CN110236673B - Database-based preoperative design method and device for reconstruction of bilateral jaw defects - Google Patents
Database-based preoperative design method and device for reconstruction of bilateral jaw defects Download PDFInfo
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Abstract
The application discloses design method and device before two side jaw defect rebuilds based on three-dimensional form database, method and device are based on predetermineeing the database, follow select in predetermineeing the database with wait to restore the head most accepted healthy head as the reference, rebuild two side defect jaw part on a large scale for lack the two side defect jaw on a large scale of healthy side contrast can also rebuild suitable jaw form and prosthesis form on a large scale.
Description
Technical Field
The application belongs to the field of medical image generation and application, and particularly relates to a preoperative design method and device for bilateral large-range jaw bone defect reconstruction based on a three-dimensional shape database.
Background
The jaw bone is the bone that constitutes the oral cavity, including the maxilla and the mandible, and the lower part is mainly by the maxilla as the bone scaffold in the face. The jaw bone defect generally refers to the tissue defect of upper and lower jaw bones caused by diseases or injuries, the jaw bone defect often causes serious appearance defect and dysfunction, and the jaw bone defect deformity directly causes great dysfunction and mental disorder of patients, so the jaw bone defect deformity and the repair and reconstruction thereof are the research hotspots of oral and maxillofacial surgery.
In recent years, the digital surgical technique has been increasingly applied to various types of jaw bone reconstruction operations, the digital external technology can provide visual and vivid three-dimensional models to obtain accurate three-dimensional visual diagnostic information, and the reconstruction operations are more personalized and refined with the assistance of the digital surgical technique. Specifically, a perfect operation scheme can be designed before an operation by utilizing a digital surgical technology and the operation implementation is simulated, so that the design defect is found, the operation scheme is improved in time, and the reduction of operation complications is facilitated; the navigation technology or the guide plate/template is used for guiding accurate positioning in the operation to guide the operation implementation, so that the operation precision and safety are improved, the aim of accurate repair is fulfilled, and a better clinical effect is achieved. The jaw bone reconstruction technique by using the digital surgical technique can not only accurately restore the cranio-maxillofacial appearance after the operation, but also achieve the aim of functional reconstruction.
Because the jaw face organs are mostly symmetrical, the defects of the unilateral organs can be reconstructed through contralateral data so as to ensure the bilateral symmetry of the face. The design of traditional mirror image method uses healthy side as the template, utilizes healthy jaw of side to be symmetrical to the sick side, resumes destroyed jaw appearance, provides the basis for the reestablishment of jaw appearance.
However, for bilateral large-scale defects crossing the midline, the design is difficult, the shape and position of the reconstructed jawbone are difficult to accurately determine without using the mirror image healthy side as a template, and the length and angle of the transplanted bone are difficult to accurately design. For bilateral large-scale defects crossing the midline, the traditional digital design can only estimate rough design by the experience of doctors, and the jaw form is recovered; or obtaining a model by adopting manual drawing of the three-dimensional model; or adopting a standard skull model, carrying out certain artificial modification, obtaining the model by a three-dimensional object form editing method such as zooming, rotating, local deformation and the like, and recovering the anatomical form of the jaw bone; or the reconstruction preoperative design is carried out by means of facial data of the close relatives of the patient.
Although the evaluation method can be based on a measurement method, for patients with a large-scale defect, the jaw bone of the residual part is often displaced to a certain extent, and there is no evaluation standard for restoring the jaw bone shape under the condition without reference, so artificial design results are different, and comparison and evaluation are difficult. If the experience of the designer is not rich, the position of the transplanted bone is not good, the face beauty of the patient is low, the occlusion function is poor, and the patient can only regrettably accept the results of face change and difficulty in long-term denture repair.
The method for obtaining the model by adopting the manual drawing of the three-dimensional model is long in time consumption, and still cannot avoid great difference among doctor designers.
Although a certain template is used as a reference for the method adopting the standard skull model, the design is quicker and has strong comparability, and the subjective influence of a designer is weakened. However, the method is long in time consumption, the reference template is single, the personalized feature is not provided, and the requirements on the capability of a designer for using software and the aesthetic design basis are high.
Disclosure of Invention
The application provides a bilateral jaw bone defect reconstruction preoperative design method based on a three-dimensional form database, the method is based on a preset database, a healthy skull most accepted by a skull to be repaired is selected from the preset database as a reference, and bilateral large-range defect jaw bone parts are reconstructed, so that the bilateral large-range defect jaw bone without healthy side contrast can be reconstructed into a proper implant form and position.
The present application aims to provide the following aspects:
in a first aspect, the present application provides a database-based preoperative planning method for bilateral jaw bone defect reconstruction, the method comprising: acquiring a skull model to be repaired and a preset database; searching a target standard skull model in a preset database; generating a defect model according to the skull model to be repaired; generating an individualized reference template according to the target standard skull model and the defect model; designing a final dentition morphology of the resection range according to the personalized reference template; and designing the position of the implant and the shape and position of the donor bone according to the personalized reference template and the final dentition shape.
With reference to the first aspect, in an implementable manner, the retrieving the target standard cranial model in the preset database comprises: searching a candidate standard skull model in a preset database; and screening a target standard skull model from the candidate standard skull according to a preset rule.
