, 1986, 212:89~100.
[4] Arazi M, Ogun TC, OKtar MN. Early weight-bearing after statically locked reamed intramed- uallary nailing of comminuted femoral fractures. J Trauma, 2001, 50(4):711-716.
[5]徐建伟,贾连顺,谭军,等.长管骨髓内钉远端交锁技术改进.中国矫形外科杂志,2001,8(8):812.
[6] T.Yamaji, K.Ando, T.Nakamura, et al. Femoral shaft fracture callus formation after intramedulla- ry nailing:a comparison of interlocking and Ender nailing. Journal Of Orthopaedic Science, 2002,7(4):472~476.
[7]钟世镇.临床应用解剖学.北京:人民军医出版社,1998,595~605.
[8]柏树令.系统解剖学.北京:人民卫生出版社,2002,35.
[9]王亦璁.骨与关节损伤.第3版.北京:人民卫生出版社,2003,910.
[10]荣国威.骨科内固定.第3版.北京:人民卫生出版社,1999,208.
[11]卢世壁.骨科标准手术技术从书:骨折.沈阳:辽宁科学技术出版社,2005,273;274;411;433.
[12] Ikpeme JO. Intramedullary interlocking nailing for humera1 fracture: experiences with the Russ el1 - Taylor humera1 nail. Injury, l994, 25:4471.
[13] Gregory P, Sanders R. The treatment of closed, unstable tibial shaft fracture with undreamed interlocking nail. Clin Orthop, 1995, 315:48.
[14] Sven Shafizadeh, Hans-Jorg Huber. Principles of Fluorosocopic-Based Navigateion in Anterior Cruciate Ligament Reconstruction. Operative Techniques in Orthopaedics, 2005, 15:70~75.
[15] Alexandru Patriciu, Dan Stoianovici, Louis L. Whitcomb. Motion-Based Robotic Instrument Targeting Under C-Arm Fluoroscopy. Medical Image computing and Computer-Assisted Intervention, October 11-14, 2000, Pittsburgh, PA, Lecture Notes in Computer Science, Springer-Verlag, Vol.1935, pp.988~998.
[16] Shoham M, Burman M, Zehavi E, et al. Bone-Mounted Miniature Robot for Surgical Procedures: Concept and Clinical Application. IEEE Transactions on Robotics and Automation, 2003, 19(5): 893~901.
[17] Norbert Suhm, Peter Messmer, Ludwig A. Jacob. Fluoroscopic Guidance Versus Surgical Navigation for Distal Locking of Intramedullary Implants A Prospective Controlled Clinical Study. Elsevier Injury, 2004, 35:567~574.
[18] Viant W J, Phillips R, Griffiths J G, et al. A Computer Assisted Orthopaedic System for Distal Locking of Intramedullary Nails. Proceeding of Institution of Mechanical Engineers, 1997, 211(H): 293~300.
[19] Voss G, Bisler A. Bockholt U, Thumler P, Veipert A. ICAPS an Integrative Computer-assisted Planning System for Pedicle Screw Insertion. Stud Health Technal Inform, 2001, 81: 561~563
[20]杜奇涛,赵兴伟,王景炎.自制调节器在股骨带锁髓内钉远端锁孔定位中的应用.中华创伤骨科杂志,2004,6(12):1423~1424.
[21] Wolinsky PR, McCarty E, Shyr Y, et al. Reamed intramedullary nailing of the femur 551 case J Trauma, 1999, 46 (3):392.
[22]张平,孙立民.远端锁孔磁力定位式带锁髓内钉治疗股骨干骨折16例分析.中国误诊学杂志,2006,6(5):963~964.
[23]王舜民.骨科手术用C-Arm影像辅助规划及导引系统[硕士学位论文].台湾:国立中央大学,2002: 5~15.
[24] Tianmiao Wang, Wenyong Liu, Lei Hu. A Fluoroscopy-Based Robot Navigating System for Distal Locking of Intramedullary Nails. IEEE Proc of Int Conf on Intelligent Robots and Systems, 2004:3321~3326.
[25] Available from: http://asisz.com/chinese/Product/Chirurgery/ASA-610V.asp
[26] Zuber K, Schneider E, Eulenbergor J,et al. Form and dimension of the bone narrow cavity of the human femur with reference to the fit of intramedullary implant. Unfallchirurg, 1988, 91(9):314~319.
[27]王永清,罗先正,刘长贵,等.国人股骨胫骨髓腔形态学研究及带锁髓内钉的改进.中华骨科杂志,1998,18(4):215~218.
