计算机辅助设计—快速成型技术在股骨近端骨折修复中的临床应用研究
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摘要
研究背景
在过去几十年里,医学影像学的发展非常迅速,如CT、MRI、PET、DSA、单光子发射断层扫描(PETCT)等,他们将人体的三维解剖信息压缩到二维的图像上,为疾病的诊断、病变点的定位、手术方案的确定提供了重要的依据,使得手术的安全性和手术的质量有了明显的提高。尽管影像学的出现对骨科的发展有积极的推动作用,但它所提供的信息并不能完全满足骨科手术的需要,近年来,随着计算机图形学、图像学的发展,以及计算机图形处理速度的迅速提高,人们研究了从二维图像到三维图像的重构技术,并进行计算机辅助设下的人体骨骼快速成型建模和快速制造出三维立体模型(CAD-RP),使得医生在复杂的骨科手术之前,可以根据患者的CT图像“量身定做”出人体标本。有了模型的指导,手术之前可以充分地进行体外模拟,设计出最佳的切入路线与步骤,使得手术的风险得到有效控制,手术质量有了明显提高。
研究目的评估计算机辅助设计-快速成型技术应用于股骨转子间骨折手术治疗的临床疗效。
方法选择2008年1月1日至2008年12月31日解放军广州军区广州总医院骨科收治的股骨转子间骨折患者30例,年龄18～55岁,平均年龄40岁,摔伤8例,车祸12例,坠落伤7例,训练伤3例,男20例,女10例,左侧转子间骨折19例,右侧转子间骨折11例,30例患者按入院顺序交替分为常规手术组(n=15),计算机辅助组(n=15)。所有患者术前均行胫骨结节牵引,计算机辅助组术前行胫骨结节牵引而后行螺旋CT扫描并将所得患者转子间骨折Dicom数据刻成光盘,于戴尔工作站运用Mimic10.0软件重建股骨转子间骨折模型,并仿真模拟股骨转子间骨折复位手术,计算机辅助软件逆向设计与股骨大转子相吻合的组件及置钉套管,计算机精确设计手术钉道,术前将设计好的STL格式文件存盘置于AFS激光快速成型机打印出的置钉模板,术前运用打印好的模型体外演练模拟手术操作制定手术计划并将模型实物带往手术室观摩,置钉模板高温消毒以便术中使用。术中患者仰卧位连续硬膜外麻醉下置于骨科牵引床,术前先行闭合复位C臂机电透见骨折端复位良好后开始手术,两组患者均采用动力髋钢板螺钉内固定,均记录手术时间(平均手术时间从切开皮肤至关闭伤口计算,闭合复位时间及电透次数不纳入统计),记录术中出血量,30例患者术后均拍摄髋关节正侧位平片,门诊随访1年并采用髋关节Harris评分标准对两组手术效果进行评估并比较临床价值。
结果应用计算机辅助设计-快速成型建立股骨转子间骨折的1：1实体模型及精确设计的置钉导向模板,将快速成型技术打印好的模型及置钉模板应用于骨科手术,精确地指导医生手术快速精确实施,大大提高了手术的安全性,计算机辅助组平均手术时间(45.07±8.09)min,出血量(115.00±10.49)ml；常规手术组手术时间(55.67±9.53)min,出血量(143.20±17.07)ml，。常规手术组术中电透(10±1.89)次,计算机辅助手术组术中电透(5±1.00)次,两组间差距具有显著性意义(P＜0.05)。相比常规组,运用计算机辅助设计-快速成型技术指导手术缩短了手术时间,减少了术中出血量,避免了术中C臂机反复透视,减少了医患的术中放射暴露,尤其对一些高龄患者更有意义。术后复查髋关节正侧位X射线见骨折端对位对线良好,金属内固定位置良好,所有患者术后均随访一年,应用Harris髋关节评分系统评估患者髋关节功能恢复情况,计算机辅助手术组harris评分(84.33±3.352)；常规手术组harris评分(82.47±3.833),结果显示两组间差别无显著性差异(P＞0.05),两组患者术后无一例无髋内翻畸形及患肢短缩畸形,均达到了术前的预期效果。
结论传统手术依赖于医生个体的外科临床经验与技能,存在精确性不足、创伤较大、术中医生和患者需要反复受到射线照射等缺点。用计算机辅助设计—快速成型技术代替医生进行手术方案的三维构思和设计比较客观、定量,且其信息可供整个手术组的每一位成员共享。并可对三维图像与同行进行交流,有了计算机辅助下的人体骨骼快速建模和快速制造设备的应用,使得医生在复杂的骨科手术之前,可以根据患者的CT图像“量身定做”出人体标本。有了置钉模板的指导,手术之前可以充分地进行体外模拟,设计出最佳的切入路线与步骤,使得手术的风险得到有效控制,利用计算机对数字化医学影像的高速处理及控制能力,通过虚拟手术环境为骨科医生从技术上提供支援,使手术成为更微创、更安全、更准确的一门新技术。计算机辅助设计-快速成型技术的发展,实现了从二维图像到三维实物的飞跃,为临床医生对疾病的诊断、病变点的定位、手术方案的确定提供了重要的依据使得手术的安全性和手术的质量有了明显的提高。计算机辅助骨科-快速成型技术应用于手术具有安全,准确等优点,术前采集图像可术中反复使用,并减少术中医患的放射性损伤。
BACKGROUND
In the past few decades, medical imaging is developing very quickly, such as computerized tomography,, magnetic resonance imaging, digital subtraction angiography, with the help of these devices three-dimensional anatomy of the human body of information were compressed into a two-dimensional image, provides an important basis for disease diagnosis, lesion-point positioning and surgical program. Improved the quality of operation and the safety of surgery. Although the imaging as positive role in the development of orthopedic promoting, but it provides information that does not fully meet the needs of development of orthopedic surgery. In recent years, with the development of computer graphics, imaging science, and computer graphics processing speed of the rapidly increasing, people study from two-dimensional image to three-dimensional image reconstruction technique. With the computer-assisted human rapid bone modeling and rapid manufacturing equipment, allowing doctors in the complex prior to orthopedic surgery may be based on patient's CT images "tailor-made" out of the human body specimens.With the guidance of model, surgery can be fully carried out prior to in vitro simulation, to design the best operative approach and steps to enable the surgical risks are effectively controlled.Development of computer-aided design (CAD)-rapid prototyping implements planar image to three-dimensional solid digitization, thus, provides guidance for disease diagnosis, focus location, and operation project confirmation, which significantly enhance the security and quality of operation.
Objective
To evaluate the therapeutic effect of CAD-Rapid Prototyping on treating femoral intertrochanteric fracture.
Methods