Wherein the retrieving of the candidate standard skull model in the preset database comprises: extracting three-dimensional feature information to be repaired, wherein the three-dimensional feature information to be repaired is the three-dimensional feature information extracted from the skull model to be repaired; acquiring normalized preset three-dimensional characteristic information and normalized to-be-repaired information, wherein the normalized preset three-dimensional characteristic information is obtained by normalizing preset three-dimensional characteristic information, and the normalized to-be-repaired three-dimensional characteristic information is obtained by normalizing the to-be-repaired three-dimensional characteristic information; sequentially calculating the similarity between each healthy skull model in the preset database and the skull to be repaired according to the normalized preset three-dimensional characteristic information and the normalized three-dimensional characteristic information to be repaired; and acquiring candidate standard skull models, wherein the candidate standard skull models are a plurality of healthy skull models with the highest similarity with the skull to be repaired.
With reference to the first aspect, in an implementable manner, the generating a defect model from the model of the skull to be repaired includes: determining a range to be repaired on the skull model to be repaired; and generating a skull defect model to be repaired according to the range to be repaired of the skull to be repaired.
With reference to the first aspect, in one implementable manner, synthesizing a personalized reference template from the target standard skull comprises: superposing the jaw bone three-dimensional shape image of the target standard skull model with the jaw bone three-dimensional shape image of the skull model to be repaired; designing a prosthesis model according to the skull defect model to be repaired and the target standard skull model; and generating an individualized reference template according to the prosthesis model and the skull defect model to be repaired.
Generating an individualized reference template according to the prosthesis model and the skull defect model to be repaired comprises the following steps: determining a prosthesis model at a corresponding position of the target standard skull model; trimming a prosthesis model according to the range to be repaired; and fusing the repaired prosthesis model with the skull defect model to be repaired.
With reference to the first aspect, in an implementable manner, after designing the implant position and the morphology and position of the donor bone from the personalized reference template, the terminal dentition morphology, the method further comprises: designing a guide plate according to the position of the implant and the shape and the position of the donor bone; and/or respectively manufacturing the skull defect model to be repaired, the jaw bone repaired model and the solid model of the guide plate.
With reference to the first aspect, in an implementable manner, after the solid models of the skull defect model to be repaired, the jaw bone post-repair model, and the guide plate are respectively made, the method further comprises: designing navigation parameters of the skull defect model to be repaired and the model after the jaw bone is repaired; and guiding the navigation parameters into an intraoperative navigator.
Wherein the navigation parameters include at least one of a navigation registration point, an osteotomy marker, a prosthesis marker, a donor bone in-position marker, an implant marker, and a post-restoration dentition marker.
The application still provides a design device before two side jaw defects rebuild based on craniomaxillofacial database, the device includes: the information acquisition unit is used for acquiring a three-dimensional shape image of the skull to be repaired and a preset database; the model retrieval unit is used for retrieving a target standard skull model from a preset database; a defect model generating unit, configured to generate a defect model according to the to-be-repaired skull model; the personalized template generating unit is used for synthesizing a personalized reference template according to the target standard skull model; a dentition form design unit for designing the final dentition form of the resection range according to the personalized reference template; and the implant design unit is used for designing the implant position and the shape and position of the donor bone according to the personalized reference template and the final dentition shape.
The present application also provides a program for a bilateral jaw defect reconstruction preoperative design based on a craniomaxillofacial database, the program being for performing the method of the first aspect of the present application.
The present application also provides a hardware medium on which the aforementioned program designed before the reconstruction of bilateral jaw defects based on the cranio-maxillofacial database is stored, and which can be executed on a processor.
Aiming at the requirements of bilateral large-range craniomaxillofacial defect repair, craniomaxillofacial three-dimensional form retrieval is carried out by relying on a craniomaxillofacial bone three-dimensional form database, so that a solution for obtaining the digital design of the craniomaxillofacial repair operation is established, and the effects of high efficiency, rapidness, reduced experience dependence and personalized repair operation design are achieved.
Compared with the traditional scheme, the scheme provided by the application can provide a personalized repair form template by utilizing a digital technology, so that a doctor can realize virtual positioning design of a transplanted bone (fibula/ilium) before an operation, can lead the data of a patient supply area into a digital software, and accurately design the length and the angle of each section of the transplanted bone according to the range and the position of jaw defects, so that the requirement of the transplanted bone on appearance and function repair can be met in a three-dimensional position.
The scheme provided by the application also has the following beneficial effects:
1. the jaw bone defect restoration personalized template established based on the three-dimensional shape database is combined with a drawing tool (such as CAD software), a 3D printing surgical guide plate technology, a surgical operation navigation system and the like, so that a complete digital solution for repairing jaw bones of patients with large-range jaw bone defects is realized;
2. the scheme provided by the application is based on a craniomaxillofacial bone three-dimensional database, the designed transplanted bone has the advantages of accurate and real shape, and the defects that the traditional scheme needs to depend on the experience of a doctor and the position of a donor bone is not ideal under the condition of no reference shape are overcome;
3. according to the scheme provided by the application, the craniomaxillofacial features are optimized by using software in the process of extracting the craniomaxillofacial features, and the whole design process adopts a picture guide mode, so that a doctor can conveniently and accurately extract feature points, and the personal error of feature point extraction is reduced;
4. the whole personalized template acquisition process is quick, the position of the donor bone with the reference template is adjusted more quickly, and the preoperative design time is shortened.
Drawings
Fig. 1 shows a flow chart of a preoperative planning method for bilateral jaw bone defect reconstruction based on a three-dimensional morphological database provided by the present application;
fig. 2 shows a program interface for semi-automatically marking the standard feature markers used in the present embodiment.