[28]王之一,王美英,宋生彪.股骨骨髓腔的应用解剖.中国临床解剖学杂志,1993,11(11): 126~128.
[29]万黎,张日华,黎建明,等.成人股骨髓腔的解剖学测量及弹力内锁钉的设计应用.中国临床解剖学杂志,2002,20(3):176~178.
[30]辛景义,张玉新,祁宝兴,等.激光定位在带锁髓内钉远端锁孔定位中的应用.中华骨科杂志,1999,19(19):302.
[31]石顺祥,张海兴,刘劲松.物理光学与应用光学.西安:西安电子科技大学出版社,2000,8:108,328~357.
[32] [美]Gerd Keiser.李玉权,等译.光纤通信(第三版).北京:电子工业出版社,2002,7.
[33] Kobayash, Katsuhiro, et al. Image fiber imaging apparatus. U. S. Patent: 6744957, 2004. 06. 01.
[34] Milton Laikin. Lens Design. Third Edition. New York: MarcelDekker Inc, 2001, 121~132.
[35]黄燕群,田爱玲.光栅投影测量物体三维轮廓的条纹中心线相对偏移量的获取.应用光学,2004,25(6):57~60.
[36]孔兵,王昭,谭玉山.基于圆拟合的激光光斑中心检测算法.红外与激光工程, 2002,31(3):275~279.
[37] Paul J, Frederick W, David L. Nova laser alignment control system. SPIE. 1984, 483. 54264.
[38]郎锐.数字图像处理学VC++实现.北京:北京希望电子出版社,2002.
[39]何斌,马天予,王运坚,等. VC + +数字图像处理.北京:人民邮电出版社,2001.
[40] [美]JeffreyRichter著.王建华译. Windows核心编程.北京:机械工业出版社,2008.
[41] Lacroute P, Levoy M. Fast volume rendering using a shear-warp factorization of the viewing transformation. In: Glassner A, ed. Proc.of the SIGGRAPH’94. New York: ACM Press, 2000, 451~458.
[42] Resk-Salama C, Engel K, Bauer M, Greiner G, Ertl T. Interactive volume rendering on standard PC graphics hardware using multi-textures and multi-stage-rasterization. In: Spencer SN, ed. Proc. of the Eurographics/SIGGRAPH Workshop on Graphics Hardware 2000, New York: ACM Press, 2000, 109~118.
[43] 3DMed(3-Dimensional Medical Image Processing and Analyzing System). http://www.3d -med.net.
[44]宋延山,尉雪波,吴风庆.应用统计学:以EXCEL为分析工具.成都:西南财经大学出版社,2006.
[45]李朋. EXCEL统计分析实例精讲.北京:科学出版社,2006.
[46]黄润龙.数据统计与分析技术.北京:高等教育出版社,2004.
[47]王乐三. SPSS在医学科研中的应用.北京:化学工业出版社,2007.
[48]池雷霆,裴福兴.交锁髓内钉的应用生物力学.中华创伤杂志2001,17(5):713~913.
[49]刘建军,刘建国,冯卫,等.带锁髓内钉治疗胫骨近端骨折生物力学分析及临床意义.中华现代医学与临床,2005,2(2):22~24.
[50]李景煜,王波,龚炜,等.交锁髓内钉治疗长管状骨骨折.中华医学实践杂志,2006,6(5):404~406.
[51]邓军.导航在长骨干骨折髓内钉固定中的应用,中华创伤骨科杂志,2005,7(7):625~626.
[52] Lang GJ, Cohen BE, Bosse MJ, et al. Prominal third fractures: should they be nailed. Clin Orthop, 1995, 3l5:64.
[53] Wiss DA, Stetson WB. Unstable fractures of the tibia treated with a reamed intramedullary interlocking nail. Clin Orthop, 1995, 315:56.
[54] Odwyer KJ, Chakravarty RD, Esler CAN. Intramedullary nailing technique and its effect on union rates of tibia shaft fractures. Injury, l994, 25 (7):461.
[55] Wu CC. Hu mera1 shaft nonunion treated by a seidel interlocking nail with a supple mentury. Clin Orthop, 1996, 326: 203~208.
[56] Gregory P, Sanders R. The treatment of closed, unstable tibial shaft fracture with undreamed interlocking nail. Clin Orthop, 1995, 315:48.
[2]吴贵亮,姚士军,郭贺荣.交锁髓内钉与加压钢板治疗股骨干骨折临床疗效比较.中国矫形外科杂志,2003,14(7):1004~1005.
