漏斗胸合并脊柱侧弯矫形手术方案的研究

Pectus Excavatum(PE )with idiopathic scoliosis(IS) deformity accounts for about 30% in the patients with PE. IS should aggravate the patient's condition of PE.In practice because of lack of mechanism of the correction the doctor haveto give up the Nuss procedure and has become a problem of the domestic operation of chest deformity.This study tries to PEmerger scoliosis deformity of the process of orthopaedic by numerical simulation and the animal study, to explore the mechanism of orthopaedic, quantitative research board shape, quantity, orthopaedic, placed the position and ribs in scoliosis deformation of the deformation of the influence, solve PEmerger scoliosis deformity with minimally invasive orthopaedic can make double deformity of benefit indications. Through the animal orthopaedic finite element analysis of stress for site, the site of the measurement the measured power of meet an emergency, solve in the human body can not complete the actual orthopaedic process the bones of thoracic mechanical change each other, virtual simulation and practical verification of orthopaedic results, modify the calculation model of our results error. Design simulation manufacturing people with thoracic spinal deformity PEexperiment device, in the lab for people of orthopaedic experiment chest funnel model, through which design, combine both the Nuss procedure and the external fixation directing PEmerger scoliosis deformity orthopaedic surgery scheme, training professional personnel, improve and improve patients anterior chest wall and scoliosis double deformity of the orthopaedic curative effect.

漏斗胸合并脊柱侧弯畸形约占漏斗胸患者的30%。临床发现，对此类患者进行漏斗胸微创矫形可能会加重脊柱侧弯畸形，因为矫形机理不明，医生被迫放弃手术，患者将终生得不到治疗，已经成为国内外胸部畸形矫形手术的难题。本项目拟综合采用三维重建，数值模拟，动物实验和人体胸廓模型实验等方法，研究漏斗胸矫形对脊柱侧弯的影响。通过对漏斗胸临床矫形病例的数值模拟和动物实验，确定数值模拟采用的计算模型和计算方法，保证计算得到的位移和应变结果准确。通过参数研究和人体胸廓模型的矫形实验，确定漏斗胸微创矫创形对脊柱侧弯的影响因素，参数研究包括漏斗胸的塌陷位置，塌陷程度，脊柱侧弯的凹凸方向和曲率大小，矫形板的形状，数量和位置等。将漏斗胸微创矫形手术方法和治疗骨折的外固定方法结合起来，提出基于计算的漏斗胸合并脊柱侧弯畸形的微创矫形手术方法，设计个性化的微创矫形手术方案，对漏斗胸合并脊柱侧弯畸形患者进行微创矫形，解除患者病痛。

因为缺少对漏斗胸合并脊柱侧弯的矫形机理的研究，医生多数依据经验设计矫形手术，因为要面临术后引发或加重患者的脊柱侧弯的风险，医生被迫放弃手术，致使患者得不到治疗。.课题组重建了漏斗胸合并脊柱侧弯病例的畸形胸廓模型，对微创矫形过程进行了数值模拟，计算结果显示，胸骨抬高位移与临床结果一致，预测的脊柱侧弯变形结果好于临床结果。为方便参数研究和适应快速为临床手术方案设计提供参考的需要，课题组提出了创建畸形胸廓模型的三维简化实体模型，梁单元和混合计算模型的方法，与临床术后结果进行了比较。提出了漏斗胸合并脊柱侧弯病症新的分型方法，考虑了脊柱侧弯与漏斗胸塌陷相对高度关系对脊柱侧弯的影响，进行了参数研究为临床手术方案设计提供了参考建议。定量研究了胸廓肌肉，韧带，椎间盘和肋间肌对脊柱侧弯变形的影响，研究发现椎间盘和肋间肌是影响畸形胸廓的脊柱侧弯变形的主要因素，其中椎间盘对平直脊柱与侧弯脊柱分别具有增大与吸收脊柱侧弯变形的作用；肋间肌对漏斗胸合并脊柱侧弯的影响与病例的类型有关，分别具有阻碍脊柱侧弯变形改善与延缓脊柱侧弯变形恶化的作用。采用3D打印技术制备了正常胸廓和畸形胸廓模型，发展了基于数值模拟结果的电测实验研究方法，进行了实验，比较了数值计算结果与实验结果的误差，改进了计算模型，提高了计算精度和效率。进行了动物胸廓模型的电测实验，得到了肋骨与胸骨的应变分布规律，与数值模拟结果进行了比较；研究了肋间肌对动物胸廓应变分布和对侧弯脊柱承载能力的影响。研究了侧弯脊柱拉伸矫形与钉棒矫形对漏斗胸变形的影响和矫形顺序对漏斗胸与脊柱侧弯变形的影响。.课题完成漏斗胸和漏斗胸矫形手术178例，积累了病例的影像资料，对影响漏斗胸和脊柱侧弯变形的因素进行了统计分析。培养硕士研究生9名，本科生2名，发表论文38篇，SCI论文10篇，EI论文3篇，ISTP论文1篇。授权发明专利1项，参加学术会议40人次，获得青年学者奖1项。