Detailed Description
Reference will now be made in detail to the exemplary embodiments, examples of which are illustrated in the accompanying drawings. When the following description refers to the accompanying drawings, like numbers in different drawings represent the same or similar elements unless otherwise indicated. The embodiments described in the following exemplary embodiments do not represent all embodiments consistent with the present application. Rather, they are merely examples of apparatus and methods consistent with certain aspects of the present application, as detailed in the appended claims.
The present application is described in detail below.
Before describing the technical solution of the embodiment of the present application, a brief description is first made of the technical scenario of the embodiment of the present application.
The morphological characteristics of the human craniofacial parts are very complex, although all the human craniofacial parts have obvious common characteristics, the human craniofacial parts have very obvious individual characteristics, and the functions of mouth opening, vision, chewing and the like can be normally performed only by being matched with the individual characteristics of the craniofacial parts. Due to the diseases of trauma, tumor, inflammation and the like, wide-range defects of facial bone tissues and soft tissues can be caused, and the reconstruction and repair effects of the facial bone tissues and the soft tissues depend on the morphological anatomical analysis of the original tissues, the morphological design of donors, the survival conditions (blood supply) of donors, functional analysis and aesthetic design.
Since, the knowledge of complex craniofacial three-dimensional structures and craniofacial abnormalities requires not only qualitative and positional observation by doctors and professionals, but also quantitative and accurate description. In the traditional scheme, doctors are generally required to make operation design templates through experience for the bilateral and large-scale defects of the craniomaxillofacial part, and the scheme completely depending on the experience of each doctor can increase operation risks and uncertainty of prognosis due to different experiences of each doctor and considered lateral emphasis points.
The method is applied to the field of medical image generation and application, and particularly relates to bilateral jaw bone defect reconstruction of a three-dimensional form database.
The method provided by this embodiment relates to processing a three-dimensional shape image of a skull to be repaired and a three-dimensional shape image of a healthy skull model in a preset database, where the three-dimensional shape image of the skull to be repaired may be obtained by three-dimensional reconstruction based on CT (Computed Tomography) or other three-dimensional shape image acquisition devices, such as data of magnetic resonance imaging, and similarly, the three-dimensional shape image of the healthy skull model may be obtained by three-dimensional shape image acquisition devices or by three-dimensional reconstruction based on CT data.
In this embodiment, the CT data may be acquired by a CT device, and it should be noted that, for the same patient, the CT data acquired by different CT devices may be different, the CT data acquired by different patients using the same CT device may be different, and the CT data acquired by the same patient using the same CT device may be the same or different.
In this embodiment, the healthy skull model is not a human-designed skull model, but is acquired skull data of a population with normal craniomaxillofacial function, where the population with normal craniomaxillofacial function refers to a population with normal craniomaxillofacial function in which at least a part of craniomaxillofacial function is normal and a part of craniomaxillofacial function is allowed to have defects, but the defects do not prevent the normal craniofacial function as a surgical design template. For example, if the patient has parotid gland tumor, but the orbital wall bone, jaw bone, etc. of the patient are normal, and the corresponding functions of these normal parts are normal, the patient can be considered as a normal population.
The application provides a bilateral jaw bone defect reconstruction preoperative design method based on a three-dimensional shape database, wherein an execution main body of the method can be a terminal comprising a display, and the shape of the terminal comprises a computer or a mobile phone.
Fig. 2 is a flowchart of a preoperative planning method for reconstructing bilateral jaw defects based on a three-dimensional morphological database, as shown in fig. 2, the method provided by the present application includes steps S101 to S106, specifically:
s101, acquiring a skull model to be repaired and a preset database.
In this embodiment, the skull model to be repaired may be reconstructed by simulation according to any one of the skull images in the prior art, such as CT data or nuclear magnetic data of a patient, and the specific reconstruction method may use any one of the methods in the prior art that generates a three-dimensional shape by using planar two-dimensional medical image simulation reconstruction.
In this embodiment, the preset database may be pre-established before the skull model to be repaired is obtained.
In an implementation manner, establishing the preset database may include steps S111 to S115, specifically:
and S111, acquiring image data of the healthy skull.
In this embodiment, the healthy skull image data may be any planar image data obtained by using the prior art, such as CT data, nuclear magnetic data, and the like.
For respective characteristics of different planar image data, reconstruction processing can be performed by using a conventional method in the field in the specific process of performing three-dimensional shape reconstruction processing. For simplicity, the present embodiment will be described with CT data as an example.
The scanning baseline of the acquired CT data may be the angular line or the eyebrow line, and since the angular line is the most commonly used baseline in CT scanning, the angular line is taken as an example in this embodiment.
For healthy skull model CT data to be included, the acquired CT data should have no obvious data loss, the scanning layer thickness is less than or equal to 2mm, so as to avoid that the accuracy of a reconstructed model is too low due to the excessively thick scanning layer thickness, further the extraction error of subsequent feature points exceeds 2mm, and the format of the CT data can be a Dicom standard format.
In this embodiment, the healthy skull model CT data generally needs to be complete, and the scanning range includes from supraorbital to submental, and the cusps are dislocated; the scanning baseline is an angular line, molar is approximately neutral, coverage is basically normal, and both sides are basically symmetrical; no operative history visible to CT; there may be small lumps or abnormalities of soft tissue but no bone involvement, fractures and defects.
The CT data of any one of the following cases is excluded in the present embodiment:
(1) CT data are seriously damaged, and artifacts which cannot be repaired exist, and other situations influencing reconstruction and important mark point selection exist;
(2) severe bone malformation, dysplasia and bone tissue tumor;
(3) the soft tissue mass affects the bone, and the bone is damaged or changed under pressure;
(4) deciduous dentition and mixed dentition children.