[3] Klemm KW,Borner M. Interlocking nailing of complex fractures of the femur and tibia.Clin Orthop, 1986, 212:89~100.
[4] Arazi M, Ogun TC, OKtar MN. Early weight-bearing after statically locked reamed intramed- uallary nailing of comminuted femoral fractures. J Trauma, 2001, 50(4):711-716.
[5]徐建伟,贾连顺,谭军,等.长管骨髓内钉远端交锁技术改进.中国矫形外科杂志,2001,8(8):812.
[6] T.Yamaji, K.Ando, T.Nakamura, et al. Femoral shaft fracture callus formation after intramedulla- ry nailing:a comparison of interlocking and Ender nailing. Journal Of Orthopaedic Science, 2002,7(4):472~476.
[7]钟世镇.临床应用解剖学.北京:人民军医出版社,1998,595~605.
[8]柏树令.系统解剖学.北京:人民卫生出版社,2002,35.
[9]王亦璁.骨与关节损伤.第3版.北京:人民卫生出版社,2003,910.
[10]荣国威.骨科内固定.第3版.北京:人民卫生出版社,1999,208.
[11]卢世壁.骨科标准手术技术从书:骨折.沈阳:辽宁科学技术出版社,2005,273;274;411;433.
[12] Ikpeme JO. Intramedullary interlocking nailing for humera1 fracture: experiences with the Russ el1 - Taylor humera1 nail. Injury, l994, 25:4471.
[13] Gregory P, Sanders R. The treatment of closed, unstable tibial shaft fracture with undreamed interlocking nail. Clin Orthop, 1995, 315:48.
[14] Sven Shafizadeh, Hans-Jorg Huber. Principles of Fluorosocopic-Based Navigateion in Anterior Cruciate Ligament Reconstruction. Operative Techniques in Orthopaedics, 2005, 15:70~75.
[15] Alexandru Patriciu, Dan Stoianovici, Louis L. Whitcomb. Motion-Based Robotic Instrument Targeting Under C-Arm Fluoroscopy. Medical Image computing and Computer-Assisted Intervention, October 11-14, 2000, Pittsburgh, PA, Lecture Notes in Computer Science, Springer-Verlag, Vol.1935, pp.988~998.
[16] Shoham M, Burman M, Zehavi E, et al. Bone-Mounted Miniature Robot for Surgical Procedures: Concept and Clinical Application. IEEE Transactions on Robotics and Automation, 2003, 19(5): 893~901.
[17] Norbert Suhm, Peter Messmer, Ludwig A. Jacob. Fluoroscopic Guidance Versus Surgical Navigation for Distal Locking of Intramedullary Implants A Prospective Controlled Clinical Study. Elsevier Injury, 2004, 35:567~574.
[18] Viant W J, Phillips R, Griffiths J G, et al. A Computer Assisted Orthopaedic System for Distal Locking of Intramedullary Nails. Proceeding of Institution of Mechanical Engineers, 1997, 211(H): 293~300.
[19] Voss G, Bisler A. Bockholt U, Thumler P, Veipert A. ICAPS an Integrative Computer-assisted Planning System for Pedicle Screw Insertion. Stud Health Technal Inform, 2001, 81: 561~563
[20]杜奇涛,赵兴伟,王景炎.自制调节器在股骨带锁髓内钉远端锁孔定位中的应用.中华创伤骨科杂志,2004,6(12):1423~1424.
[21] Wolinsky PR, McCarty E, Shyr Y, et al. Reamed intramedullary nailing of the femur 551 case J Trauma, 1999, 46 (3):392.
[22]张平,孙立民.远端锁孔磁力定位式带锁髓内钉治疗股骨干骨折16例分析.中国误诊学杂志,2006,6(5):963~964.
[23]王舜民.骨科手术用C-Arm影像辅助规划及导引系统[硕士学位论文].台湾:国立中央大学,2002: 5~15.
[24] Tianmiao Wang, Wenyong Liu, Lei Hu. A Fluoroscopy-Based Robot Navigating System for Distal Locking of Intramedullary Nails. IEEE Proc of Int Conf on Intelligent Robots and Systems, 2004:3321~3326.
[25] Available from: http://asisz.com/chinese/Product/Chirurgery/ASA-610V.asp
[26] Zuber K, Schneider E, Eulenbergor J,et al. Form and dimension of the bone narrow cavity of the human femur with reference to the fit of intramedullary implant. Unfallchirurg, 1988, 91(9):314~319.