A total of 30 cases of intertrochanteric fracture, aged 18-55 years, were selected from Department of Orthopaedics, General Hospital of Guangzhou Command (2008.1.1-2008.12.31). Falls in 8 cases, car accidents 12 cases, fall injury in 7 cases, training injury in 3 cases,20 males and 10 females,19 cases of intertrochanteric fracture of the left side, right side of 11 cases of intertrochanteric fracture; 30 patients were randomly divided into two groups, conventional surgery group (n= 15), only routine preoperative tibial tubercle traction; Computer-aided group (n= 15), computer-aided preoperative tibial tubercle traction first and then spiral CT scan and the data derived from patients with intertrochanteric fractures carved CD-ROM, Dell workstation using mimics10.0 software to reconstruct the intertrochanteric fracture model. And the simulation of intertrochanteric fracture reduction surgery, computer-aided design software reverse is consistent with the greater trochanter of the components and set screw casing, computer designed precision screw patch surgery.Preoperative STL format designed to will be keep a USB flash disk placed AFS Laser Rapid Prototyping Machine print physical models, preoperative use of printed model simulation exercises, ensure operative surgical planning and taken to the operating room sterile disinfect in surgery. patients were under epidural anesthesia placed orthopedic traction bed during Surgery, C-arm mechanical and electrical penetration see a good reduction of the fracture before surgery, all patients in two groups were using dynamic hip screw fixation, all recorded operative time (mean operative time from skin incision to closure of the wound), all recorded blood loss,30 patients were followed up for 12 months and using Harris hip score standards, evaluated the results of operations.
Results
Computer-Aided Design-Rapid Prototyping of intertrochanteric fractures of the establishment of the 1:1 physical model and accurate design of the set screw-driven template, Rapid--prototyping technology print a good model in orthopedic surgery, accurately guiding surgical quickly and accurately implementation, greatly enhanced the safety of operation, compared with the conventional surgical group shortened operative time, reduced operative blood loss, avoid the repeated intraoperative C-arm machine perspective, particularly for some elderly patients with more significantlly. After the operation reviewing X-rays see the good fracture reduction, the metal fixation in good position, all patients were followed up after twelve months, application of Harris hip score standards in patients with good recovery and no hip varus deformity and limb shortening deformities, significantly improve the effectiveness of the surgery, all patients reached the pre-expected results.
Conclusion
Traditional surgery depends on doctors with clinical experience of individual surgical skills, that lack of accuracy, and larger trauma, during surgery both doctors and patients need repeated radiation exposure and other shortcomings and so on.Surgery using a computer program instead of doctors three-dimensional ideas are more objective, quantitative, and its information available for the entire surgical team members to share. If the introduction of three-dimensional images of specific images can communicate with their peers, with computer-assisted human bone modeling and rapid-prototyping manufacturing equipment, allowing doctors in the complex orthopedic surgery can be fully carried out prior to in vitro simulation, to design the best route and steps according to the guidance physical model from patient's CT images; then surgical risks can be effectively controlled Using computer digital medical imaging on high-speed processing and control capabilities, through virtual surgical environment for the orthopedic surgeon from the technical support, to make surgery a more minimally invasive, safer, more accurate a new technology. Computer-aided design-the development of rapid prototyping technology to make the transformation from two-dimensional images into three-dimensional model of leap, for clinicians to disease diagnosis, lesion location point of the surgery to determine the program provides an important basis for making the safety of operation and the quality of surgery has been markedly improved. Computer-Aided Design-Rapid Prototyping technology in surgery is safe, and accurate, preoperative image acquisition intraoperative repeated use, and reduce the radiation damage doctor-patient surgery.
