Razvoj sistema za zagotavljanje načrtovanega položaja kolčnih endoprotez s pacientu prilagojenimi medicinskimi pripomočki

Kostevšek Šegula, Urška

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Title:	Razvoj sistema za zagotavljanje načrtovanega položaja kolčnih endoprotez s pacientu prilagojenimi medicinskimi pripomočki
Authors:	ID Kostevšek Šegula, Urška (Author) ID Drstvenšek, Igor (Mentor) More about this mentor... ID Balič, Jože (Comentor) ID Vogrin, Matjaž (Comentor)
Files:	DOK_Kostevsek_Segula_Urska_2020.pdf (3,10 MB) MD5: B2EA2EEC56ACF815F0874BB690D5A976 PID: 20.500.12556/dkum/12ddd69f-6b7d-4ca6-852f-c9c58f53b222
Language:	Slovenian
Work type:	Dissertation
Typology:	2.08 - Doctoral Dissertation
Organization:	FS - Faculty of Mechanical Engineering
Abstract:	Popolna zamenjava kolka (ang. Total Hip Arthroplasty (THA)) je poseg, v katerem poškodovani kolk zamenjajo z notranjo sklepno protezo (endoprotezo). Če želijo zagotoviti pravilno in dolgoročno delovanje endoproteze, je treba oba dela vsadka pravilno orientirati v medeničnem prostoru. Slednjemu je namenjeno pred-operativno načrtovanje. Pred-operativno načrtovanje v ustaljeni kirurški praksi še vedno izvajajo na dvo-razsežnih rentgenskih slikah. 2D načrtovanje je načrtovanje na projekciji kosti, ki le stežka da oprijemljiv občutek trirazsežnosti defekta. Za ponovno vzpostavitev biomehanike kolčnega sklepa pri velikih defektih morajo ortopedski kirurgi defekt zapolniti s sestavljanjem standardnih komponent, ki se po podatkih iz obstoječih registrov ne obnesejo najbolje. Zaradi slednjega smo v sklopu te doktorske disertacije razvili in vzpostavili sistem načrtovanja in izdelave pacientu prilagojenih medicinskih pripomočkov. Razvili in izdelali smo sistem načrtovanja vsadka in vodil, ki so bila sredstvo za prenos načrtovanih parametrov v operativno okolje. Vsadek je oblikovno zapolnil defekt in je bil za vsakega pacienta posebej prilagojen glede na anatomske parametre njegove medenice, obliko defekta in razpoložljivo kost. Sistem smo klinično preizkusili na pacientih, ki so bili načrtovani za poseg zamenjave kolčne endoproteze in so imeli veliko izgubo kosti. Za vsakega v raziskavo vključenega pacienta smo na podlagi posnetkov medenice z računalniškim tomografom (CT) izvedli rekonstrukcijo tri-razsežnega modela, tri-razsežno načrtovanje posega, skonstruirali in izdelali sklope pacientu prilagojenih medicinskih pripomočkov, izdelali vso potrebno dokumentacijo, dokumentirali vsak operativni poseg in rezultate na podlagi po-operativnega CT posnetka analizirali. V sklopu doktorske disertacije smo izdelali 10 sistemov za 10 pacientov. Vsi klinični preizkusi sistema so bili uspešni, saj smo pri vseh pacientih dosegli stabilnost, trdnost in načrtovano biomehaniko sklepa. Povprečna razlika med načrtovanimi in pooperativnimi vrednostmi je glede na po-operativne CT posnetke vseh 10 bolnikov znašala 6 mm in 10°. Slednje je območje dosegljivih natančnosti zagotavljanja načrtovanega položaja kolčnih endoprotez s pacientu prilagojenimi medicinskimi pripomočki.
Keywords:	trirazsežno načrtovanje, individualni medicinski pripomočki, dodajalna izdelava, operacija kolka
Place of publishing:	[Maribor
Publisher:	U. Kostevšek Šegula]
Year of publishing:	2020
PID:	20.500.12556/DKUM-73163
UDC:	004.925:615.477.2(043.3)
COBISS.SI-ID:	32756739
NUK URN:	URN:SI:UM:DK:RG0T8AYF
Publication date in DKUM:	16.10.2020
Views:	1734
Downloads:	118
Metadata:
Categories:	KTFMB - FS
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Licences

License:	CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

Link:	http://creativecommons.org/licenses/by-nc-nd/4.0/
Description:	The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.
Licensing start date:	22.02.2019

Secondary language

Language:	English
Title:	Development of a system for ensuring the planned position of hip endoprostheses by patient specific medical devices
Abstract:	Total hip arthroplasty (THA) is an operation in which the damaged hip joint is replaced by an endoprosthesis. If surgeons want to ensure the correct and long-term functionality of endoprosthesis, both parts of the endoprosthesis must be properly positioned in the pelvic area. To achieve this, pre-operational planning is necessary. Pre-operational planning in conventional surgical practice is still carried out on two-dimensional X-ray images. X-ray images are bone projections and planning solely by them makes it difficult to get a sense of the three-dimensional defect. For the restoration of the hip joint in case of big defects, orthopaedic surgeons must fill the defect by assembling standard components, which according to the data from the existing registers, often does not yield a satisfactory result. Because of this, in the scope of this doctoral dissertation, a system of planning and manufacturing of a patient specific medical device was developed. System for construction of a patient specific implant and guides that transfer the planned parameters in to operating environment was established. The implant filled the defect and was specifically adapted for each patient according to the anatomical parameters of his pelvis, defect shape, and available bone. The system was clinically tested in patients who were planned for the revision operation of a failed THA and had a large bone loss. For each patient, reconstruction of the bones from the computed tomography (CT) studies, three-dimensional planning of the operations, the construction of the patient specific medical device packages, elaboration of all necessary documentation, documentation of each surgical procedure, and the analysis on the basis of the post-operative CT was made. The doctoral dissertation contains 10 systems for 10 patients. All clinical trials of the system were successful, with correctly achieved stability, strength and planned biomechanics of the joint in all patients. In the analysis of post-operative CT of all ten patients, an average difference between post-operative and planned data of 6 mm and 10 ° was detected. These results show the area of attainable precision in ensuring the planned position of the hip endoprosthesis with the use of the developed system of patient specific medical devices.
Keywords:	3D planning, custom made medical devices, additive manufacturing, hip operation

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