基于MATLAB的微创骨科穿刺规划平台构建与临床验证

Construction and clinical verification of minimally invasive orthopedic puncture planning platform based on MATLAB

目的:探讨MATLAB的影像微创骨科穿刺规划平台建立所需技术及临床应用指标。方法:利用MATLAB建立图像导入、三维重建与定位平台。选取重度椎间盘脱出患者40例,随机分为试验组与对照组各20例。试验组所得CT数据导入三维骨科微创定向系统(3DDisplay2.0)中进行三维重建,利用平台进行穿刺点定位、角度与穿刺深度测量;对照组CT数据打印成醋酸酯胶片,在术中进行定位、角度与深度测量。利用C臂机进行术中透视确认穿刺效果,记录穿刺耗时与术中并发症并做统计学处理。结果:建立起图像导入,三维显示与断层定位3个主要模块;试验组与对照组穿刺时程卡方值为14.546>10.828(P=0.001),透视次数卡方值为28.972>10.828(P=0.001);穿刺时程与透视次数的t值分别为6.022>4.144(P=0.001),10.314>4.144(P=0.001);试验组术中出现酸胀与疼痛为2例(10%),低于对照组的15例(75%)。结论:以MATLAB为基础的模块设计可有效对CT术前影像进行重构、定位与三维重建;病灶、棘突与穿刺点的三角关系可对穿刺方向进行有效修正;基于三维可视与夹角修正的骨科微创引导平台在椎间孔镜穿刺中可显著降低穿刺时程,减少透视次数与术中并发症。

Objective To explore the techniques and clinical application index for the establishment of a MATLABbased platform for minimally invasive orthopedic puncture planning.Methods MATLAB was used to establish the platform of image import,3D reconstruction,and localization.Forty patients with severe intervertebral disc herniation were randomly selected and divided into 20 cases in the experimental group and 20 cases in the control group.The CT data obtained by the experimental group were imported into the 3D orthopedic minimally invasive orientation system(3DDisplay2.0)for 3D reconstruction,and the platform was used for puncture point positioning,and puncture angle and depth measurement.The CT datas of the control group were printed into acetate film,and the positioning,angle,and depth were measured during the operation.The C-arm machine was used for intraoperative fluoroscopy to confirm the puncture effect,and the puncture time and intraoperative complications of the two groups were recorded and statistically processed.Results Three main modules of image import,3D display,and tomographic location were established;The chisquare value of puncture duration in the experimental group and the control group was 14.546>10.828(P=0.001),and the chi-square value of fluoroscopy times was 28.972>10.828(P=0.001).The t-values of puncture duration and fluoroscopy times were 6.022>4.144(P=0.001)and 10.314>4.144(P=0.001)respectively.The incidence of intraoperative pain and distension was 2 cases(10%)in the experimental group,which was lower than that in the control group(15 cases,75%).Conclusion The module design based on MATLAB can effectively reconstruct,locate and 3D reconstruct the CT preoperative images.The triangular relationship between lesion,spinous process and puncture point can effectively correct the puncture direction.The minimally invasive orthopedic guidance platform based on 3D visualization and angle correction can significantly reduce the puncture time,the number of fluoroscopy and intraoperative complications in the intervertebral foraminoscopic puncture.