在过去几十年里,医学影像学的发展非常迅速,如CT、MRI、PET、DSA、单光子发射断层扫描(PETCT)等,他们将人体的三维解剖信息压缩到二维的图像上,为疾病的诊断、病变点的定位、手术方案的确定提供了重要的依据,使得手术的安全性和手术的质量有了明显的提高。尽管影像学的出现对骨科的发展有积极的推动作用,但它所提供的信息并不能完全满足骨科手术的需要,近年来,随着计算机图形学、图像学的发展,以及计算机图形处理速度的迅速提高,人们研究了从二维图像到三维图像的重构技术,并进行计算机辅助设下的人体骨骼快速成型建模和快速制造出三维立体模型(CAD-RP),使得医生在复杂的骨科手术之前,可以根据患者的CT图像“量身定做”出人体标本。有了模型的指导,手术之前可以充分地进行体外模拟,设计出最佳的切入路线与步骤,使得手术的风险得到有效控制,手术质量有了明显提高。
研究目的评估计算机辅助设计-快速成型技术应用于股骨转子间骨折手术治疗的临床疗效。
方法选择2008年1月1日至2008年12月31日解放军广州军区广州总医院骨科收治的股骨转子间骨折患者30例,年龄18～55岁,平均年龄40岁,摔伤8例,车祸12例,坠落伤7例,训练伤3例,男20例,女10例,左侧转子间骨折19例,右侧转子间骨折11例,30例患者按入院顺序交替分为常规手术组(n=15),计算机辅助组(n=15)。所有患者术前均行胫骨结节牵引,计算机辅助组术前行胫骨结节牵引而后行螺旋CT扫描并将所得患者转子间骨折Dicom数据刻成光盘,于戴尔工作站运用Mimic10.0软件重建股骨转子间骨折模型,并仿真模拟股骨转子间骨折复位手术,计算机辅助软件逆向设计与股骨大转子相吻合的组件及置钉套管,计算机精确设计手术钉道,术前将设计好的STL格式文件存盘置于AFS激光快速成型机打印出的置钉模板,术前运用打印好的模型体外演练模拟手术操作制定手术计划并将模型实物带往手术室观摩,置钉模板高温消毒以便术中使用。术中患者仰卧位连续硬膜外麻醉下置于骨科牵引床,术前先行闭合复位C臂机电透见骨折端复位良好后开始手术,两组患者均采用动力髋钢板螺钉内固定,均记录手术时间(平均手术时间从切开皮肤至关闭伤口计算,闭合复位时间及电透次数不纳入统计),记录术中出血量,30例患者术后均拍摄髋关节正侧位平片,门诊随访1年并采用髋关节Harris评分标准对两组手术效果进行评估并比较临床价值。
结果应用计算机辅助设计-快速成型建立股骨转子间骨折的1：1实体模型及精确设计的置钉导向模板,将快速成型技术打印好的模型及置钉模板应用于骨科手术,精确地指导医生手术快速精确实施,大大提高了手术的安全性,计算机辅助组平均手术时间(45.07±8.09)min,出血量(115.00±10.49)ml；常规手术组手术时间(55.67±9.53)min,出血量(143.20±17.07)ml，。常规手术组术中电透(10±1.89)次,计算机辅助手术组术中电透(5±1.00)次,两组间差距具有显著性意义(P＜0.05)。相比常规组,运用计算机辅助设计-快速成型技术指导手术缩短了手术时间,减少了术中出血量,避免了术中C臂机反复透视,减少了医患的术中放射暴露,尤其对一些高龄患者更有意义。术后复查髋关节正侧位X射线见骨折端对位对线良好,金属内固定位置良好,所有患者术后均随访一年,应用Harris髋关节评分系统评估患者髋关节功能恢复情况,计算机辅助手术组harris评分(84.33±3.352)；常规手术组harris评分(82.47±3.833),结果显示两组间差别无显著性差异(P＞0.05),两组患者术后无一例无髋内翻畸形及患肢短缩畸形,均达到了术前的预期效果。
结论传统手术依赖于医生个体的外科临床经验与技能,存在精确性不足、创伤较大、术中医生和患者需要反复受到射线照射等缺点。用计算机辅助设计—快速成型技术代替医生进行手术方案的三维构思和设计比较客观、定量,且其信息可供整个手术组的每一位成员共享。并可对三维图像与同行进行交流,有了计算机辅助下的人体骨骼快速建模和快速制造设备的应用,使得医生在复杂的骨科手术之前,可以根据患者的CT图像“量身定做”出人体标本。有了置钉模板的指导,手术之前可以充分地进行体外模拟,设计出最佳的切入路线与步骤,使得手术的风险得到有效控制,利用计算机对数字化医学影像的高速处理及控制能力,通过虚拟手术环境为骨科医生从技术上提供支援,使手术成为更微创、更安全、更准确的一门新技术。计算机辅助设计-快速成型技术的发展,实现了从二维图像到三维实物的飞跃,为临床医生对疾病的诊断、病变点的定位、手术方案的确定提供了重要的依据使得手术的安全性和手术的质量有了明显的提高。计算机辅助骨科-快速成型技术应用于手术具有安全,准确等优点,术前采集图像可术中反复使用,并减少术中医患的放射性损伤。
BACKGROUND
In the past few decades, medical imaging is developing very quickly, such as computerized tomography,, magnetic resonance imaging, digital subtraction angiography, with the help of these devices three-dimensional anatomy of the human body of information were compressed into a two-dimensional image, provides an important basis for disease diagnosis, lesion-point positioning and surgical program. Improved the quality of operation and the safety of surgery. Although the imaging as positive role in the development of orthopedic promoting, but it provides information that does not fully meet the needs of development of orthopedic surgery. In recent years, with the development of computer graphics, imaging science, and computer graphics processing speed of the rapidly increasing, people study from two-dimensional image to three-dimensional image reconstruction technique. With the computer-assisted human rapid bone modeling and rapid manufacturing equipment, allowing doctors in the complex prior to orthopedic surgery may be based on patient's CT images "tailor-made" out of the human body specimens.With the guidance of model, surgery can be fully carried out prior to in vitro simulation, to design the best operative approach and steps to enable the surgical risks are effectively controlled.Development of computer-aided design (CAD)-rapid prototyping implements planar image to three-dimensional solid digitization, thus, provides guidance for disease diagnosis, focus location, and operation project confirmation, which significantly enhance the security and quality of operation.
