快速成型个体化导航模板辅助胸椎椎弓根螺钉置入可行性研究  

Feasibility study of transpedicular screw placement assisted by individual navigation templates in the thoracic spines

作　　者：陈玉兵[1] 陆声[1] 徐永清[1] 张元智[2] 师继红[1] 陈国平[1] 

机构地区：[1]成都军区昆明总医院全军骨科中心昆明医学院成都军区昆明总医院临床学院,云南昆明650032 [2]内蒙古医学院第一附属医院骨科,内蒙古呼和浩特010050

出　　处：《中国矫形外科杂志》2009年第20期1557-1561,共5页Orthopedic Journal of China

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

摘　　要：[目的]通过尸体标本实验的方法探讨个体化导航模板辅助胸椎椎弓根螺钉置入的准确性及可行性。[方法]对6具胸椎尸体标本进行CT扫描,根据CT扫描资料,利用逆向工程原理及快速成型技术设计制造出个体化导航模板,利用个体化导航模板在尸体标本上辅助置入胸椎椎弓根螺钉,所有螺钉的置入由同一位具有腰椎椎弓根螺钉置钉经验但无胸椎椎弓根螺钉置钉经验的骨科医师进行操作,随后采用大体解剖的方法肉眼观察置钉的准确性;并根据螺钉是否穿破椎弓根、穿出距离及穿破方向进行分级。[结果]共设计制作了72个个体化导航模板辅助置入胸椎椎弓根螺钉144枚,132枚(91.7%)螺钉完全在椎弓根内;12(8.3%)枚螺钉穿破椎弓根,其中2枚螺钉穿破椎弓根内侧壁(穿破距离分别为0.6、0.8 mm),10枚螺钉穿破椎弓根外侧壁(9枚螺钉穿出距离<2 mm,1枚螺钉穿出距离为2.5 mm);没有椎弓根上方、下方及椎体前方穿破的螺钉。所有穿破椎弓根壁的螺钉均在安全可接受的范围内。[结论]快速成型个体化导航模板辅助胸椎椎弓根螺钉置入准确率高,对术者无特别的经验要求,手术操作简单、安全,可避免术中放射性损伤,为胸椎椎弓根螺钉的置入提供了一种新的可行方法,尤其适用于初学者。[ Objective] To validate the accuracy and feasibility of transpedicular screw placement assisted by individual navigation templates in the thoracic spines by a cadaveric study. [ Method ] A novel individual navigation template was developed by reverse engineering and rapid prototyping according to pre-operative CT data of six thoracic cadavers. The templates were used for thoracic pedicle screw placement in the cadavers. All screws were implanted by an experienced orthopaedic surgeon in the lumbar spines but not in the thoracic spines. Subsequently, an anatomic dissections were performed to evaluate the accuracy of the placed screw and orientation relative to the pediele axis. The relative position of the screw to the pedicle was graded. [ Result] Totally 144 pedicle screws assisted by 72 individual navigation templates were implanted in the eadaveric thoracic spines. Totally 132 （91. 7% ） screws were completely inserted within the pedicle. Twelve（8.3% ） screws breached the pediele cortex, which included 2 medial and 10 lateral breaches. Two medial breaches were respectively 0.6 mm and 0.8 mm distance from pediele cortex, and 9 lateral breaches were less than 2 mm and the other one were 2.5 mm. No screw breaches were superior or inferior to the pedicle, or anterior to the vertebral body. All misplaced screws were within an aeceptable range.[ Conclusion ] Transpedicular screw placement assisted by individual navigation templates has a high accuracy and safety in the thoracic spines. The operative procedure is simple, without special experience requirements for surgeons. The exposure of the surgeon to radiation can be avoided. The use of individual navigational templates to place thoracic ped- icle screws is feasible and is especially suited to the beginners.

关 键 词：胸椎 椎弓根螺钉 快速成型 逆向工程 个体化导航模板 

分 类 号：R687.3[医药卫生—骨科学]