术中实时三维导航下经皮骶髂关节螺钉固定术的初步探讨  

Percutaneous insertion of sacroiliac joint screws under real-time 3D navigation

作　　者：王会祥[1] 汪方[1] 王秋根[1] 林艳萍[2] 陈豪[1] 陶星光[1] 

机构地区：[1]上海交通大学附属第一人民医院骨科,200080 [2]上海交通大学机械与动力工程学院

出　　处：《中华创伤骨科杂志》2013年第5期425-429,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81000795）;上海交通大学医工交叉重点基金（YG201121705）

摘　　要：目的探讨基于术前CT扫描的术中实时三维导航技术应用于经皮骶髂关节螺钉置入术的可行性。方法术前沿着5具正常骨盆标本骼骨翼各置入1枚钛钉后行CT扫描。将扫描数据导入Superlmage 软件完成骨盆的三维重建。将三维模型导入导航软件中，获得钛钉标识点在三维虚拟空间的坐标，并规划骶髂关节螺钉置入的安全路径。术中通过导航探针，获取钛钉的实际空间坐标，并与虚拟标识点进行配准；通过导航系统实时跟踪术中骨盆及手术器械的空间位置。在实时三维导航下按照虚拟规划的安全路径，在5具骨盆标本上各完成1枚经皮骶髂关节螺钉的置入，并记录手术操作时间。术后行骨盆CT扫描及三维重建，观察螺钉的位置，并与术前规划结果进行对比。结果在5具正常骨盆标本上按照术前虚拟规划的路径各顺利置入1枚骶髂关节螺钉。术后CT扫描显示5枚螺钉位置均满意，与术前虚拟规划结果基本一致。手术操作时间为19~23min,平均21.6min。结论术中实时三维导航技术充分利用术前虚拟规划信息，术中螺钉置入精度高，且无需X线透视，操作流程简单、快捷，在经皮骶髂关节螺钉固定术中具有良好的可行性。Objective To study the feasibility of using real-tine three-dimensional （3D） navigation based on preoperative CT scans in percutaneous insertion of sacroiliac joint screw. Methods CT scanning was performed in 5 cadaveric specimens of normal pelfvis into which 5 titanium screws were inserted as markers along the iliac wings . The CT scan data were imported to the Superlmage software for 3D reconstruction of the pelvis models. The 3D models were transferred to the navigation software to determine safe approaches for placement of sacroiliac joint screws on the basis of coordinates of the titanium screw markers in the virtual 3D space. Coordinates of the titanium screws in real space were obtained by the navigation probe before they were matched to the markers in the 3D model to complete the registration. Next the system real-time tracked the positions of surgical instrument and the cadaveric pelvis. Under the real-time 3D navigation, percutaneous implantation of one sacroiliac jint screw was completed in each of the 5 pelvis specimens in accordance with the safe approaches planned preoperation. Operative time was record. CT scans of the pelvis were obtained postoperatively for 3D reconstruction. Positions of the screws in postop-erative 3D models were observed and compared with those in the preoperative models. Results Ineach of the 5 cadaveric specimens of normal pelvis, one sacroiliac screw was successfully inserted along safe approach planned preoperatively. Postoperative CT scanning showed that the placement of 5 screws was highly accurate and consistent with the preoperative virtual planning. The operative time ranged from 19 to 23 minutes, averaging 21.6 minutes. Conclusions Since 3D real-time navigation can make a good use of preoperative virtual planning, screws can be placed accurately, simply and quickly in the operation without X-ray fluoroscopy. It is feasile to use 3D real-time navigation on the basis of preoperative CT scans in the percutaneous fixation with sacroiliac joint screws.

关 键 词：骨盆 骶髂关节 骨钉 外科手术 计算机辅助 体层摄影术 X线计算机 

分 类 号：R687.4[医药卫生—骨科学]