Objective
To evaluate the therapeutic effect of CAD-Rapid Prototyping on treating femoral intertrochanteric fracture.
Methods
A total of 30 cases of intertrochanteric fracture, aged 18-55 years, were selected from Department of Orthopaedics, General Hospital of Guangzhou Command (2008.1.1-2008.12.31). Falls in 8 cases, car accidents 12 cases, fall injury in 7 cases, training injury in 3 cases,20 males and 10 females,19 cases of intertrochanteric fracture of the left side, right side of 11 cases of intertrochanteric fracture; 30 patients were randomly divided into two groups, conventional surgery group (n= 15), only routine preoperative tibial tubercle traction; Computer-aided group (n= 15), computer-aided preoperative tibial tubercle traction first and then spiral CT scan and the data derived from patients with intertrochanteric fractures carved CD-ROM, Dell workstation using mimics10.0 software to reconstruct the intertrochanteric fracture model. And the simulation of intertrochanteric fracture reduction surgery, computer-aided design software reverse is consistent with the greater trochanter of the components and set screw casing, computer designed precision screw patch surgery.Preoperative STL format designed to will be keep a USB flash disk placed AFS Laser Rapid Prototyping Machine print physical models, preoperative use of printed model simulation exercises, ensure operative surgical planning and taken to the operating room sterile disinfect in surgery. patients were under epidural anesthesia placed orthopedic traction bed during Surgery, C-arm mechanical and electrical penetration see a good reduction of the fracture before surgery, all patients in two groups were using dynamic hip screw fixation, all recorded operative time (mean operative time from skin incision to closure of the wound), all recorded blood loss,30 patients were followed up for 12 months and using Harris hip score standards, evaluated the results of operations.
Results
Computer-Aided Design-Rapid Prototyping of intertrochanteric fractures of the establishment of the 1:1 physical model and accurate design of the set screw-driven template, Rapid--prototyping technology print a good model in orthopedic surgery, accurately guiding surgical quickly and accurately implementation, greatly enhanced the safety of operation, compared with the conventional surgical group shortened operative time, reduced operative blood loss, avoid the repeated intraoperative C-arm machine perspective, particularly for some elderly patients with more significantlly. After the operation reviewing X-rays see the good fracture reduction, the metal fixation in good position, all patients were followed up after twelve months, application of Harris hip score standards in patients with good recovery and no hip varus deformity and limb shortening deformities, significantly improve the effectiveness of the surgery, all patients reached the pre-expected results.
