CN113576661B - 面向骨折手术机器人的踝关节骨折术后早期量化康复方法 - Google Patents
面向骨折手术机器人的踝关节骨折术后早期量化康复方法 Download PDFInfo
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Abstract
本发明公开了一种面向骨折手术机器人的踝关节骨折术后早期量化康复方法,基于有限元分析,采用骨间位移作为安全运动的限制条件,建立了踝关节骨折术后早期被动康复训练的定量方法。通过有限元分析,还可以揭示踝关节运动过程中,关节内部生物力学行为变化规律。弥补了传统生物力学研究中,针对踝关节骨折康复训练方法的缺失。同时,本发明对于其他可被重建的踝关节骨折类型具有普适性。该方法不需要大量的循环试验,可以大大降低时间成本和经济成本,且能够直接应用在机器人辅助康复工程中,降低术后并发症概率,提高康复质量。
Description
技术领域:
本发明涉及机器人与康复医学工程交叉领域,尤其涉及一种面向骨折手术机器人的踝关节骨折术后早期量化康复方法。
背景技术:
踝关节骨折是一种多发性疾病,脱位骨折必须手术治疗。准确的解剖复位和强力内固定可以最大限度地恢复踝关节的生理结构。然而,术后静养可能会导致踝关节功能丧失。早期康复训练已被证实可减少甚至避免深静脉血栓、肌肉挛缩、关节粘连和创伤性关节炎等系列并发症。一般而言,踝关节骨折术后康复训练分为被动康复和主动康复两种模式。被动康复通常由医生或器械辅助患者进行背屈/跖屈的康复训练,是术后早期最常用的康复方式。目前,被动康复训练方案的制定依赖于医生的经验,不适当或过度的运动范围可能会阻碍愈合甚至继发性损伤,至今尚无明确的踝关节骨折术后早期量化康复方法。
确定踝关节骨折的早期生物力学行为是量化康复运动范围的关键。有限元分析是解决生物力学问题最有效的技术之一。现有研究提供了建立完整踝关节有限元模型的方法,揭示了踝关节的不同类型损伤在静态载荷作用下的力学行为。然而,踝关节屈伸运动对关节内部力学环境(尤其是骨折部位)的影响规律尚无揭示。而这正是量化术后早期康复训练范围的核心和难题。
发明内容:
本发明的目的是基于有限元分析的手段,提供一种具有普适性的面向骨折手术机器人的踝关节骨折术后早期量化康复方法。
本发明解决上述技术问题采用的技术方案为:
提供一种面向骨折手术机器人的踝关节骨折术后早期量化康复方法,其包括以下步骤:
步骤1,对健康志愿者的CT数据集进行三维重建。
采集健康志愿者踝关节的CT图像,导入医用图像处理软件中进行阈值分割等操作,重建为包含胫骨、腓骨、距骨、跟骨(包括皮质骨和松质骨)、胫骨软骨、距骨软骨和两块距跟软骨的3D几何表面模型。导入逆向重建软件中进行精确曲面操作,形成三维实体。
步骤2,对健康踝关节的几何模型进行虚拟骨折和手术。
在三维绘图软件中进行虚拟截断模拟各种踝关节骨折类型,并根据实际情况用内固定器械模型进行虚拟内固定术。
步骤3,建立完整的踝关节骨折术后有限元模型。
在有限元仿真软件中***弹簧单元模拟踝关节韧带,胫腓联合近端施加固定约束,远端建立踝关节运动坐标系,施加背屈20°~跖屈32°的运动载荷,形成踝关节骨折术后有限元模型,并进行仿真计算。
步骤4,建立骨间位移与运动角度的关系,设置安全条件,得出康复训练范围。
将各个骨折部位的骨块断裂表面和本体断裂表面的平均位移差定义为骨间位移。输出骨间位移与运动角度之间的关系。根据以往研究结果,以150μm作为安全限制条件,即可由步骤4中得到的关系量化踝关节骨折术后早期的被动康复范围。
本发明的有益效果为:
本发明提供了完整的踝关节骨折术后有限元模型的建立方法,通过施加屈伸运动载荷,分析了康复运动刺激下的关节内部生物力学行为。提出了一种具有普适性的面向骨折手术机器人的踝关节骨折术后早期量化康复方法。理论上,该方法适用于任何可以三维重建的踝关节骨折类型。解决了踝关节骨折术后早期康复训练的盲目化、经验化问题。
