等比例三维模型在Anderson Ⅱ型齿状突骨折后路术式中的应用  

APPLICATION OF PROPORTIONAL THREE-DIMENSIONAL CERVICAL MODEL IN MANAGEMENT OF ANDERSON TYPE ⅡODONTOID FRACTURES WITH POSTERIOR C1/2 PEDICLE SCREW

作　　者：龚凯[1] 屈波[1] 朱妍[2] 梁锋[1] 肖伟[3] 李霖[1] 刘达[1] 盛珺[1] 潘显明[1] 冉金伟[4] 张传志[4] 

机构地区：[1]成都军区总医院骨科,四川省成都市610083 [2]成都军区总医院手术室 [3]成都军区雅安第三十七医院 [4]重庆市中医院

出　　处：《中国煤炭工业医学杂志》2016年第8期1120-1123,共4页Chinese Journal of Coal Industry Medicine

基　　金：重庆市卫生局医学科研项目(编号:2013-2-089)

摘　　要：目的制作上颈椎等比例三维实物模型,探讨其在寰枢椎后路融合治疗AndersonⅡ型齿状突骨折的应用效果。方法采集28例AndersonⅡ型齿状突骨折术前CT扫描数据,进行数字化三维重建、快速成型制备的等比例三维上颈椎实物模型,使用模型进行术前计划,术前制钉预操作,术中直观参考指导置钉,测量进针点及钉道参数并行统计学分析及比较。结果所有患者手术过程顺利,术中所见与术前三维实体模型的病灶结构变化一致,术前计划与术中实际进钉点及钉道各参数间比较未见明显统计学差异(P>0.05)。术后VAS及JOA评分与术前比较差异有统计学意义(P<0.01),术中置钉过程顺利,未发生椎动脉、脊髓损伤。结论针对AndersonⅡ型齿状突骨折行后路寰枢椎融合术,等比例三维颈椎实物模型能准确、有效指导制定手术计划和术中置钉。Objective To construct proportional three- dimensional model of upper cervical spine by using digital CT and rapid prototyping and investigate its value in managing Anderson type Ⅱ odontoid fractures with posterior C1/2 pedicle screw. Methods The CT scans of 28 patients with Anderson type Ⅱ odontoid fractures were used for three - dimension reconstruction and the rapid prototype proportional mode of the upper cervical spine. Preoperative plan, pre - operation with nail and intraoperative visual guide was a- chieved by the three- dimensional model. The location of screw and parameter of screw channel was meas- ured and compared between pre opreation and intra- operation. Results All operations were successfully performed under the guidance of 3D entity model There was no complication reported. Intraoperative find- ings, distance from the entry point to the midline, extroversion angle and deepth of screw path of 28 patients were the same as those on the models of upper cervical spine（ P〉0.05）. The postoperative VAS and JOAscore was significantly improved than the preoperative ones（P〈0.05）. Conclusion For Anderson typeⅡ odontoid fractures treated by C 1 and 2 pedicle screw and fusion,proportional three- dimensional cervical model shows its accuracy and advantage in making pre - operation plan and screw placement.

关 键 词：三维重建 等比例实物模型 寰枢椎螺钉 AndersonⅡ型齿状突骨折 

分 类 号：R683.2[医药卫生—骨科学]