计算机辅助下术前测量下颈椎弓根内固定相关的解剖学参数  

Anatomical study of computer-assisted subaxial cervical pedicle fixation

作　　者：申洪全 柯珍勇[1] 汪洋[1] 顾琪珊[2] 班照楠[2] 周利强[2] 许冰[2] 

机构地区：[1]重庆医科大学附属第二医院骨科,重庆400010 [2]成都市第五人民医院骨科,成都611130

出　　处：《第三军医大学学报》2015年第16期1677-1681,共5页Journal of Third Military Medical University

摘　　要：目的计算机辅助模拟及测量各个下颈椎椎弓根螺钉置入的相关解剖数据,为临床个体化置入提供参考。方法对拟行下颈椎弓根螺钉内固定患者(共29例)行对应节段CT扫描,将结果导入Mimics 10.01观察及测量颈椎弓根皮质骨及松质骨宽度;再将三维重建导入Imageware 13.2中,按椎弓根轴线模拟钉道置入后测量模拟钉道的最大长度、与对应上下终板的角度、横向外倾角、内外偏角安全范围、头尾倾角安全范围等个体参数;模拟进钉点及其与横断面上与侧块最外缘的距离和矢状面与上关节突后下缘的距离;作为后期临床中个体化螺钉置入的参考。结果 1C3~C7椎弓根宽度逐渐增大,松质骨宽度范围为2.05~3.91 mm,皮质骨宽度范围为4.33~7.87 mm,其中C7最大,C3最小。2模拟椎弓根钉道横向外倾角35.012 6°~49.299 6°,模拟椎弓根钉道内偏角安全范围6.112 6°~9.219 6°、外偏角安全范围4.473 1°~8.779 6°;C3~C7模拟椎弓根钉道与对应上下终板的角度范围在12.6873°^-16.961 8°,模拟椎弓根钉道头倾角安全范围2.557 2°~5.834 2°、尾倾角安全范围7.063 2°~10.984 2°。3C3~C7椎弓根进钉通道长度逐渐增大,范围为26.813 6~35.341 9 mm,其中C7最大,C3最小。结论计算机辅助下对下颈椎椎弓根的个体化模拟及测量,可以在术前充分了解拟行椎弓根内固定的各个下颈椎相关解剖学参数。Objective To simulate and measure various anatomical data of subaxial cervical pedicle screw placement with computer assistance in order to provide reference for clinical individualized placement. Methods CT scanning was preformed preoperatively on the corresponding segment of the cervical pedicle screw fixation in 29 patients, and the data were then introduced into Mimics 10.01 for observation and measurement of pedicle width （PW） and pedicle sponge width （PSW）. Three dimensional reconstruction results were introduced to UG Imageware 13.2. After simulation of screw placement in the subaxial cervical spine, the following data were stimulated, including mimic screw maximum length, angles between analog pedicle screw and terminal plate of vertebral, distance between lateral mass in cross-sectional and X point, distance between lateral mass outer edge in sagittal plane and X point, angles between simulated screw and sagittal line, and internal, external, head and tail angle ranges of simulated screw, and the parameter were used as reference for the selection and determination of the individual screw placement. Results （1） The PW of C3 to C7 was increased gradually, and in a range of 4.33 to 7.87 mm, with that of C7 maximal while that of C3 minimal. The PSW of the segments was in a range of 2.05 to 3.91 mm. （2） The C3 to C7 angles between simulated screw channel and sagittal line was 35. 0126° to 49. 299 6°, the internal angle range of simulated screw channel was 6. 112 6° to 9.219 6°, and the external angle range of simulated screw was 4. 473 1° to 8.779 6°. The angles between simulated screw channel and terminal plate of vertebral was 12. 687 3° to - 16. 961 8°, the head angle range of simulated screw was 2. 557 2° to 5. 834 2°, and the tail angle range of simulated screw channel was 7. 063 2° to 10. 894 2°. （3） The stimulated screw channel length of C3 to C7 was increased, in a range of 26. 813 6 to 35. 341 9 mm, with that of C7 the longest and that of C3 the shortest. Conclusion We

关 键 词：颈椎椎弓根测量 模拟椎弓根螺钉道 计算机辅助 

分 类 号：R319[医药卫生—基础医学] R323.1