附图说明:
图1本发明提出的踝关节骨折术后早期康复训练范围的量化方法流程图;
图2本发明的其中一个实例的骨折模拟示意图;
图2a外踝骨折方式示意图;
图2b内踝骨折方式示意图;
图2c后踝骨折线定义示意图;
图2d后踝骨折方式示意图;
图3本发明的其中一个实例的术后有限元模型示意图;
图3a正面;
图3b背面;
其中:1-骨间膜;2-胫腓前韧带;3-胫腓后韧带;4-胫距前韧带;5-胫距后韧带;6-距腓前韧带;7-距腓后韧带;8-跟腓韧带;9-胫跟韧带;10-距跟内韧带;11-距跟外韧带;12-距跟内韧带;
图4本发明的其中一个实例的骨间位移与运动角度曲线图;
具体实施方式:
下面将以44A3.3型骨折作为本发明的其中一个实施例,对本发明的技术方案进行清楚、完整地描述。
参阅附图1,本发明提出的一种面向骨折手术机器人的踝关节骨折术后早期量化康复方法,包括以下步骤:
步骤1,采集健康志愿者的CT图像导入医用图像处理软件,结合逆向工程软件,重建出完整踝关节三维实体模型。
在本发明的其中一个实施例中,将CT图像导入Mimic中进行阈值分割,分割出胫骨,距骨,腓骨和跟骨的位置及大致轮廓。结合手动操作填充4块骨头内部空腔,形成4个完整蒙版。此时,皮质骨和松质骨并未分割。采用形态学腐蚀操作结合手动修饰,从4块完整骨头蒙版中,分割出相应的松质骨蒙版。采用布尔运算,分割出相应的皮质骨蒙版。根据CT图像和踝关节软骨的解剖学位置,从相应的骨蒙版中,手动绘制胫骨软骨、距骨软骨和2块距跟软骨,采用布尔运算从骨蒙版中分割软骨并结合手动修饰形成4块软骨的蒙版。将它们重建为三维表面后,进行平滑处理和网格简化,以STL格式保存。
在本发明的其中一个实施例中,将得到的12个模型导入Geomagic Studio中进行精确曲面操作,形成三维实体模型,以STEP格式保存。
在本发明的其中一个实施例中,将皮质骨和软骨在SolidWorks中打开进行布尔运算,保证模型间接触平滑无干涉。以STEP格式保存。
步骤2,在三维绘图软件中进行虚拟截断模拟踝关节骨折,并根据实际情况用内固定器械模型进行虚拟内固定术。
在本发明的其中一个实施例中,将得到的胫骨和腓骨模型导入SolidWorks中。骨折的模拟是根据AO分型实施的。参阅附图2,腓骨骨折的模拟是以距离外踝前缘22mm并与横断面平行的平面切断;内踝骨折是在踝榫部位,用与横断面夹角30度的平面截断;连接胫骨远端外侧两凸起AB作为参考线,连接后踝与内踝交点O与AB线1/4处点C作为骨折线,后踝骨折的模拟用过OC线与横断面成60度的平面截断。
在本发明的其中一个实施例中,内固定器械包括钢板和螺钉,其中钢板是通过CT图像重建出的模型,螺钉由圆柱体模型代替。将骨折模型与内固定器械模型组装形成骨折术后的三维实体模型,以STEP格式保存。
步骤3,在有限元仿真软件中,建立完整的踝关节骨折术后有限元模型。
在本发明的其中一个实施例中,参阅附图3,将全部模型导入Ansys Workbench中进行下一步操作。韧带的模拟采用线性弹簧来模拟,考虑包括12种:骨间膜(Inte)、经费前韧带(ATiFL)、胫腓后韧带(PTiFL)、胫距前韧带(ATiTL)、胫距后韧带(PTiTL)、距腓前韧带(ATaFL)、距腓后韧带(PTaFL)、跟腓韧带(CaFL)、胫跟韧带(TiCL)、距跟内韧带(MTaCL)、距跟外韧带(LTaCL)和距跟后韧带(PTaCL)。韧带的刚度和数量列于表1中。
表1韧带刚度
所有的骨和植入物都假设为各向同性的线弹性特征,所用到的材料属性列在表2中。由于骨和软骨表面的复杂性,选择***格划分的方法。网格模型有58627个节点,28730个单元。为了使整个模型更加接近真实生物力学条件,谨慎选择相互作用类型,螺钉与骨之间进行绑定约束模拟螺钉的预紧力。软骨和骨之间施加绑定约束固定他们的相对位置。软骨之间,断裂骨块与本体之间定义为摩擦类型,摩擦系数分别为0.1和0.4。