Conclusion
Traditional surgery depends on doctors with clinical experience of individual surgical skills, that lack of accuracy, and larger trauma, during surgery both doctors and patients need repeated radiation exposure and other shortcomings and so on.Surgery using a computer program instead of doctors three-dimensional ideas are more objective, quantitative, and its information available for the entire surgical team members to share. If the introduction of three-dimensional images of specific images can communicate with their peers, with computer-assisted human bone modeling and rapid-prototyping manufacturing equipment, allowing doctors in the complex orthopedic surgery can be fully carried out prior to in vitro simulation, to design the best route and steps according to the guidance physical model from patient's CT images; then surgical risks can be effectively controlled Using computer digital medical imaging on high-speed processing and control capabilities, through virtual surgical environment for the orthopedic surgeon from the technical support, to make surgery a more minimally invasive, safer, more accurate a new technology. Computer-aided design-the development of rapid prototyping technology to make the transformation from two-dimensional images into three-dimensional model of leap, for clinicians to disease diagnosis, lesion location point of the surgery to determine the program provides an important basis for making the safety of operation and the quality of surgery has been markedly improved. Computer-Aided Design-Rapid Prototyping technology in surgery is safe, and accurate, preoperative image acquisition intraoperative repeated use, and reduce the radiation damage doctor-patient surgery.
引文
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[3]Zhang BZ,Qiu GX. Zhonghua Chuangshang Zazhi.2005;21(8):582-584.张保中,邱贵兴.高龄股骨转子间骨折的手术治疗[J].中华创伤杂志,2005,21(8)：582-584.
[4]Wang G,Chen KN,Chen B,et al. Zhonghua Chuangshang Guke Zahi.2008；8(10)：701-703.王钢,陈凯宁,陈滨,等.动力髋螺钉在股骨转子间骨折治疗中的应用价值[J].中华创伤骨科杂志,2008,8(10)：701-703.
[5]Gou SH,Wang Q,Liu Y,et al. Zhonghua Chuangshang Guke Zazhi.2007；9(4)：319-322.苟三怀,王琪,刘岩,等.股骨转子间骨折的治疗方法选择(附1037例分析)[J].中华创伤骨科杂志,2007,9(4)：319-322.
[6]Kitamura S,Hasegawa Y,Suzuki S,et al. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res.1998;(348):29-36.
[7]He SH,Peng JY,Zhao X. The comparison of three operation methods for treatment of femoral intertrochanteric fracture.Zhongguo Gu Shang. 2009;22(1):6-9.
[8]Jensen JS, Sonne-Holm S, T ndevold E. Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation[J]. Acta OrthopScand,1980,51 (6):949-962.
[9]季卫锋,童培建,章建华,等.人工股骨头置换术治疗高龄不稳定股骨转子间骨折[J].中华创伤杂志,2005,21(3)：226-227.
[10]卢世璧.转子间骨折分型及其内固定的选择[J].中华骨科杂志,1989,27(6)：331.
[11][11]Abalo A,Dossim A,Ouro Bangna AF,et al. Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures. J Orthop Surg (Hong Kong).2008;16(1):35-38.
[12]Cong F,Zhu Y,Wang L,et al. Zhonghua Chuangshang Guke Zazhi.2002；4(3)：188-191.从风,朱越,王磊,等.459例动力髋螺钉治疗转子周围骨折结果分析[J].中华创伤骨科杂志,2002,4(3)：188-191.
[13]Floey KT. Simon DA.Rampersand YR.Virtual fluroscop computer-assisted fluroscopy navigation. Spine 2001,26:347-351
[14]Simon DA.Lavallee.S.Medical imaging and registration in computer assisted surgery.Clin orthop,1998(354):17-27
[15]B.S. Shin.A new rapid manufacturing process for multi-face high-speed machining. The intermational journal of advanced manufacturing technology,2003,22:68-74
[16]Potamianos P, AmisAA, ForesterAJ, et al. Rap id p rototyp ing for orthopaedic surgery. Proc InstnMech Engrs,1998,212 (5):383-393.
[1]Sunil Gopakumar.RP in medicine:a case study in cranial reconstructive surgery[J]. Rapid Prototyping Journal,2004,10 (3):2072211.
[2]Xiao Jin, Yin Qing-shui, Zhang Mei-chao, Zhao Wei-dong, Ma Xiang-yang, Li Jian-yi. Rapid prototyping of scoliosis model based on three-dimensional skeletal data using Minmics software. Journal of Clinical Rehabilitative Tissue Engineering Research,2008,12(35)：6835-8肖进,尹庆水,张美超,赵卫东,马向阳,李鉴轶.Mimics软件重建脊柱三维骨骼数据基础上快速成型的脊柱畸形模型,中国组织工程研究与临床康复,2008,12(35)：6835-8
[3]肖德明.计算机辅助骨科导航技术面临的主要问题[J].中华创伤骨科杂志,2005,(07).