For example, one CT data for the present embodiment is obtained according to the following parameters:
16 rows of spiral CT (Siemens, Germany), scan voltage 120kV, scan current >200mA, matrix 512X 512, scan layer thickness 1.25 mm.
The CT data obtained under the parameters are complete, and the scanning range comprises the cross dislocation of the cusps from the supraorbital to the submental; the scanning baseline is an angular line, molar is approximately neutral, coverage is basically normal, and both sides are basically symmetrical; there was no visible surgical history of CT.
And S112, generating a three-dimensional shape image of the healthy skull model according to the CT data of the healthy skull model.
In this embodiment, the acquired CT data may be transmitted to the processor by using a network or in other manners, the CT data is stored in the memory by using a universal Dicom standard format, and a three-dimensional cranio-maxillofacial bone tissue is reconstructed based on the CT data by using a preset window width, a preset window level and a preset defined threshold, so as to generate a three-dimensional morphological image of the healthy skull, and the three-dimensional morphological image of the healthy skull model may be output as an stl format file and stored in the memory.
In the present embodiment, any method of three-dimensional reconstruction based on CT data in the prior art may be used to reconstruct the three-dimensional cranio-maxillofacial bone tissue, and optionally, a method based on surface rendering may be used to reconstruct the three-dimensional cranio-maxillofacial bone tissue.
In this embodiment, the preset window width is a window width suitable for observing the morphology of the cranio-maxillofacial bone, for example, 500Hu, the preset window level is a window level suitable for observing the pathological condition of the cranio-maxillofacial bone, for example, +100Hu, and the defined threshold may be 226 to 3071 Hu.
The window technique is a display technique for observing normal tissues or lesions with different densities in CT examination, and comprises window width and window level. Since various tissue structures or lesions have different CT values, when a detail of a certain tissue structure is to be displayed, a window width and a window level suitable for viewing the tissue or lesion should be selected to obtain an optimal display. The window width is the range of CT value displayed on the CT image, the tissues and lesions in the range of CT value are displayed in different simulated gray scales, the CT value is higher than the upper limit of the range and is displayed in white shadow, and if the CT value is lower than the lower limit of the range, the tissues and lesions are displayed in black shadow. The window width is increased, the range of CT values indicated by the CT image is increased, the number of texture structures exhibiting different densities is increased, but the difference in gray scale between the structures is decreased, the window width is decreased, the number of texture structures exhibiting different densities is decreased, but the difference in gray scale between the structures is increased. The window level is the center position of the window, the same window width, and the upper and lower limit positions of the included CT value range are different due to the difference of the window levels, for example, the window width is 100H, when the window level is 0H, the corresponding CT value range is-50H- +50H, if the window level is +35H, the corresponding CT value range is-15H- + 85H.
In the embodiment, the window width adopts 500Hu, the window level adopts +100Hu, the optimal display of the craniomaxillofacial bone can be obtained by adopting 226-3071 Hu as the defined threshold, and the three-dimensional morphological image of the skull model reconstructed on the basis of the CT data can meet the requirement of contrast analysis.
S113, selecting standard characteristic mark points from the three-dimensional shape image of each healthy skull model.
In this embodiment, the standard feature mark points refer to feature mark points extracted from a three-dimensional morphological image of a healthy skull model, and the feature mark points may include cranium mark points, maxillary mark points, mandibular mark points, and the like, where the cranium mark points may include a nasion point (the foremost point of the nasofrontal suture on the median sagittal plane), left and right nasal forehead points (the intersection point of the maxillary frontal process and the nasofrontal suture), a sphenoid saddle point (the central point of the sphenoid saddle), a skull base point (the central point of the anterior border of the greater occipital bone), and the like; the upper jaw mark points can comprise an anterior nasal spine point (an anterior nasal spine tip), an upper socket seat point (a most concave point of a bone between an anterior nasal spine and an upper socket edge on a median sagittal plane), an upper socket edge point (a most front point of an upper socket on the median sagittal plane) and an upper middle incisor point (a most front point of a cutting edge of an upper middle incisor on the median sagittal plane), and the like; the mandibular landmark points may include the lower incisor point (the most anterior point of the incisor margins of the upper and lower middle incisors in the midsagittal plane), the left and right lower first molar points (the most anterior point of the lower first molar near the buccal cusp), the lower alveolar margin point (the most anterior point of the lower alveolar process on the midsagittal plane), and the lower alveolar seat point (the most concave point of the bone between the lower alveolar margin and the front of the chin in the midsagittal plane), etc.
In this embodiment, the standard feature mark point may be automatically identified and marked in the three-dimensional morphological image of the healthy skull model by using any automatic marking module in the prior art, may be manually marked on the three-dimensional morphological image of the healthy skull model by an operator, or may be semi-automatically marked by interaction between the operator and a computer. When an operator marks standard characteristic mark points in a three-dimensional shape image of a healthy skull, a computer system prompts that the first standard characteristic mark point is a nasion root point and prompts that the position of the standard characteristic mark point is the most anterior point of a nasofrontal suture on a median sagittal plane, the operator can find the standard characteristic mark point according to the prompt, and all the standard characteristic mark points are marked in a man-machine interaction manner in sequence. The applicant finds that the standard characteristic mark points obtained by the semi-automatic marking of the interaction between the operator and the computer can not only avoid the error caused by the mechanical property of the pure automatic marking, but also improve the working efficiency and the accuracy of the operator.