表2材料属性
根据国际生物力学学会对踝关节坐标系的定义,以内踝尖与外踝尖连线的中点为原点,连线为旋转轴,建立踝关节坐标系,分别在踝关节正常运动范围内施加背屈20°和跖屈32°的旋转载荷,并经过多次试验,在旋转同时在背屈时施加3mm的y轴负向位移和2mm的z轴负向位移,在跖屈时施加3mm的y轴正向位移和1mm的z轴负向位移,用来保证踝关节接触面的贴合,胫骨和腓骨近端表面施加固定约束。
步骤4,建立骨间位移与运动角度的关系,设置安全条件,得出康复训练范围。
在本发明的其中一个实施例中,分别选择外踝,内踝,后踝骨块的断裂面和本体的断裂面输出平均位移,将数据已csv格式保存。在Matlab中进行数据整理和计算,得到骨块与本体之间的相对位移差随时间的变化,这里将相对位移差称为骨间位移。参阅附图4,将时间步中运动角度随时间的变化映射到骨间位移得到骨间位移与运动角度曲线图。
在本发明的其中一个实施例中,参考Fujie H等人和Shimamura Y等人的研究。(详情请查阅参考文献:Fujie H.机械刺激对骨折愈合的负面影响[J].Jscbrr,1988,10.和Shimamura Y,Kaneko K,Kume K,et al.模拟内踝骨折的三种内固定方法后踝关节的初始安全运动范围.Clinical Biomechanics,2006,21(6):617-622.)以150μm作为安全限制条件(附图4),得出了该实施例的术后早期安全运动范围:背屈10.1°~跖屈12.5°。
综上所述,本发明基于有限元分析,采用骨间位移作为安全运动的限制条件,建立了踝关节骨折术后早期被动康复训练的定量方法。通过有限元分析,还可以揭示踝关节运动过程中,关节内部生物力学行为变化规律。弥补了传统生物力学研究中,针对踝关节骨折康复训练方法的缺失。同时,本发明对于其他可被重建的踝关节骨折类型具有普适性。该方法不需要大量的循环试验,可以大大降低时间成本和经济成本,且能够直接应用在机器人辅助康复工程中,降低术后并发症概率,提高康复质量。
本发明的实施方式并不局限于上述的具体实施例。如果本领域的普通技术人员受其启示,在不脱离本发明宗旨和权利要求所保护范围的情况下,做出其他变化或变型,均属于本发明的保护范围。
Claims (2)
1.一种面向骨折手术机器人的踝关节骨折术后早期量化康复方法,其特征在于,包括以下步骤:
步骤1,对健康志愿者的CT数据集进行三维重建;
采集健康志愿者踝关节的CT图像,导入医用图像处理软件中进行阈值分割操作,重建为包含胫骨、腓骨、距骨、跟骨、胫骨软骨、距骨软骨和两块距跟软骨的3D几何表面模型;导入逆向重建软件中进行精确曲面操作,形成三维实体;
步骤2,对健康踝关节的几何模型进行虚拟骨折和手术;
在三维绘图软件中进行虚拟截断模拟各种踝关节骨折类型,并根据实际情况用内固定器械模型进行虚拟内固定术;
步骤3,建立完整的踝关节骨折术后有限元模型;
在有限元仿真软件中***弹簧单元模拟踝关节韧带,胫腓联合近端施加固定约束,远端建立踝关节运动坐标系,施加背屈20°~跖屈32°的运动载荷,形成踝关节骨折术后有限元模型,并进行仿真计算;
步骤4,建立骨间位移与运动角度的关系,设置安全条件,得出康复训练范围;
将各个骨折部位的骨块断裂表面和本体断裂表面的平均位移差定义为骨间位移;输出骨间位移与运动角度之间的关系;根据以往研究结果,以150μm作为安全限制条件,即可由步骤4中得到的关系量化踝关节骨折术后早期的被动康复范围。
2.根据权利要求1所述面向骨折手术机器人的踝关节骨折术后早期量化康复方法,其特征在于,所述步骤1中跟骨包括皮质骨和松质骨。
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