借助三维重建建立特发性脊柱侧凸新分型
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摘要
第一部分借助逆向工程软件Mimics建立特发性脊柱侧凸三维模型
目的
基于特发性脊柱侧凸(Idiopathic Scoliosis, IS)患者Dicom格式的CT数据,借助逆向工程软件Mimics实现仿真模型的三维重建。
方法
对特发性脊柱侧凸患者进行全脊柱的CT扫描,然后将所得数据直接以Dicom格式文件导入Mimics10.01,经阈值选定、分割结构、区域种植等处理后进行三维重建。
结果
实现了基于CT二维资料的三维重建,获得以三维形式表现的特发性脊柱侧凸仿真模型;同时可以利用Mimics自身所带工具对IS仿真模型进行相关二维和三维数据的测量。
结论
用螺旋CT扫描获得Dicom格式的二维影像资料,借助逆向工程软件Mimics实现三维重建,从而可获得IS患者精确逼真、形象立体、三维表现的仿真模型。
第二部分特发性脊柱侧凸新分型的建立
目的
建立一种特发性脊柱侧凸新分型,使之相对以往King分型、Lenke分型更为全面、更加简单易记、更加形象具体、可三维评估、手术指导性更强、可信度和可重复性更高,以方便临床骨科医师记忆使用。
方法
1、回顾分析2004—2009年收集整理共80例特发性脊柱侧凸患者临床资料,测量患者站立位全脊柱正侧位X线片、仰卧位左右Bending像并根据脊柱侧弯研究协会(Scoliosis Research Society,SRS)关于脊柱侧凸和侧凸顶点的定义初步提出特发性脊柱侧凸新分型。
2、对特发性脊柱侧凸患者进行全脊柱CT扫描,然后进行三维重建,获得
最终以三维形式表现的特发性脊柱侧凸新分型的仿真模型。
3、将自主建立的新分型分别与特发性脊柱侧凸King分型、Lenke分型在以下六个方面做分析对比,即分型全面性、简单易记性、形象直观性、三维评估性、手术指导性、可靠性及可重复性。
结果
新分型共可分为2大型14个亚型,其中I型占71.5% ,II型占28.5%,几乎囊括所有特发性脊柱侧凸临床常见类型;新分型的各亚型间具有很好的逻辑性和规律性;三维仿真模型具有形象直观性;新分型从冠状面、矢状面乃至轴状面都进行了评估和量化分析;新分型规定了每亚型的手术入路、融合范围以及具体的融合节段,并且对选择性融合也做出了具体说明;新分型、King分型及Lenke分型在不同观察者间可信度平均为:84.4%(Kappa值=0.817)、81.6%(Kappa值=0.787)、59.4%(Kappa值= 0.548);同一观察者内可重复性平均为90.9%(Kappa值=0.897)、88.4%(Kappa值=0.870)、80.3%(Kappa值= 0.771)。
结论
这种三维直观的特发性脊柱侧凸新分型相对于以往的King分型和Lenke分型而言,拥有更好的全面性、易记性、直观性、三维评估性、手术指导性、可信度及可重复性,是一种可方便临床骨科医师记忆使用的新分型。
ⅠA three-dimensional model construction of IS with Mimics :a reverse engineering software
Objective
To construct a three-Dimensional model of idiopathic scoliosis (IS) based on the CT data with Mimics (a reverse engineering software).
Methods
The CT digital data of an IS patient was obtained,and imported into the computer,using the software Mimics10.01 to rebuild a 3-D model by the following steps: orientation,thresholding,division,region growing,calculation 3D image, emeshing.
Results
A 3-D simulation model was established with the CT data. Some relevant 2-D and 3-D informations of IS were measured with Mimics10.01.
Conclusions
The 3-D simulation model rebuilt according to the CT data is pricise and vivid with the help of the reverse engineering software Mimics.