For example, as shown in fig. 2, the program interface is a semi-automatic program interface for marking standard feature mark points, by which a three-dimensional image of a healthy skull can be clearly displayed at multiple angles, natural illumination can be given at a specific angle, so that the three-dimensional display effect is obviously enhanced, an image can be freely dragged and rotationally zoomed, so that observation at each angle can be facilitated, the feature mark points can be accurately positioned, and the program presets the extraction sequence of the standard feature mark points, and prompts a user with pictures and characters, so that the feature points can be quickly and accurately extracted.
S114, acquiring feature information of each standard feature mark point, wherein the feature information comprises: standard feature mark point coordinates, standard line spacing, standard angles and standard scale parameters.
In this embodiment, after the standard feature marker points are marked in the three-dimensional morphological image of the healthy skull model, feature information corresponding to each standard feature marker point is extracted, so as to provide a basis for calculating the similarity between the skull to be repaired and the healthy skull.
In one implementation, the standard feature landmark point coordinates are position coordinates of each standard feature landmark point.
The standard line distances are the cranium line distances, the orbital line distances, the lower jaw line distances, the upper jaw line distances, the face height line distances and the like of the healthy skull model, wherein the cranium line distances specifically comprise the anterior skull base length, the posterior skull base length and the total skull base length, and the orbital line distances specifically comprise the left and right orbital lateral distances, the left and right orbital medial distances, the left and right orbital heights and the left and right orbital widths; the lower jaw line distance specifically comprises the width of a lower jaw, the height of left and right lower jaw branches, the height of the left and right lower jaw branches and the body length of the left and right lower jaws; the maxillary line spacing specifically comprises: upper width, cheekbone width, middle width, upper jaw length and upper alveolar height; the face height line distance specifically comprises: the front is high, the upper front is high, the lower front is high and the rear is high.
The standard angle is an included angle of each structure in the three-dimensional morphological image of the healthy skull model, such as a skull base angle measured at the skull portion, a left and right mandible angle measured at the upper and lower jawbones, and the like.
The standard proportion parameters are the proportion of each line distance of the healthy skull model, such as the ratio of the front-back face height, the ratio of the front-back face height to the front face height, the ratio of the mandible width to the zygomatic face width, the ratio of the mandible width to the orbital width, the ratio of the mandible width to the condylar process width, the ratio of the zygomatic face width to the orbital width, the ratio of the zygomatic face width to the condylar process width and the like.
In an implementation manner, the standard feature landmark point coordinates, the standard line distance, the standard angle and the standard scale parameter can be calculated by a software module according to the extracted feature points.
And S115, generating a preset database according to the characteristic information of each standard characteristic mark point, wherein the preset database comprises a plurality of pieces of healthy skull model characteristic information, and each piece of healthy skull model characteristic information comprises the characteristic information of all standard characteristic points corresponding to the healthy skull model.
In this embodiment, the three-dimensional shape image of each healthy skull model and the standard feature information corresponding to all the standard feature marking points of the healthy skull are all in a corresponding relationship to form a database including a plurality of healthy skull model feature information, which is a preset database.
In this embodiment, feature marker points are also extracted for the obtained skull model to be repaired, and the method for extracting the feature marker points of the skull model to be repaired is similar to the method for extracting the standard feature marker points of the healthy skull model, and the difference is that the feature marker points of the jaw bone defect part are skipped, and the feature marker points are not extracted.
S102, a target standard skull model is searched in a preset database.
In this embodiment, the retrieving the target standard skull model in the preset database may specifically include:
and S121, searching a candidate standard skull model in a preset database.
In this embodiment, specifically, the retrieving the candidate standard skull model in the preset database may include:
s1211, extracting three-dimensional feature information to be repaired, wherein the three-dimensional feature information to be repaired is the three-dimensional feature information extracted from the skull model to be repaired.
The extracting of the three-dimensional feature information to be repaired may specifically include:
marking a plurality of characteristic mark points on the three-dimensional shape image of the skull to be repaired;
and acquiring characteristic information corresponding to each characteristic mark point, wherein the characteristic information comprises characteristic mark point coordinates, line distances, angles and proportion parameters.
In this embodiment, the step S113 may be referred to as an implementation manner of marking a plurality of feature mark points on the three-dimensional morphological image of the skull to be repaired, and details are not repeated herein.
In this embodiment, the implementation manner of obtaining the feature information corresponding to each feature mark point may specifically refer to step S114, which is not described herein again.
And S1212, acquiring normalized preset three-dimensional feature information and normalized to-be-repaired information, wherein the normalized preset three-dimensional feature information is obtained by normalizing preset three-dimensional feature information, and the normalized to-be-repaired three-dimensional feature information is obtained by normalizing to-be-repaired three-dimensional feature information.
In this embodiment, the normalized preset three-dimensional feature information includes a line distance, an angle, a proportion parameter, a normalized feature marker point coordinate, and the like of the healthy skull model, and similarly, the normalized to-be-repaired three-dimensional feature information includes a line distance, an angle, a proportion parameter, a normalized feature marker point coordinate, and the like of the to-be-repaired skull model, where the normalized feature marker point coordinate is a coordinate of a feature marker point marked in the original image after normalization processing. Parameters such as line distance, angle and proportion parameters can use corresponding values generated by the skull model in the original three-dimensional form image, so that errors caused by normalization processing are avoided, and the errors are difficult to avoid in the normalization process.
