计算机辅助个体化导航模板在Hangman骨折中的临床应用  

Clinical application of computer-assisted navigational template in Hangman fracture surgery

作　　者：陆声[1] 徐永清[1] 张元智[2] 师继红[1] 李军[1] 丁晶[1] 陈国平[1] 陈玉兵[1] 冯子良[3] 

机构地区：[1]成都军区昆明总医院全军骨科中心,650032 [2]内蒙古医学院第一附属医院骨科 [3]成都军区疾病预防控制中心博士后工作站

出　　处：《中华创伤杂志》2009年第10期886-889,共4页Chinese Journal of Trauma

基　　金：基金项目：国家博士后基金资助项日（20080431420）;云南省社会发展（基础研究）基金资助项目（2008CD210）

摘　　要：目的利用计算机辅助个体化导航模板为Hangman骨折后路经椎弓根固定提供准确定位。方法Hangman骨折患者CT连续扫描，三维重建软件MIMICS 10．01建立Hangman骨折三维模型，以STL格式导出模型。在UG Imageware 12．0平台打开三维重建模型。利用逆向工程（RE）原理寻找椎弓根的最佳进钉钉道。提取椎板的表面解剖学形态，建立与椎板解剖学形态一致的模板。拟合模板和椎弓根孔道成定位模板，将椎体和定位模板通过激光快速成形技术生产出实物模板，手术时利用建立的定位模板与椎体的后部结构相吻合，通过导航孔进行C2椎弓根的定位，置入椎弓根螺钉。同法制作C3椎弓根钉导航模板，对需行C2,3后路固定时进行C3椎弓根钉的导航定位。术后根据X线片和CT扫描评价椎弓根螺钉的位置。结果应用于4例患者，2例行C2椎弓根固定融合，例行单纯C2椎弓根螺钉固定；共置入C2椎弓根螺钉8枚，C3椎弓根螺钉4枚。术中模板与暴露的椎板贴合紧密，稳定性好，所有椎弓根螺钉置入均顺利。所有患者术中和术后未出现血管和神经并发症。结论利用逆向工程原理和快速成形技术生产出的导航模板具有较好的准确性，为Hangman骨折椎弓根的定位提供了一种新的方法，利用该方法可使Hangman骨折后路固定手术简单及安全化。Objective To provide accurate location for pedicle fixation with the help of computerassisted navigational template in hangman fracture surgery. Methods CT scanning of patients with Hangman fracture was performed, and three dimensional （3D） model of Hangman fracture was constructed by using software MIMICS 10. Of. The 3D model was then exported in STL format, and opened in a workstation running software UG imagewarel2.0. The optimal pediele channel was located according to reverse engineering. A virtual navigational template was established according to the laminar anatomic trait. The physical vertebrae and navigational template were manufactured by using rapid prototyping. The navigational template was sterilized and used to assist the placement of Hangman fracture pedicle screw. The C3 navigational template was made with the same method. The placement of the screws was confirmed by postoperative X-ray and CT scanning. Results Four patients were involved in the study, of whom two patients received C2 and C3 fusion and the other two patients received C2 pedicle fixation. A total of eight C2 pedicle screws and four C3 pedicle screws were inserted. The navigational template was found to be highly fit with the lamina of vertebra. No nerve or blood vessel complication was observed during and after operation. Conclusions The navigational template designed according to reverse engineering and made by rapid prototyping can facilitate cervical pediele location and make posterior operation for Hangman fractures safer.

关 键 词：脊柱骨折 枢椎 外科手术 计算机辅助 HANGMAN骨折 

分 类 号：R687.3[医药卫生—骨科学]