ⅡEstablishment of a new classification for idiopathic scoliosis
Objective
To establish a new idiopathic scoliosis classification superior to King and Lenke classification.
Methods
1. Eighty cases of idiopathic scoliosis with comprehensive data were reviewed.The images of standing A-P, lateral and supine side-bending radiograph and clinical data were analyzed by the SRS (Scoliosis Research Society) definition of scoliosis and its apex, in order to establish a new classification for idiopathic scoliosis.
2. All the 3-D simulation models were rebuilt with the CT data of the IS patients.
3. The new classification was compared with King and Lenke classification for the following aspects: comprehensiveness, simplicity, vividness, 3-D evaluation, clinical guidance, reliability and reproducibility. 4.
Results
The new classification for idiopathic scoliosis is composed of two major types and fourteen subtypes.Of the eighty cases ,Type I accounted for 71.5%, Type II for 28.5%. The new classification almost includes all the IS types,and is more regular , vivid and 3-D evaluative.The new classification also gives definite suggestion about surgical fusion level.The inter-observer reliability of the three classification(the new, the King and the Lenke) was 84.4%(Kappa coefficient =0.817)、81.6%(Kappa coefficient =0.787)、59.4%(Kappa coefficient = 0.548) respectively;while the intra-observer reproducibility was 90.9%(Kappa coefficient =0.897)、88.4%(Kappa coefficient =0.870)、80.3%(Kappa coefficient = 0.771)
Conclusions
Compared with King and Lenke classification, the new classification is more comprehensive, simple, vivid, 3-D evaluative, clinic directive, reliable and reproducible.
目的
基于特发性脊柱侧凸(Idiopathic Scoliosis, IS)患者Dicom格式的CT数据,借助逆向工程软件Mimics实现仿真模型的三维重建。
方法
对特发性脊柱侧凸患者进行全脊柱的CT扫描,然后将所得数据直接以Dicom格式文件导入Mimics10.01,经阈值选定、分割结构、区域种植等处理后进行三维重建。
结果
实现了基于CT二维资料的三维重建,获得以三维形式表现的特发性脊柱侧凸仿真模型;同时可以利用Mimics自身所带工具对IS仿真模型进行相关二维和三维数据的测量。
结论
用螺旋CT扫描获得Dicom格式的二维影像资料,借助逆向工程软件Mimics实现三维重建,从而可获得IS患者精确逼真、形象立体、三维表现的仿真模型。
第二部分特发性脊柱侧凸新分型的建立
目的
建立一种特发性脊柱侧凸新分型,使之相对以往King分型、Lenke分型更为全面、更加简单易记、更加形象具体、可三维评估、手术指导性更强、可信度和可重复性更高,以方便临床骨科医师记忆使用。
方法
1、回顾分析2004—2009年收集整理共80例特发性脊柱侧凸患者临床资料,测量患者站立位全脊柱正侧位X线片、仰卧位左右Bending像并根据脊柱侧弯研究协会(Scoliosis Research Society,SRS)关于脊柱侧凸和侧凸顶点的定义初步提出特发性脊柱侧凸新分型。
2、对特发性脊柱侧凸患者进行全脊柱CT扫描,然后进行三维重建,获得
最终以三维形式表现的特发性脊柱侧凸新分型的仿真模型。
3、将自主建立的新分型分别与特发性脊柱侧凸King分型、Lenke分型在以下六个方面做分析对比,即分型全面性、简单易记性、形象直观性、三维评估性、手术指导性、可靠性及可重复性。
结果
新分型共可分为2大型14个亚型,其中I型占71.5% ,II型占28.5%,几乎囊括所有特发性脊柱侧凸临床常见类型;新分型的各亚型间具有很好的逻辑性和规律性;三维仿真模型具有形象直观性;新分型从冠状面、矢状面乃至轴状面都进行了评估和量化分析;新分型规定了每亚型的手术入路、融合范围以及具体的融合节段,并且对选择性融合也做出了具体说明;新分型、King分型及Lenke分型在不同观察者间可信度平均为:84.4%(Kappa值=0.817)、81.6%(Kappa值=0.787)、59.4%(Kappa值= 0.548);同一观察者内可重复性平均为90.9%(Kappa值=0.897)、88.4%(Kappa值=0.870)、80.3%(Kappa值= 0.771)。
结论
这种三维直观的特发性脊柱侧凸新分型相对于以往的King分型和Lenke分型而言,拥有更好的全面性、易记性、直观性、三维评估性、手术指导性、可信度及可重复性,是一种可方便临床骨科医师记忆使用的新分型。
ⅠA three-dimensional model construction of IS with Mimics :a reverse engineering software
Objective
To construct a three-Dimensional model of idiopathic scoliosis (IS) based on the CT data with Mimics (a reverse engineering software).
