The Study Of Computer-aided Design Osteotomy To Treat Genu Valgum And Shorting

Objectives1. the use of computer-assisted technology to many not measured data can now beaccurately measured by computer-assisted; collecting data in normal adult limb alignmentand establish a database to provide the best reference data for lower limb surgery.2.the use of computer-aided technical guidance knee valgus deformity shortening surgeryorthopedic surgery to achieve individual design, and with the reverse engineering andrapid prototyping technology to produce osteotomy template, so that patients andshortening valgus deformity correction while assisting orthopedic surgeons choose the most appropriate surgical plan.Materials and Methods1.the normal anatomy of the human lower limb joints dimensional measurement parameters and database creation(1) CT scan, three-dimensional reconstruction:Choose lower limb morphology in normal adults:19cases of lower limb, with128rows of double helical CT/TLC scanning to obtain two-dimensional image data of the pelvis to the ankle, the use of a computer with a medical image processing software Mimics12.1(Materialise company, Belgium)(2) normal anatomy of lower limb joint three-dimensional digital measurement parameters1) point cloud image analysis and processing:the pelvis to the foot bone3D anatomical models, input Imageware13.2(Siemens) software for point cloud image processing, software-aided analysis2) Determine the standard position:include pelvic alignment, the alignment of the femur, tibia and fibula bone alignment.3)Determine baseline femoral anatomical parameters:the anatomical axis of the femur is established, the establishment of the distal femoral articular surface tangent, both inside and outside the rear of the femoral condyle tangent establish femur force spools establish femoral neck axis.4. Determine the measurement reference plane:a position to establish a standard reference plane; establish cross-section of the femur; femur sagittal femoral frontal plane established to build(3) The main measurement parameters:the former includes a femoral neck anteversion, femoral torsion angle, angle of the femur, tibia angle, medial tibial plateau angle, lateral tibial plateau angle, hip-knee-ankle angle, tibiofemoral angle, and the establishment of a database.(4) The statistical software SPSS13.0.1)According to the measurement results, the use of statistical average.2)According to the literature search using the bones of variance test measurement and computer-aided measurements of two independent samples2. lower limb deformities collection cases and surgical treatment(1) lower limb joint reconstruction and measurement:(2) After the establishment of the two-dimensional image data to obtain lower limb joints by CT scan, medical image processing software to import two-dimensional anatomical model of lower limb joints import reverse engineering software Imageware13.2(EDS company, USA), based on point cloud analysis and design after setting the standard position, establish a baseline measurement of the lower limbs, the cross-section, sagittal and coronal plane, measuring the relevant angles.1)Computer Aided determine the osteotomy site and osteotomy angle:places for unilateral lesions of the contralateral limb angle of correction standards; mean for patients with bilateral disease, then take to build a model of the database measurements of lower extremity to orthopedic standards.2) CAD design template assisted surgery osteotomy:osteotomy site identified in accordance with computer-aided design osteotomy template-assisted surgery done to make physical prototypes, sterilized.3)Computer simulation of lower limb deformity reconstruction process:using computer software to simulate knee valgus osteotomy template installation, operation designed to verify the feasibility of the program.(3) Select high qualification and experienced chief physician row specific surgical procedure.(4)The evaluation criteria and indicators:ask follow-up period in accordance with standard HSS score:a comprehensive evaluation from the pain, function, range of motion, muscle strength, flexion deformity, stability and so on.(5) Statistical analysis:anatomic parameters for computer-aided measurement and X-ray measurements using SPSS13.0statistical software to analyze and process concludes3. Results(1) The results of lower limbs measurements by the computer-aided way: The femoral angle:80.3±2.3°; The anteversion angle of femoral neck9.1±5.1°; The torsion angle:11.8±6.4°; The neck-shaft angle:130.6±5.2°; The anatomical axis of the femur and the mechanical axis angle:4.7±0.8°; The tibial torsion angle:28±5.9°; The tibial angle:94.4±3.6°; The after the lateral tibial plateau inclination:7.6±3.8°; The medial tibial plateau angle:10.4±3.7°; The hip-knee-ankle angle:177.5±2.3°; The tibiofemoral angle:176.3±2.0°.(2) Homogeneity of variance test have a good result。(3) computer-aided design osteotomy surgery results:Femoral angle from preoperative62.5±10.7°postoperatively was81.4±2.6°; tibiofemoral angle of164.1±3.4°preoperative and postoperative improvement of174.2±2.5°; knee score improved from preoperative52.4±16.2points to postoperative83.8±8.6min; leg length (mm):678.4±90.2preoperatively improved to710.5±74.2°. T examination confirmed by preoperative and postoperative statistically significant.4. Conclusions(1) Using computer-aided software measurement is consistent with the bare bone measurements, the angle three-dimensional space is more intuitive, more specifically, the measurement results more accurate; avoiding the difficulty of obtaining cadavers,measuring factors such as lack of constraints; avoid geographic, ethnic, etc. individual differences in the use of common surgical failure resulting angle for personalization provides a basis for more precise surgery compacted.(2) computer-aided design surgery patients can accurately analyze the deg ree of deformity, design the best surgical program, through a surgery whi le addressing the complex knee valgus deformity and shortening, not only significantly improve the success rate of surgery, but also greatly reduc es the patient’s pain and improve the quality of life of patients and red uce health care costs of patients and the community.