3D打印导航模块辅助腰椎弓根螺钉数字化置入的实验精度  

Experimental accuracy of lumbar pedicle screw placement based on digital design and 3D printing navigation module

作　　者：林海滨[1] 张国栋[1,2] 陈宣煌[1] 吴长福[1] 郑晓晖[3] 陈旭[1] 余正希 林益军[4] 黄文华[2] 

机构地区：[1]福建医科大学莆田学院附属医院教学医院骨科,南方医科大学附属莆田医院骨科,莆田学院附属医院骨科,莆田351100 [2]南方医科大学基础医学院人体解剖学教研室,广州510515 [3]中国人民武装警察部队福建省总队医院骨科,福州350003 [4]福建医科大学莆田学院附属医院教学医院医学影像科,南方医科大学附属莆田医院医学影像科,莆田学院附属医院医学影像科,莆田351100

出　　处：《解剖学杂志》2016年第4期459-464,共6页Chinese Journal of Anatomy

基　　金：中国国家高技术研究发展计划(“863计划”)(2012AA02A603);福建省医学创新课题(2012-CX-34);福建省自然科学基金(2016J01607);广东省科技计划项目(2015B010125005);广东省广州市科学研究专项项目(2014J4100153);福建省教育厅中青年教师教育科研项目(JA14274);福建省卫生和计划生育委员会青年科研课题(2015-2-32);福建省莆田学院校内科研项目(2016055)

摘　　要：摘要目的：探讨3D打印导航模块技术辅助下实施腰椎椎弓根螺钉置入数字化设计的实验精度及准确度的评价方法，探讨影响准确度的关键技术。方法：14具成人尸体腰椎标本，经过薄层CT扫描，三维编辑分离椎骨，按照钉道对称原则设计钉道，根据骨面可剥离范围设计具有定位面及稳定面的导航模块，高精度3D打印导航模块，在尸体标本上实施导航模块辅助下腰椎椎弓根螺钉置入。术后腰椎与术前设计进行三维配准，采集术前设计以及术后螺钉的钉道的进、出钉点三维坐标值，以其差值的绝对值为实验精度指标，统计不同等级精度下的合格钉点，设计组和手术组进行卡方检验。结果：128根腰椎椎弓根螺钉无1例穿出骨质外。进钉点X、Y、Z轴精度分别为0．60mm±0．44mm、0．66nml±0．64nlm及0．48mm±0．36mm，出钉点则为1．13mm±0．82mm、0．51mm±o．44mm及0．67mm±0．62mm。结论：腰椎椎弓根螺钉数字化置入的精度可用术前设计和术后的进、出钉点的三维坐标值的差值绝对值衡量，实施的准确度可以用不同等级精度评判；根据骨面可剥离范围设计具有定位面以及稳定面的卡位模块，可实现术中唯一卡位位置；钉道对称是手术设计及实施都要遵循的原则。Objective： To explore the evaluation method of experimental precision and accuracy for the implementation of lumbar pedicle screw based on digital design and 3D printing technology, and to investigate the key techniques that affect the accuracy. Methods： 14 adult cadaveric lumbar spine specimens were used in this experiment. All specimens were treated with thin slice CT scanning to separate vertebraes by 3D editing in Mimics 14. 0 to design the screw channels according to the symmetry principle, and to design the navigation module that had a locating surface and a stabilizing surface according to the dissect- able area on the bone surface. The navigation modules were 3D printed with high precision. Lumbar pedicle screws were inserted into the specimens by using the assisted navigation modules. 3D registration was performed between the postoperative and the preoperative designed lumbars to obtain the data of the three dimensional coordinate values of postoperative and the preoperative designed screw channels. Taking the absolute value of the difference as the experimental precision index, the qualified screw points under various levels precision in design group and operation group were treated with chi square test. Results： Of 128 lumbar pedicle screws, no one was found penetrating out of the bone substance. The precision of entrance points of X, Y, Z axis were 0.60 mm±0. 44 mm, 0.66 mm±0.64 mm, 0.48 mm±0. 36 mm respectively, while the piercing points were 1.13 mm±0.82 mm, 0.51 mm±0.44 mm, 0.67mm±0.62 mm respectively. Conclusion： The precision of the digitized placement of lumbar pedicle screw can be judged by the absolute value of the difference of three-dimensional coordinate values of postoperative and the preoperative entrance points and piercing points, and the accuracy of the implementation can be judged by various levels precision. The unique intraoperative clamping position can be realized by using the clamping module that has a locating surface and a stabilizing surface, which is designed ac

关 键 词：腰椎椎弓根螺钉 内固定 数字化 3D打印 计算机辅助 

分 类 号：R687.3[医药卫生—骨科学] TP391.73[医药卫生—外科学]