Methods
The CT digital data of an IS patient was obtained,and imported into the computer,using the software Mimics10.01 to rebuild a 3-D model by the following steps: orientation,thresholding,division,region growing,calculation 3D image, emeshing.
Results
A 3-D simulation model was established with the CT data. Some relevant 2-D and 3-D informations of IS were measured with Mimics10.01.
Conclusions
The 3-D simulation model rebuilt according to the CT data is pricise and vivid with the help of the reverse engineering software Mimics.
ⅡEstablishment of a new classification for idiopathic scoliosis
Objective
To establish a new idiopathic scoliosis classification superior to King and Lenke classification.
Methods
1. Eighty cases of idiopathic scoliosis with comprehensive data were reviewed.The images of standing A-P, lateral and supine side-bending radiograph and clinical data were analyzed by the SRS (Scoliosis Research Society) definition of scoliosis and its apex, in order to establish a new classification for idiopathic scoliosis.
2. All the 3-D simulation models were rebuilt with the CT data of the IS patients.
3. The new classification was compared with King and Lenke classification for the following aspects: comprehensiveness, simplicity, vividness, 3-D evaluation, clinical guidance, reliability and reproducibility. 4.
Results
The new classification for idiopathic scoliosis is composed of two major types and fourteen subtypes.Of the eighty cases ,Type I accounted for 71.5%, Type II for 28.5%. The new classification almost includes all the IS types,and is more regular , vivid and 3-D evaluative.The new classification also gives definite suggestion about surgical fusion level.The inter-observer reliability of the three classification(the new, the King and the Lenke) was 84.4%(Kappa coefficient =0.817)、81.6%(Kappa coefficient =0.787)、59.4%(Kappa coefficient = 0.548) respectively;while the intra-observer reproducibility was 90.9%(Kappa coefficient =0.897)、88.4%(Kappa coefficient =0.870)、80.3%(Kappa coefficient = 0.771)
Conclusions
Compared with King and Lenke classification, the new classification is more comprehensive, simple, vivid, 3-D evaluative, clinic directive, reliable and reproducible.
引文
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[1] King HA,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracic idiopathicscoliosis[J].J Bone Joint Surg(Am),1983,65(9):1302-1313.
[2] Lenke LG, Bridwell KH, Blanke K, et al. Radiographic results of arthrodesis with Cotrel-Dubousset instrumentation for the treatment of adolescent idiopathic scoliosis. A five to ten- year follow-up study. J Bone Joint Surg Am 1998;80:807-814
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[6] King HA,Moe JH,Bradford DS,et a1.The selection of fusion levels in thoracic idiopathic scoliosis.J Bone Joint Surg(Am),1983,65:1302-1313.
[7] Bridwen KH,McAllister JW,Betz R,et al.Coronal decompensation
[8] produced by Cotrel Dubousset“derotation”maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
[9] Cummings RJ,Loveless EA,Campbell J,et a1.Interobserver refiabflity and intraobserver reproducibility of the system of King et a1. for the classification of adolescent idiopathic scoliosis.J Bone Joint Surg(Am),1998,80:1107—1111.