In this embodiment, since a coordinate system (hereinafter, referred to as an original coordinate system) in which the three-dimensional morphological images of the healthy skull models are located is related to a CT photographing baseline and a head position during photographing, the three-dimensional morphological images of the healthy skull models are different from a standard anatomical orientation of a human body, and in order to facilitate comparison of coordinate differences of characteristic mark points between different skull bones and subsequent similarity comparison requirements, a unified coordinate system, namely normalization (Regularize), is established for the skull models (including the healthy skull model and the skull to be repaired), and the three-dimensional morphological images of all the skull models are recorded in a normalization database after being normalized.
In the present embodiment, an FH-S-N coordinate system is defined as a standardized coordinate system. The FH-S-N coordinate system refers to a datum plane FH plane (orbital-ear plane) in two-dimensional cephalography, a plane formed by a middle point of the lower edge of the orbit and ear points at two sides is taken as an XOY plane, a butterfly saddle point is taken as a normal line of the XOY plane and is taken as a Z axis, an intersection point of the Z axis and the XOY plane is taken as an origin O, the XOZ plane is obtained by passing the Z axis and a nose root point, an intersection line of the XOY and the XOZ plane is taken as an X axis, and a straight line which passes through the origin and is vertical to the X axis in the XOY plane is taken as a Y axis, so that the FH-S-N coordinate system is.
Converting all points on the three-dimensional shape image of the skull model into a FH-S-N coordinate system, and unitizing the vector in the FH-S-N coordinate system along the X-axis direction to obtain a unit vector
The unit vector along the Y-axis direction can be obtained by the same method
Unit vector in Z-axis direction
And is
And
one unit orthogonal basis under the FH-S-N coordinate system is constructed.
S1213, sequentially calculating the similarity between each healthy skull model in the preset database and the skull to be repaired according to the normalized preset three-dimensional characteristic information and the normalized three-dimensional characteristic information to be repaired.
In the embodiment, the similarity of the skull model to be repaired and the healthy skull model in three-dimensional morphology can be calculated by using a characteristic point minimum distance method.
Specifically, the characteristic mark point of the skull model to be repaired can be defined as Pi(xi,yi,zi) Defining the characteristic mark point of any healthy skull model in the preset database corresponding to the skull model to be repaired to be P'i(x′i,y′i,z′i) Firstly unifying the model of the skull to be repaired and the healthy skull model to the FH-S-N coordinate system by the method, and calculating the Euclidean distance E between the model of the skull to be repaired and any three-dimensional characteristic mark point of each healthy skull model in the FH-S-N coordinate systemiThe Euclidean distance EiThe calculation can be made according to the following formula (1):
in this embodiment, a similarity function F between the model of the skull to be repaired and the model of the healthy skull is defined as a mean value of euclidean distances between all corresponding feature points between two skull, and may be calculated according to the following formula (2):
F＝∑Ei/n (2)
wherein i is 1,2,3 … n
As can be seen from equation (2), the larger the F value is, the smaller the similarity between the two skull models is, whereas the smaller the F value is, the larger the similarity between the two skull models is.
S1214, obtaining candidate standard skull models, wherein the candidate standard skull models are a plurality of healthy skull models with the highest similarity with the skull to be repaired.
Because the structure of the craniomaxillofacial part is extremely complex, the similarity of several craniums with the highest similarity obtained by calculation through the method may only differ a few bits after a decimal point, that is, there is almost no difference from the similarity data, so that the problem that the surgical design template selected by simply depending on the similarity may also be unmatched with the specific situation of the patient may exist, therefore, in the embodiment, a plurality of healthy cranium models with the highest similarity are selected as candidate cranium models, for example, 3 candidate cranium models may be selected.
And S122, screening a target standard skull model from the candidate standard skull according to a preset rule.
In this embodiment, the preset rule may be a rule set by the experience of the doctor, or may be another rule suitable for selecting the target standard skull model, for example, a candidate skull model with the greatest similarity to the skull model to be repaired may be screened as the target standard skull model by using inverse engineering software, for example, a color spectrum comparison method provided by geogic.
In this embodiment, screening the candidate skull model with the greatest similarity to the skull model to be repaired by using the chromatographic comparison method provided by Geomagic can be briefly described as the following steps:
respectively loading the three-dimensional surface drawing data of the candidate skull model and the three-dimensional surface drawing data of the skull model to be repaired into reverse engineering software, such as Geomagic and the like;
and analyzing and comparing the similarity degree, namely the coincidence degree, of the skull model to be repaired and each candidate skull model by using the chromatographic comparison method carried by the reverse engineering software, and selecting one skull model which is most similar to the skull model to be repaired from the candidate skull models.
In this embodiment, the selection of one skull model that is most similar to the skull model to be repaired from the candidate skull models may be completely based on the result of the chromatographic comparison method provided by the reverse engineering software, or may be mainly based on the similarity between the corresponding position of the part to be repaired and the healthy skull.
In this embodiment, there is only one target standard cranial model.
S103, generating a defect model according to the skull model to be repaired.
In this embodiment, the generating a defect model according to the model of the skull to be repaired includes:
s131, determining a range to be repaired on the skull model to be repaired.
In this embodiment, the area to be repaired may be defined on the skull model to be repaired according to the area to be repaired or the focal area.
In this embodiment, the delineation of the range to be repaired may be performed according to the repair requirement.
S132, generating a skull defect model to be repaired according to the range to be repaired of the skull to be repaired.
