数字化技术在脊柱畸形手术中的应用  

Digital technique used in spinal deformity surgery

作　　者：陆声[1] 徐永清[1] 张元智[3] 师继红[1] 李栋平[2] 罗浩天[1] 安梅[1] 姜楠[1] 朱崇涛[1] 

机构地区：[1]成都军区昆明总医院全军骨科中心,昆明650032 [2]成都军区昆明总医院神经外科 [3]内蒙古医学院附属医院骨科

出　　处：《中华创伤骨科杂志》2011年第12期1156-1160,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81171428）;云南省社会发展科技计划（2011CA015）

摘　　要：目的介绍利用数字化技术为脊柱畸形手术提供更好的术前设计和术中实施措施。方法2006印11月至2011年8月利用三维町视化技术进行脊柱畸形术前计划，并采用个体化导航模板辅助置钉进行脊朴畸形纠正手术58例，男21例，女37例；年龄3-68岁，平均21岁。先对脊柱畸形部位行三维CT扫描，图像以．dicom格式保存，然后转换到Mimics软件里生成需要的脊柱三维重建模刊，通过术前脊柱畸形二维可视化研究进行于术规划；通过建立与椎体后部解剖学形态一致的模板设计虚拟的导向模板，将椎体和定位模板通过快速成型技术生产出实物导航模板，通过导航模板辅助畸形惟体的置钉。结果通过虚拟三维模型的术前规划为手术的准确实施提供了良好参考，在术中通过建赢的导航模板准确地完成了各种螺钉的精确置入，每枚螺钉的置入时间0．7-1．2min，平均1．03min，未出现与置钉相关的并发症。结论利用数字化技术提高了对脊柱畸形的进一步认识，并为脊住畸形手术各种内同定螺钉的覆人提供了一种新的方法。Objective To provide a better preoperative design and precise intraoperative navigation in the spinal deformity surgery by digital technique. Methods From December 2006 through August 2011, 58 patients with spinal defurmily requiring instrumentation were recruited for the present study. They were 21 men and 37 women, aged from 3 to 68 years （average, 21 years） . After a three dimensional CT scanning of the deformed spine was performed, the data were transferred via a . dicom network to a computer workstation. Mimics software was used to generate three dimensional reconstruction models of the spine. Vi- sual preoperational plans simulating the actual surgery were designed. And visual drill templates which po- tentially enabled a fit in a lock-and-key fashion similar to a physical casting of the vertebral surfaee were also designed. Acrylate drill guides were manufactured using rapid prototyping. The biomodels and drill guides were sterilized and used intraoperatively to assist surgical navigation and placement of instrumentation. Results The three dimensional preoperalional plans were found to be of great assistance in the execution of the surgery. The navigational templates provided accurate screw placement without instnlmental complications. The designs of the first 2 templates were suboptimal as the contact surface was too large and complex. Operating time was reduced as a result nf less reliance on intraoperative radiographs. Conclusion The digital technique is a novel method which can produce better preoperative design and precise intraoperative navigation for pedicle screw placement in the spinal deformity surgery.

关 键 词：成像 三维 外科手术 计算机辅助 脊柱 模型 解剖学 

分 类 号：R687.3[医药卫生—骨科学]