[10] Lenke LG,Betz RR,Bridwell KH,et a1.Intraobserver and interobserver reliability of the classification of thoracic adolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80:1097—1106.
[11] Lenke LG,Betz RR,Harms J,et al.Adolescent idiopathic scollosis:a new classification to determine extent of spinal arthrodesis[J].J Bone Joint Burg(Am),2001,83(8):1169-1181.
[12] Puno RM,An KC,Puno RL,et al.Treatment recommendations for idiopathic scoliosls:an assessment of the Lenke classification[J].Spine,2003,28(18): 2102-2114.
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[15] Ogon M,Giesinger K,Behensky H,et a1.Interobserver and intraobserver reliability of Lenke’s new scoliosis classification system. Spine,2OO2,27:858-862
[16] Richards BS,Sucato DJ,Konigsbcrg DE,et al.Comparison of reliability between the Lenke and King classification systems for adolescent idiopathic scoliosis using radiographs that were not premeasured[J].Spine,2003,28(11):1148-1157.
[17] Guixing Q,Jianguo Z,Yipeng W,et al.A new operative classification of idiopathic scoliosis:a Peking Union Medical College method[J].Spine,2005,30(12):1419-1426.
[18] Lenke LG,Betz RR,Haher TR,et al.Multisurgeon assessment of surgical decision making in adolescent idiopathic scoliosis:curve classification, operative approach,and fusion levels[J].Spine, 200I,26(21): 2347-2353.
[1] Bianchi SD,Ramier G,De Gioanni PP.The validation of stereolithographic anatomical replicas : The author's own experience and a review of the literature.Radiol-Med-Torino,1997,94(5):503.
[2]张美超,张志凌,夏虹,等.枢椎齿突骨折的有限元分析[J].中国临床解剖学杂志,2005,23(1):96-99.
[3]胡小春,郭松青,叶铭.基于CT图像建立人体足部骨骼三维有限元模型的研究[J].合肥工业大学学报:自然科学版,2006,28(9):1189-1191.
[4]付裕,阮狄克,刘斌,等.显示与虚拟互动的第3-7颈椎应力分析比较[J].内蒙古医学杂志,2006,38(4):305-308.
[5]张美超,廖进民,李敏,等.激光三维扫描系统重建下颌骨[J].第一军医大学学报,2004,24(7):756-757.
[6]徐明志,王燕一,徐薪,等.应用三维激光扫描技术建立下颌固定义齿的三维有限元模型[J].口腔医学研究,2006,22(2):159-161.
[7]袁野,靳安民,何丽英,等.利用CT扫描及CAD技术建立腰椎活动节段的有限元模型[J].中国临床解剖学杂志,2002,20(4):298-300.
[8] Kling Petersen T, Rydmark M. Modeling and modification of medical 3D objects;The benefit of using a haptic modeling tool. Stud Health Technol Inform.2000;70:162-167.
[9] Durand LG, Garcia D,Sakr F,et al.A new flow model for Doppler ultrasound study of prosthetic heart valves. J Heart Valve Dis 1999;8(1):85-89.
[10]张建国,芦俊鹏,阮世捷,等.以头部为例的人体有限元几何模型重建的方法初步探讨[J].微计算机信息(管控一体化),2006,22(3):249-252.
[11]段彦静,孙文磊.逆向工程在医学上的应用[D].中华现代影像学杂志,2005,2(11):49—51.
[12] Potamianos P, Amis AA, Forester AJ, McGurk M, Bircher M. Rapid prototyping for orthopaedic surgery.Proc Inst Mech Eng [H]. 1998;212(5):383-93. Review.
[13]张曙,穆澜。快速原型技术的医学应用。机械与零件,2000,3(2):36～39.