[4]张坚.选择性激光烧结在快速制模中的应用[J].模具工业,2004,(6)：45-48
[5]B.S. Shin.A new rapid manufacturing process for multi-face high-speed machining. Theintermational journal of advanced manufacturing technology,2003,22:68-74
[6]Wai Yee Yeong, Chee Kai Chua, Kahr Fai Leong, et al. Rapid prototyping in tissue engineering:challenges and potential [J]. Trends in Biotechnology,2004, 22 (12):643-650.
[7]Cummings SR,Rubin SM,Black D. The future of hip fractures in the United States. Numbers,costs,and potential effects of postmenopausal estrogen. Clin Orthop Relat Res.1990;(252):163-166.
[8]Kitamura S,Hasegawa Y,Suzuki S,et al. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res.1998;(348):29-36.
[9]季卫锋,童培建,章建华,等.人工股骨头置换术治疗高龄不稳定股骨转子间骨折[J].中华创伤杂志,2005,21(3)：226-227.
[10]卢世璧.转子间骨折分型及其内固定的选择[J].中华骨科杂志,1989,27(6)：331.
[11]Abalo A,Dossim A,Ouro Bangna AF,et al. Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures. J Orthop Surg (Hong Kong).2008;16(1):35-38.
[12]裴国献,相大勇.计算机辅助骨科技术的现状与未来,中华创伤骨科,2003,5(2)：85-88
[13]喻忠,王黎明.骨科手术导航系统研究现状.国际骨科学杂志,2005,26(3)：140-143.
[14]段彦静,孙文磊.逆向工程和快速成型技术及医学应用[J].医疗卫生装备,2006,27(10)：31-34
[15]王军强,孙磊,王满宜.计算机辅助骨科的应用和进展.中华创伤骨科杂志2004；6(1)：110-114
[16]陆蓉,闫玉华.快速成型技术原理及其医学应用[J].生物骨科材料与临床研究.2004,2(1)：29-32
[17]Brown GA, Firoozbakhsh K, De Coster TA, et al. Rapid prototyping:the future of trauma surgery [J]. J Bone Joint Surg(Am),2003,85(suppl 4):49-55.
[18]毛克亚,陈继营,郝立波,等.数字化人体骨骼的初步临床应用[J].中国矫形外科杂志,2005,13(1)：67-68.
[19]杨永宏,郑杰.计算机辅助导航系统及其骨科应用.中华创伤骨科杂志,2005,7(7)：614-616.
[1]Siko rsk i JM, Chauhan S. Computer assisted orthopaedic surgery:do we need CAOS [J]. J Bone Joint Surg (B r),2003,85 (3):3192323.
[2]No lte L P, Slomczykow sk iMA,Berlemann U, et al. Anew approach to computer aided spine surgery:Fluoro scopy based surgical navigation [J]. EurSpine J,2000,9 (Suppl 1):78288.(1):1052113.
[3]Philippe MERLOZ,吴昊.计算机辅助外科手术的基本概念.中国修复重建外科杂志,2006,20(3)：276-278.
[4]杨永宏,郑杰.计算机辅助导航系统及其骨科应用.中华创伤骨科杂志,2005,7(7)：614-616
[5]吕宝仪,邓宁,苏伟权,等.选择外科导航系统的参考要素.中华创伤骨科杂志,2005,7(7)：651-656.
[6]Jenny JY, Boeri C. Computer-assisted implantation of a total knee arthroplasty: a case-controlled study in comparison with classical instrumentation.Rev Chir Orthop Reparatrice Appar Mot,2001,87(7):645-652.
[7]Bathis H, Perlick L, Tingart M, et al. Alignment in total knee arthroplasty:A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg(Br),2004,86(5):682-687.
[8]Weidner A,Wah lerM, Ch iu ST, et al. Modificat ion of C1～C2 transart-icular screw fixat ion by image2guided surgery[J]. Sp ine,2000; 25 (20): 266822674.
[9]王雪松,冯华,洪雷,等.导航下前交叉韧带重建手术与关节镜下重建手术 骨隧道位置的对比研究.中国运动医学杂志,2006,25(5)：564-567.
[10]Mayman D, Vasarhelyi EM, Long W, et al. Computer-assisted guidewire insertion for hip fracture fixation. J Orthop Trauma,2005,19(9):610-615.
[11]Stockle U, Konig B, Schaffler A, et al.Clinical experience with the SiremobilIso-C(3D) imaging system in pelvic surgery.Unfallchirurg,2006, 109(1):30-40.
[12]Amiot LP, Poulin F.Computed tomography-based navigation for hip,knee, and spine surgery.Clin Orthop Relat Res,2004, (421):77-86.
[13]裴国献,相大勇.计算机辅助骨科技术的现状和未来.中华创伤骨科杂志,2003,5(2)：85-88.