In this embodiment, in the process of delineating the range to be repaired on the skull to be repaired, a candidate repair range corresponding to the range to be repaired is correspondingly delineated on the target standard skull model at the same time, the range to be repaired and the candidate repair range are generated at the same time, and specifically, the range to be repaired may be a closed region formed at any number of any points on the skull to be repaired.
In the embodiment, the method is used for determining the range to be repaired and the candidate repair range, so that the candidate repair range most similar to the range to be repaired can be quickly defined on the target standard healthy skull.
In this embodiment, the skull model to be repaired excluding the range to be repaired is the defect model to be repaired.
And S104, generating a personalized reference template according to the target standard skull model and the defect model to be repaired.
In this embodiment, the synthesizing of the personalized reference template according to the target standard skull specifically includes:
and S141, superposing the jaw bone three-dimensional shape image of the target standard skull model and the jaw bone three-dimensional shape image of the skull model to be repaired.
In the embodiment, the upper jaw or the lower jaw is taken as a reference, the three-dimensional shape image of the target standard skull model is superposed with the three-dimensional shape image of the skull model to be repaired, so that the characteristic mark points of the skull model to be repaired and the target standard healthy skull are superposed and corresponding on the three-dimensional shape image as much as possible, and the precision and the applicability of the designed prosthesis on the skull to be repaired are improved.
And S142, designing a prosthesis model according to the skull defect model to be repaired and the target standard skull model.
In this embodiment, the candidate repair range defined on the target standard healthy skull model may be captured in the form of a module through a function preset by software, and for convenience of expression, the captured module is simply referred to as a to-be-repaired model, and the to-be-repaired module may be embedded into a to-be-repaired area of the to-be-repaired skull model.
Because the skull model to be repaired has inevitable difference with the target standard healthy skull model, the edge joint of the to-be-repaired module is likely to have a non-fit part after being embedded into the to-be-repaired area of the to-be-repaired skull model, and therefore the to-be-repaired module can be trimmed, so that the to-be-repaired module is matched with the edge joint of the to-be-repaired area formed on the to-be-repaired skull model.
And S143, generating an individualized reference template according to the prosthesis model and the skull defect model to be repaired.
In this embodiment, the generating a personalized reference template according to the prosthesis model and the to-be-repaired skull defect model may specifically include:
determining a prosthesis model according to the range to be repaired at the corresponding position of the target standard skull model;
trimming the prosthesis model;
and connecting the repaired prosthesis model with the skull defect model to be repaired to form a model.
In this embodiment, after the to-be-repaired module is embedded into the to-be-repaired skull model, a boundary line is left on the to-be-repaired skull model to form an embedding trace, so that the to-be-repaired module and the to-be-repaired skull model can be connected by adopting a curved surface editing technology to form coherent and uniform face grid data, and the face grid data obtained by fusion is used as an individualized reference template.
In this embodiment, since the step 104 is to define the range to be repaired by a limited number of selected points, the defined module to be repaired is relatively coarse, and the definition of the range to be repaired may also have an inaccurate problem, where the selected points are the points selected in the step 104 for defining the range to be repaired.
Therefore, the personalized reference template obtained in steps 101 to 104 may be regarded as a preliminary design template, and the precise range to be repaired may be further determined based on the personalized reference template in this embodiment.
In addition, the personalized reference template designed by the target standard healthy skull model has dentition, and the surgical template acquired by other schemes lacks dentition design, so that the embodiment chooses to further design the shape of the prosthesis on the basis of the personalized reference template.
In this embodiment, since the maxilla and the mandible are occluded with each other under the closed condition, the reconstructed maxilla and the mandible of the skull model to be repaired have overlapping portions on the image, and therefore, the skull model to be repaired is divided into two independent sub-models according to the maxilla and the mandible, so that the situation that the irrelevant maxilla and the mandible are delineated into the region to be repaired when the region to be repaired is delineated is avoided.
Jaw resection ranges are determined on separate maxillary and mandibular images, respectively, the jaw resection ranges being precisely determined according to the lesion site.
In the present embodiment, in the process of determining the jaw bone resection range, the prosthesis range is accurately determined on the personalized reference template at the same time.
And S105, designing the final dentition form of the resection range according to the personalized reference template.
In this embodiment, the final dentition form within the jaw resection range may be obtained according to the personalized reference template, the final dentition form may be embedded into the jaw resection range, and the final dentition form may be adjusted according to the dentition on the edge of the jaw range.
And S106, designing the implant position and the shape and position of the donor bone according to the personalized reference template and the final dentition shape.
In this embodiment, after the final dentition design is completed, the shapes and positions of the implant and the donor bone are further modified according to the personalized reference template and the designed final dentition shape, so as to complete the design of the bilateral large-area defective craniomaxillary bone repair.
The applicant finds that the design time is greatly shortened to 1-2 hours from the original 4-5 hours by using the method provided by the application to carry out surgical design on the large-area defective craniofacial bones on both sides, and the method provided by the application is accurately designed according to the three-dimensional shape big data of healthy people and a computer, so that the complicated cases of the large-area defective craniofacial bones on both sides are standardized and evidentified from the traditional surgical design which completely depends on the experience of doctors and is not standardized, and meanwhile, the individual characteristics and the functional characteristics are ensured. The designed prosthesis has higher matching degree with the area to be repaired, the prosthesis is used for repairing the large-area defects on both sides, the aesthetic degree and the functional recovery of the patient after the operation are both greatly improved by the traditional method,
in this embodiment, after step 106, the method may further include: designing a guide plate according to the position of the implant and the shape and the position of the donor bone; and/or respectively manufacturing the skull defect model to be repaired, the jaw bone repaired model and the solid model of the guide plate.
