文章摘要
王爽,李宏伟,王海洲,王帅,付玉平.基于三维重建模拟手术的胸椎椎弓根螺钉通用置钉技术的研究:数字解剖学研究.骨科,2019,10(2):111-114
基于三维重建模拟手术的胸椎椎弓根螺钉通用置钉技术的研究:数字解剖学研究
Uniform technology of inserting thoracic pedicle screws based on three-dimensional reconstructing surgery simulation: digital anatomy
投稿时间:2018-11-21  
DOI:10.3969/j.issn.1674-8573.2019.02.006
中文关键词: 胸椎  椎弓根螺钉  计算机,模拟
英文关键词: Thoracic vertebrae  Pedicle screw  Computers, analog
基金项目:辽宁省自然科学基金计划面上项目(201602746、201801208)
作者单位E-mail
王爽 北部战区总医院和平分院骨科沈阳 110003  
李宏伟 北部战区总医院和平分院骨科沈阳 110003 spinelihongwei@163.com 
王海洲 北部战区总医院和平分院骨科沈阳 110003  
王帅 北部战区总医院和平分院骨科沈阳 110003  
付玉平 北部战区总医院和平分院骨科沈阳 110003  
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中文摘要:
      目的 应用数字技术对一种胸椎椎弓根螺钉置钉技术的可行性进行探讨。方法 以53例中国成人胸椎三维CT为研究对象,在MIMICS软件中进行三维重建,向各节胸椎中置入椎弓根螺钉,进钉点统一选择上关节突外缘与横突上缘交点尾侧3 mm,进钉角度在矢状面垂直于上一椎体下关节突和本椎体下关节突连线,外展角度根据实际情况以棘突为参考确定。完成置钉后,观察各螺钉与周围骨质的关系以确定是否实现最佳位置置钉;以棘突为参考测量外展角,比较左右侧外展角度差异。结果 按所设计的方案可完成全部研究对象T1~12椎弓根螺钉的置钉,共1 272枚螺钉,除T3、T4双侧螺钉的外展角差异无统计学意义外,其余节段螺钉双侧外展角的差异均有统计学意义(P均<0.05)。结论 统一进钉点和矢状面进钉角度的方法可完成胸椎椎弓根螺钉置钉,考虑到多数椎体双侧椎弓根螺钉角度存在差异,应在术前完善三维CT等检查以明确解剖情况,必要时进行数字化模拟手术以提高置钉准确性。
英文摘要:
      Objective To discuss the feasibility of a novel method that inserting thoracic pedicle screws by digital technology. Methods The 3D-CT images of thoracic vertebrae in 53 Chinese adults were collected. In software MIMICS, the 3D reconstruction was done, and the pedicle screws were inserted using a uniform entry point as 3 mm caudal to the junction of the lateral margin of the superior articulating process and the upper margin of transverse process. The sagittal trajectory was vertical to the link-line of the inferior articular processes of the involved vertebra and upper vertebra. The relationship between the screw and the surrounding bone was observed to determine whether the best position for screw placement was achieved. Then the angulations of the screws in the software were measured using spinous processes as reference and the difference between left and right side of the same vertebrae was compared. Results There were 1 272 screws and all screws were inserted correctly using the current method. There were no significant differences between the angulations in each side of T3 and T4. The angulations of all other vertebrae were different in each side (P<0.05 for all). Conclusion It seems feasible to insert thoracic pedicle screws using a uniform entry point and fixed sagittal angle. It is helpful to do 3D-CT before operations since most angulations of the pedicle screws are different on the two sides of the same vertebrae. Also the process of ex-ante surgical simulation contributes to the improvement in the accuracy of the operation.
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