[14] Erkula G,Sponseller PD,Kiter AE.Rib deformity in scoliosis[J].Eur Spine J.2003,12(3):281-287.
[15] Polly DW,Potter BK,Kuklo T,et al.Volumetric spinal canal intrusion, acomparison between thoracic pedicle screws and thoracic hooks[J].Spine,2004, 29:63-69.
[16]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.
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[1] King HA,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracic idiopathicscoliosis[J].J Bone Joint Surg(Am),1983,65(9):1302-1313.
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[1]贾连顺.现代脊柱外科学[M].北京:人民军医出版社,2007.949.
[2] Newton PO, Wenger DR. Idiopathic and congenital scoliosis.In: Morrissy RT, Weinstein SL, eds.Lovell and Winter’s Pediatric Orthopaedics, Fifth edition. Philadelphia: Lippincott Williams & Wilkins; 2001: 677-740
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[15] Ogon M,Giesinger K,Behensky H,et a1.Interobserver and intraobserver reliability of Lenke’s new scoliosis classification system. Spine,2OO2,27:858-862
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[18] Lenke LG,Betz RR,Haher TR,et al.Multisurgeon assessment of surgical decision making in adolescent idiopathic scoliosis:curve classification, operative approach,and fusion levels[J].Spine, 200I,26(21): 2347-2353.
[1] Bianchi SD,Ramier G,De Gioanni PP.The validation of stereolithographic anatomical replicas : The author's own experience and a review of the literature.Radiol-Med-Torino,1997,94(5):503.
[2]张美超,张志凌,夏虹,等.枢椎齿突骨折的有限元分析[J].中国临床解剖学杂志,2005,23(1):96-99.
[3]胡小春,郭松青,叶铭.基于CT图像建立人体足部骨骼三维有限元模型的研究[J].合肥工业大学学报:自然科学版,2006,28(9):1189-1191.
[4]付裕,阮狄克,刘斌,等.显示与虚拟互动的第3-7颈椎应力分析比较[J].内蒙古医学杂志,2006,38(4):305-308.
[5]张美超,廖进民,李敏,等.激光三维扫描系统重建下颌骨[J].第一军医大学学报,2004,24(7):756-757.
[6]徐明志,王燕一,徐薪,等.应用三维激光扫描技术建立下颌固定义齿的三维有限元模型[J].口腔医学研究,2006,22(2):159-161.
[7]袁野,靳安民,何丽英,等.利用CT扫描及CAD技术建立腰椎活动节段的有限元模型[J].中国临床解剖学杂志,2002,20(4):298-300.
[8] Kling Petersen T, Rydmark M. Modeling and modification of medical 3D objects;The benefit of using a haptic modeling tool. Stud Health Technol Inform.2000;70:162-167.
[9] Durand LG, Garcia D,Sakr F,et al.A new flow model for Doppler ultrasound study of prosthetic heart valves. J Heart Valve Dis 1999;8(1):85-89.
[10]张建国,芦俊鹏,阮世捷,等.以头部为例的人体有限元几何模型重建的方法初步探讨[J].微计算机信息(管控一体化),2006,22(3):249-252.
[11]段彦静,孙文磊.逆向工程在医学上的应用[D].中华现代影像学杂志,2005,2(11):49—51.
[12] Potamianos P, Amis AA, Forester AJ, McGurk M, Bircher M. Rapid prototyping for orthopaedic surgery.Proc Inst Mech Eng [H]. 1998;212(5):383-93. Review.
[13]张曙,穆澜。快速原型技术的医学应用。机械与零件,2000,3(2):36～39.
[14] Erkula G,Sponseller PD,Kiter AE.Rib deformity in scoliosis[J].Eur Spine J.2003,12(3):281-287.
[15] Polly DW,Potter BK,Kuklo T,et al.Volumetric spinal canal intrusion, acomparison between thoracic pedicle screws and thoracic hooks[J].Spine,2004, 29:63-69.
[16]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.