[14]H sieh PH, Chang YH, Sh ih CH. Image guided periacetabular o steo tomy: computer-assisted navigation compared w ith the conventional technique: Arandom ized study of 36 patients fo llow ed for 2 years [J].A cta o rthopaedica, 2006,77 (4):5912597.
[15]杨述华,傅德浩.计算机辅助导航系统及其在骨科的应用[J].中国医疗器械,2007,13(2)：1-4
[16]喻忠,王黎明.骨科手术导航系统研究现状[J].国外医学：骨科学分册,2005,26(3)：140-144
[2]徐龙江,何志敏.牵引治疗股骨粗隆间骨折[J].骨与关节损伤杂志,2003,16(2)：130
[3]Zhang BZ,Qiu GX. Zhonghua Chuangshang Zazhi.2005;21(8):582-584.张保中,邱贵兴.高龄股骨转子间骨折的手术治疗[J].中华创伤杂志,2005,21(8)：582-584.
[4]Wang G,Chen KN,Chen B,et al. Zhonghua Chuangshang Guke Zahi.2008；8(10)：701-703.王钢,陈凯宁,陈滨,等.动力髋螺钉在股骨转子间骨折治疗中的应用价值[J].中华创伤骨科杂志,2008,8(10)：701-703.
[5]Gou SH,Wang Q,Liu Y,et al. Zhonghua Chuangshang Guke Zazhi.2007；9(4)：319-322.苟三怀,王琪,刘岩,等.股骨转子间骨折的治疗方法选择(附1037例分析)[J].中华创伤骨科杂志,2007,9(4)：319-322.
[6]Kitamura S,Hasegawa Y,Suzuki S,et al. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res.1998;(348):29-36.
[7]He SH,Peng JY,Zhao X. The comparison of three operation methods for treatment of femoral intertrochanteric fracture.Zhongguo Gu Shang. 2009;22(1):6-9.
[8]Jensen JS, Sonne-Holm S, T ndevold E. Unstable trochanteric fractures. A comparative analysis of four methods of internal fixation[J]. Acta OrthopScand,1980,51 (6):949-962.
[9]季卫锋,童培建,章建华,等.人工股骨头置换术治疗高龄不稳定股骨转子间骨折[J].中华创伤杂志,2005,21(3)：226-227.
[10]卢世璧.转子间骨折分型及其内固定的选择[J].中华骨科杂志,1989,27(6)：331.
[11][11]Abalo A,Dossim A,Ouro Bangna AF,et al. Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures. J Orthop Surg (Hong Kong).2008;16(1):35-38.
[12]Cong F,Zhu Y,Wang L,et al. Zhonghua Chuangshang Guke Zazhi.2002；4(3)：188-191.从风,朱越,王磊,等.459例动力髋螺钉治疗转子周围骨折结果分析[J].中华创伤骨科杂志,2002,4(3)：188-191.
[13]Floey KT. Simon DA.Rampersand YR.Virtual fluroscop computer-assisted fluroscopy navigation. Spine 2001,26:347-351
[14]Simon DA.Lavallee.S.Medical imaging and registration in computer assisted surgery.Clin orthop,1998(354):17-27
[15]B.S. Shin.A new rapid manufacturing process for multi-face high-speed machining. The intermational journal of advanced manufacturing technology,2003,22:68-74
[16]Potamianos P, AmisAA, ForesterAJ, et al. Rap id p rototyp ing for orthopaedic surgery. Proc InstnMech Engrs,1998,212 (5):383-393.
[1]Sunil Gopakumar.RP in medicine:a case study in cranial reconstructive surgery[J]. Rapid Prototyping Journal,2004,10 (3):2072211.
[2]Xiao Jin, Yin Qing-shui, Zhang Mei-chao, Zhao Wei-dong, Ma Xiang-yang, Li Jian-yi. Rapid prototyping of scoliosis model based on three-dimensional skeletal data using Minmics software. Journal of Clinical Rehabilitative Tissue Engineering Research,2008,12(35)：6835-8肖进,尹庆水,张美超,赵卫东,马向阳,李鉴轶.Mimics软件重建脊柱三维骨骼数据基础上快速成型的脊柱畸形模型,中国组织工程研究与临床康复,2008,12(35)：6835-8
[3]肖德明.计算机辅助骨科导航技术面临的主要问题[J].中华创伤骨科杂志,2005,(07).
[4]张坚.选择性激光烧结在快速制模中的应用[J].模具工业,2004,(6)：45-48
[5]B.S. Shin.A new rapid manufacturing process for multi-face high-speed machining. Theintermational journal of advanced manufacturing technology,2003,22:68-74
[6]Wai Yee Yeong, Chee Kai Chua, Kahr Fai Leong, et al. Rapid prototyping in tissue engineering:challenges and potential [J]. Trends in Biotechnology,2004, 22 (12):643-650.
