使用CAD、有限元分析和真实肌肉骨骼力输入对骨折锁骨和重建板进行建模

Marie Cronskär, M. Bäckström
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引用次数: 4

摘要

本博士论文致力于研究在骨科手术中使用增材制造(AM)和基于计算机断层扫描(CT)的设计来生产患者特定植入物的可能性,最初是在一个广阔的视角,论文的第二部分侧重于定制锁骨骨合成板。研究中使用的主要增材制造方法是电子束熔化(EBM)技术。使用AM,零件直接从3D计算机模型中构建,通过熔化或以其他方式一层一层地连接薄层材料来构建零件。在过去的20年里,这种全新的制造方式和快速发展的软件,用于从医学成像中重建解剖模型的数字3D,为设计和制造特定患者的植入物开辟了全新的机会。基于计算机断层扫描(CT)中的信息,可以创建解剖结构的数字和物理模型,并根据解剖模型定制植入物。使用的主要方法是进行一些案例研究,重点关注生产链的不同部分,从ct扫描到最终植入,并有几个目标:了解程序中不同步骤的细节,找到合适的应用,开发方法并进行试验。第一项研究是定制髋关节干,重点是EBM方法及其特殊的前提条件和可能性。随后进行了骨板的研究,设计遵循患者特定的骨轮廓,在这种情况下,胫骨骨折包括整个生产链。此外,为了发展和评估该方法,我们进行了4例锁骨骨折患者特异性钢板固定。在Ostersund医院的一名骨科医生的合作下,这些钢板与病人的骨头吻合度进行了测试。在案例研究的同时,开发了一种对锁骨固定板进行有限元分析的方法,并将其用于不同钢板和不同电镀方法的强度比较分析。在有限元模型中,锁骨上的载荷是在肌肉和韧带水平上定义的,使用多体肌肉骨骼模拟,比早期的类似研究更真实地加载。最初的研究(论文I和II)表明,EBM方法具有巨大的潜力,无论是在定制髋关节茎和骨板的应用;在某些条件下,与传统制造方法相比,由于节省了材料和文件准备时间,EBM制造可以显著降低成本。然而,在实施之前,需要在这两个应用领域做进一步的工作。使用患者特异性锁骨钢板固定骨折的研究表明,该方法可以方便外科医生在计划和手术室的工作,并有可能获得更光滑的钢板,更好的配合和针对特定骨折量身定制的螺钉定位(论文VI)。然而,使用患者特异性钢板的临床益处还需要进行大规模的临床试验。有限元模拟显示,患者专用板和商业板中的应力分布和位移相似(论文III至VI)。总之:本文的结果有助于患者专用植入物的数字设计和增材制造领域,具有广泛的关于所使用技术的知识基础,以及需要进一步工作的领域,以便在更大规模地实施该技术。此外,已经开发并初步评估了一种方法用于锁骨骨折固定领域的实施,包括比较不同锁骨钢板强度的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Modeling of fractured clavicles and reconstruction plates using CAD, finite element analysis and real musculoskeletal forces input
This doctoral thesis is devoted to studying the possibilities of using additive manufacturing (AM) and design based on computed tomography (CT), for the production of patient-specific implants within orthopedic surgery, initially in a broad perspective and, in the second part of the thesis focusing on customized clavicle osteosynthesis plates. The main AM method used in the studies is the Electron Beam Melting (EBM) technology. Using AM, the parts are built up directly from 3D computer models, by melting or in other ways joining thin layers of material, layer by layer, to build up the part. Over the last 20 years, this fundamentally new way of manufacturing and the rapid development of software for digital 3D reconstruction of anatomical models from medical imaging, have opened up entirely new opportunities for the design and manufacturing of patient-specific implants. Based on the information in a computed tomography (CT) scan, both digital and physical models of the anatomy can be created and of implants that are customized based on the anatomical models. The main method used is a number of case studies performed, focusing on different parts of the production chain, from CT-scan to final implant, and with several aims: learning about the details of the different steps in the procedure, finding suitable applications, developing the method and trying it out. The first study was on customized hip stems, focusing on the EBM method and its special preconditions and possibilities. It was followed by a study of bone plates, designed to follow the patient-specific bone contour, in this case a tibia fracture including the whole production chain. Further, four cases of patient-specific plates for clavicle fracture fixation were performed in order to develop and evaluate the method. The plates fit towards the patient’s bone were tested in cooperation with an orthopedic surgeon at Ostersund hospital. In parallel with the case studies, a method for finite element (FE) analysis of fixation plates placed on a clavicle bone was developed and used for the comparative strength analysis of different plates and plating methods. The loading on the clavicle bone in the FE model was defined on a muscle and ligament level using multibody musculoskeletal simulation for more realistic loading than in earlier similar studies. The initial studies (papers I and II) showed that the EBM method has great potential, both for the application of customized hip stems and bone plates; in certain conditions EBM manufacturing can contribute to significant cost reductions compared to conventional manufacturing methods due to material savings and savings in file preparation time. However, further work was needed in both of the application areas before implementation. The studies on the fracture fixation using patient-specific clavicle plates indicated that the method can facilitate the work for the surgeon both in the planning and in the operating room, with the potential of a smoother plate with a better fit and screw positioning tailored to the specific fracture (paper VI). However, a large clinical trial is required to investigate the clinical benefit of using patient-specific plates. The FE simulations showed similar stress distributions and displacements in the patient-specific plates and the commercial plates (papers III to VI). To summarize: the results of this thesis contribute to the area of digital design and AM in patient-specific implants with broad basis of knowledge regarding the technologies used and areas in which further work is needed for the implementation of the technology on a larger scale. Further, a method has been developed and initially evaluated for implementation in the area of clavicle fracture fixation, including an approach for comparing the strength of different clavicle plates.
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