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首页> 外文期刊>Clinical biomechanics >New brace design combining CAD/CAM and biomechanical simulation for the treatment of adolescent idiopathic scoliosis
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New brace design combining CAD/CAM and biomechanical simulation for the treatment of adolescent idiopathic scoliosis

机译：结合CAD / CAM和生物力学模拟的新型支架设计，用于治疗青少年特发性脊柱侧弯

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Background: A numerical based brace design platform, including biomechanical simulation, Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) was developed to rationalize braces for the treatment of adolescent idiopathic scoliosis. The objective of this study was to test the feasibility of the approach and assess the effectiveness of braces issued from this platform as compared to standard brace design. Methods: The biomechanical finite element model was built using the 3D reconstruction of the trunk skeleton from bi-planar radiographs and of the torso surface from surface topography. The finite element model is linked to a CAD/CAM software (Rodin4D), allowing the iterative design and simulation of the correction provided by the brace, as well as predicting pressures exerted on the torso. The resulting brace design was then fabricated using a numerical controlled carver. A brace designed using this platform (New Brace) as well as a standard thoraco-lumbo-sacral orthosis (Standard Brace) were built for six scoliotic patients. Both brace effectiveness was assessed using radiographs and compared to the simulations. Findings: The New Brace corrected on average the spine deformities within 5° of Cobb angle of the simulated correction and with a similar correction as compared to the Standard Brace (average correction of 16°vs. 11°(MT); P = 0.1 and 13°vs. 16°(TL/L); P = 0.5 for the Standard Brace and the New Brace respectively). The two braces had a similar 10°lordosing effect of the thoracic curve. The coronal balance was quite similar (7.3 vs. 6.8 mm balance improvement respectively for New Brace vs. Standard Brace). Interpretation: These first clinical results showed the feasibility of building computer-assisted braces, equivalent to standard orthosis. An extended study on more cases is under way to fully assess this new design paradigm, which in the long term would allow improving brace design and rationalize the conservative treatments of scoliosis.
机译：背景：开发了基于数值的支架设计平台，包括生物力学模拟，计算机辅助设计和计算机辅助制造（CAD / CAM），以合理化支架以治疗青少年特发性脊柱侧弯。这项研究的目的是测试该方法的可行性，并评估与标准支架设计相比从该平台发布的支架的有效性。方法：使用3D重建双平面X射线照片的躯干骨骼和表面形貌的躯干表面，建立生物力学有限元模型。有限元模型链接到CAD / CAM软件（Rodin4D），从而可以迭代设计和模拟由支架提供的矫正，以及预测施加在躯干上的压力。然后，使用数控雕刻机来制作得到的支架设计。使用此平台设计的支架（New Brace）以及标准的胸腰lum矫形器（Standard Brace）为六名脊柱侧弯患者建造。两种支架的有效性均通过X光片进行了评估，并与模拟进行了比较。研究结果：新矫正器平均矫正了模拟矫正的Cobb角5°以内的脊柱畸形，并且与标准矫正器相比具有类似的矫正（平均矫正为16°vs。11°（MT）; P = 0.1和13°vs。16°（TL / L）;标准支撑和新支撑分别为P = 0.5）。这两个牙套的胸部曲线具有类似的10°配剂量作用。冠状平衡非常相似（新支撑与标准支撑的平衡分别提高了7.3与6.8毫米）。解释：这些最初的临床结果表明，建造与标准矫形器相当的计算机辅助支架的可行性。目前正在进行一项针对更多病例的扩展研究，以全面评估这种新的设计范例，从长远来看，这将有助于改善牙套设计并合理化脊柱侧弯的保守治疗方法。

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