[7]Cummings SR,Rubin SM,Black D. The future of hip fractures in the United States. Numbers,costs,and potential effects of postmenopausal estrogen. Clin Orthop Relat Res.1990;(252):163-166.
[8]Kitamura S,Hasegawa Y,Suzuki S,et al. Functional outcome after hip fracture in Japan. Clin Orthop Relat Res.1998;(348):29-36.
[9]季卫锋,童培建,章建华,等.人工股骨头置换术治疗高龄不稳定股骨转子间骨折[J].中华创伤杂志,2005,21(3)：226-227.
[10]卢世璧.转子间骨折分型及其内固定的选择[J].中华骨科杂志,1989,27(6)：331.
[11]Abalo A,Dossim A,Ouro Bangna AF,et al. Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures. J Orthop Surg (Hong Kong).2008;16(1):35-38.
[12]裴国献,相大勇.计算机辅助骨科技术的现状与未来,中华创伤骨科,2003,5(2)：85-88
[13]喻忠,王黎明.骨科手术导航系统研究现状.国际骨科学杂志,2005,26(3)：140-143.
[14]段彦静,孙文磊.逆向工程和快速成型技术及医学应用[J].医疗卫生装备,2006,27(10)：31-34
[15]王军强,孙磊,王满宜.计算机辅助骨科的应用和进展.中华创伤骨科杂志2004；6(1)：110-114
[16]陆蓉,闫玉华.快速成型技术原理及其医学应用[J].生物骨科材料与临床研究.2004,2(1)：29-32
[17]Brown GA, Firoozbakhsh K, De Coster TA, et al. Rapid prototyping:the future of trauma surgery [J]. J Bone Joint Surg(Am),2003,85(suppl 4):49-55.
[18]毛克亚,陈继营,郝立波,等.数字化人体骨骼的初步临床应用[J].中国矫形外科杂志,2005,13(1)：67-68.
[19]杨永宏,郑杰.计算机辅助导航系统及其骨科应用.中华创伤骨科杂志,2005,7(7)：614-616.
[1]Siko rsk i JM, Chauhan S. Computer assisted orthopaedic surgery:do we need CAOS [J]. J Bone Joint Surg (B r),2003,85 (3):3192323.
[2]No lte L P, Slomczykow sk iMA,Berlemann U, et al. Anew approach to computer aided spine surgery:Fluoro scopy based surgical navigation [J]. EurSpine J,2000,9 (Suppl 1):78288.(1):1052113.
[3]Philippe MERLOZ,吴昊.计算机辅助外科手术的基本概念.中国修复重建外科杂志,2006,20(3)：276-278.
[4]杨永宏,郑杰.计算机辅助导航系统及其骨科应用.中华创伤骨科杂志,2005,7(7)：614-616
[5]吕宝仪,邓宁,苏伟权,等.选择外科导航系统的参考要素.中华创伤骨科杂志,2005,7(7)：651-656.
[6]Jenny JY, Boeri C. Computer-assisted implantation of a total knee arthroplasty: a case-controlled study in comparison with classical instrumentation.Rev Chir Orthop Reparatrice Appar Mot,2001,87(7):645-652.
[7]Bathis H, Perlick L, Tingart M, et al. Alignment in total knee arthroplasty:A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg(Br),2004,86(5):682-687.
[8]Weidner A,Wah lerM, Ch iu ST, et al. Modificat ion of C1～C2 transart-icular screw fixat ion by image2guided surgery[J]. Sp ine,2000; 25 (20): 266822674.
[9]王雪松,冯华,洪雷,等.导航下前交叉韧带重建手术与关节镜下重建手术 骨隧道位置的对比研究.中国运动医学杂志,2006,25(5)：564-567.
[10]Mayman D, Vasarhelyi EM, Long W, et al. Computer-assisted guidewire insertion for hip fracture fixation. J Orthop Trauma,2005,19(9):610-615.
[11]Stockle U, Konig B, Schaffler A, et al.Clinical experience with the SiremobilIso-C(3D) imaging system in pelvic surgery.Unfallchirurg,2006, 109(1):30-40.
[12]Amiot LP, Poulin F.Computed tomography-based navigation for hip,knee, and spine surgery.Clin Orthop Relat Res,2004, (421):77-86.
[13]裴国献,相大勇.计算机辅助骨科技术的现状和未来.中华创伤骨科杂志,2003,5(2)：85-88.
[14]H sieh PH, Chang YH, Sh ih CH. Image guided periacetabular o steo tomy: computer-assisted navigation compared w ith the conventional technique: Arandom ized study of 36 patients fo llow ed for 2 years [J].A cta o rthopaedica, 2006,77 (4):5912597.
[15]杨述华,傅德浩.计算机辅助导航系统及其在骨科的应用[J].中国医疗器械,2007,13(2)：1-4
[16]喻忠,王黎明.骨科手术导航系统研究现状[J].国外医学：骨科学分册,2005,26(3)：140-144