[27]王永清,罗先正,刘长贵,等.国人股骨胫骨髓腔形态学研究及带锁髓内钉的改进.中华骨科杂志,1998,18(4):215~218.
[28]王之一,王美英,宋生彪.股骨骨髓腔的应用解剖.中国临床解剖学杂志,1993,11(11): 126~128.
[29]万黎,张日华,黎建明,等.成人股骨髓腔的解剖学测量及弹力内锁钉的设计应用.中国临床解剖学杂志,2002,20(3):176~178.
[30]辛景义,张玉新,祁宝兴,等.激光定位在带锁髓内钉远端锁孔定位中的应用.中华骨科杂志,1999,19(19):302.
[31]石顺祥,张海兴,刘劲松.物理光学与应用光学.西安:西安电子科技大学出版社,2000,8:108,328~357.
[32] [美]Gerd Keiser.李玉权,等译.光纤通信(第三版).北京:电子工业出版社,2002,7.
[33] Kobayash, Katsuhiro, et al. Image fiber imaging apparatus. U. S. Patent: 6744957, 2004. 06. 01.
[34] Milton Laikin. Lens Design. Third Edition. New York: MarcelDekker Inc, 2001, 121~132.
[35]黄燕群,田爱玲.光栅投影测量物体三维轮廓的条纹中心线相对偏移量的获取.应用光学,2004,25(6):57~60.
[36]孔兵,王昭,谭玉山.基于圆拟合的激光光斑中心检测算法.红外与激光工程, 2002,31(3):275~279.
[37] Paul J, Frederick W, David L. Nova laser alignment control system. SPIE. 1984, 483. 54264.
[38]郎锐.数字图像处理学VC++实现.北京:北京希望电子出版社,2002.
[39]何斌,马天予,王运坚,等. VC + +数字图像处理.北京:人民邮电出版社,2001.
[40] [美]JeffreyRichter著.王建华译. Windows核心编程.北京:机械工业出版社,2008.
[41] Lacroute P, Levoy M. Fast volume rendering using a shear-warp factorization of the viewing transformation. In: Glassner A, ed. Proc.of the SIGGRAPH’94. New York: ACM Press, 2000, 451~458.
[42] Resk-Salama C, Engel K, Bauer M, Greiner G, Ertl T. Interactive volume rendering on standard PC graphics hardware using multi-textures and multi-stage-rasterization. In: Spencer SN, ed. Proc. of the Eurographics/SIGGRAPH Workshop on Graphics Hardware 2000, New York: ACM Press, 2000, 109~118.
[43] 3DMed(3-Dimensional Medical Image Processing and Analyzing System). http://www.3d -med.net.
[44]宋延山,尉雪波,吴风庆.应用统计学:以EXCEL为分析工具.成都:西南财经大学出版社,2006.
[45]李朋. EXCEL统计分析实例精讲.北京:科学出版社,2006.
[46]黄润龙.数据统计与分析技术.北京:高等教育出版社,2004.
[47]王乐三. SPSS在医学科研中的应用.北京:化学工业出版社,2007.
[48]池雷霆,裴福兴.交锁髓内钉的应用生物力学.中华创伤杂志2001,17(5):713~913.
[49]刘建军,刘建国,冯卫,等.带锁髓内钉治疗胫骨近端骨折生物力学分析及临床意义.中华现代医学与临床,2005,2(2):22~24.
[50]李景煜,王波,龚炜,等.交锁髓内钉治疗长管状骨骨折.中华医学实践杂志,2006,6(5):404~406.
[51]邓军.导航在长骨干骨折髓内钉固定中的应用,中华创伤骨科杂志,2005,7(7):625~626.
[52] Lang GJ, Cohen BE, Bosse MJ, et al. Prominal third fractures: should they be nailed. Clin Orthop, 1995, 3l5:64.
[53] Wiss DA, Stetson WB. Unstable fractures of the tibia treated with a reamed intramedullary interlocking nail. Clin Orthop, 1995, 315:56.
[54] Odwyer KJ, Chakravarty RD, Esler CAN. Intramedullary nailing technique and its effect on union rates of tibia shaft fractures. Injury, l994, 25 (7):461.
[55] Wu CC. Hu mera1 shaft nonunion treated by a seidel interlocking nail with a supple mentury. Clin Orthop, 1996, 326: 203~208.
[56] Gregory P, Sanders R. The treatment of closed, unstable tibial shaft fracture with undreamed interlocking nail. Clin Orthop, 1995, 315:48.