In this embodiment, the guide plate is a virtual image formed through computer simulation, and in an actual repair process, a physical entity with the same shape can be manufactured according to the guide plate to assist the implant and the donor bone to be realized in an actual operation.
In the present embodiment, the guide plate may be any one of the guide plates available in the prior art, for example: the bone cutting guide plate can be four types of guide plates, such as a jaw bone cutting guide plate, a donor bone cutting guide plate, a bone positioning guide plate, an implanting guide plate and the like, or a plurality of guide plates can be combined.
In this embodiment, the guide plate entity may be obtained by means of 3D printing, and the guide plate entity may include a jaw bone defect model, a jaw bone post-repair model, an intraoperative guide plate, and the like.
In this embodiment, after step 106, the method may further include: designing navigation parameters of the skull defect model to be repaired and the model after the jaw bone is repaired; and guiding the navigation parameters into an intraoperative navigator.
Wherein the navigation parameters include at least one of a navigation registration point, an osteotomy marker, a prosthesis marker, a donor bone in-position marker, an implant marker, and a post-restoration dentition marker.
In this embodiment, the model for generating the navigation parameters includes generating a model of a jawbone defect after osteotomy and a model after jawbone restoration, importing the models into navigation design software, designing key fixed-point positions by using the navigation design software, and exporting navigation files to the intraoperative navigator.
In this embodiment, any one of the navigation methods and the navigator in the prior art can be adopted as the navigation method and the navigator matched with the navigation method.
The application still provides a design device before two side jaw coloboma rebuilds based on craniomaxillofacial three-dimensional form database, the device includes: the information acquisition unit is used for acquiring a three-dimensional shape image of the skull to be repaired and a preset database; the model retrieval unit is used for retrieving a target standard skull model from a preset database; a defect model generating unit, configured to generate a defect model according to the to-be-repaired skull model; the personalized template generating unit is used for synthesizing a personalized reference template according to the target standard skull model; a dentition form design unit for designing the final dentition form of the resection range according to the personalized reference template; and the implant design unit is used for designing the implant position and the shape and position of the donor bone according to the personalized reference template and the final dentition shape.
In this embodiment, the functions of each unit and the manner of implementing the functions are as described in the foregoing method, and are not described herein again.
The present application also provides a program for a bilateral jaw defect reconstruction preoperative design based on a craniomaxillofacial database, the program being for performing the method of the first aspect of the present application.
The present application also provides a hardware medium on which the aforementioned program designed before the reconstruction of bilateral jaw defects based on the cranio-maxillofacial database is stored, and which can be executed on a processor.
The present application has been described in detail with reference to specific embodiments and illustrative examples, but the description is not intended to limit the application. Those skilled in the art will appreciate that various equivalent substitutions, modifications or improvements may be made to the presently disclosed embodiments and implementations thereof without departing from the spirit and scope of the present disclosure, and these fall within the scope of the present disclosure. The protection scope of this application is subject to the appended claims.
Claims (1)
1. A bilateral jaw bone defect rebuilds preoperative design device based on craniomaxillofacial database, its characterized in that, the device includes:
the information acquisition unit is used for acquiring a three-dimensional shape image of the skull to be repaired and a preset database;
the model retrieval unit is used for retrieving a target standard skull model from a preset database;
the defect model generating unit is used for generating a defect model according to the skull model to be repaired;
the personalized template generating unit is used for synthesizing a personalized reference template according to the target standard skull model and the defect model;
the dentition form design unit is used for designing the final dentition form of the resection range according to the personalized reference template;
the implant design unit is used for designing an implant position and the shape and the position of a donor bone according to the personalized reference template and the final dentition shape; wherein the content of the first and second substances,
the model retrieval unit is specifically configured to: marking a plurality of characteristic mark points on the three-dimensional shape image of the skull to be repaired; acquiring characteristic information corresponding to each characteristic mark point, wherein the characteristic information comprises characteristic mark point coordinates, line distances, angles and proportion parameters;
the characteristic mark points comprise cranium mark points, upper jaw mark points and lower jaw mark points, wherein the cranium mark points comprise nasal root points, left and right nasal forehead points, sphenoid saddle points and skull base points; the upper jaw mark points comprise an anterior nasal spine point, an upper gullet seat point, an upper gullet edge point and an upper middle incisor point; the lower jaw mark points comprise lower incisor points, left and right lower first molar points, lower tooth socket marginal points and lower tooth socket base points;
the personalized template generating unit is specifically configured to:
superposing jaw three-dimensional morphological images of a target standard skull model with jaw three-dimensional morphological images of a skull model to be repaired, wherein the skull model to be repaired is divided into two independent sub models according to the upper jaw and the lower jaw;
designing a prosthesis model according to the skull defect model to be repaired and the target standard skull model;
generating an individualized reference template according to the prosthesis model and the skull defect model to be repaired, wherein the individualized reference template is provided with dentitions;
further, generating a personalized reference template according to the prosthesis model and the skull defect model to be repaired comprises: determining a prosthesis model at a corresponding position of the target standard skull model; trimming the restoration body model according to the range to be restored; and fusing the repaired prosthesis model with the skull defect model to be repaired.
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| CN112017275B (en) * | 2020-08-26 | 2022-10-21 | 长春理工大学 | Auxiliary positioning method for face midsagittal reference plane |
| CN112826641B (en) * | 2021-01-12 | 2021-12-14 | 北京长木谷医疗科技有限公司 | Guide plate design method for total hip replacement and related equipment |
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