基于数字化三维重建及模拟置钉技术的儿童后路枕骨髁螺钉置钉可行性研究  

Feasibility of screw fixation for posterior occipitalcondyle in children:based upon digital three-dimensional reconstruction and simulated screw placement technique

作　　者：蒋毅 娄桢祺 马维虎[2] 秦力 吴可沁 李哲[1] 胡安全 王扬[2] Jiang Yi;Lou Zhenqi;Ma Weihu;Qin Li;Wu Keqin;Li Zhe;Hu Anquan;Wang Yang(Department of Orthopedics Surgery,Affiliated Hospital,Jiaxing University,Jiaxing 314000,China;Department of Spinal Surgery,Ningbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]嘉兴学院附属医院骨科,314000 [2]宁波市第六医院脊柱外科,315040

出　　处：《中华小儿外科杂志》2020年第8期744-749,共6页Chinese Journal of Pediatric Surgery

基　　金：浙江省自然基金(LY19H060002);浙江省医药卫生项目(2020KY284);嘉兴市重点扶持学科-骨外科学(19-fc-01)。

摘　　要：目的利用数字化三维重建技术优化测量儿童枕骨髁解剖学特征,并通过模拟置钉评估其置钉可行性。方法收集2016年12月至2019年6月行上颈椎螺旋CT扫描的年龄段为3~12岁非脊柱疾患儿童上颈椎CT影像学资料104例,其中男61例,女43例,依据年龄分为5组。将获得的CT数据导入Mimics软件,在三维视图下测量枕骨髁解剖学参数。随后,通过数字化三维重建技术获得枕骨及寰椎3D骨性结构并模拟置钉,计算不同年龄段后路枕骨髁螺钉置入成功率并在3-Matic软件协助下优化测量螺钉置钉参数,比较分析儿童枕骨髁解剖学参数及螺钉置钉参数间的差异。结果测得儿童枕骨髁解剖学参数长、宽、高及寰枕距离分别为(18.91±1.70)mm、(9.75±1.19)mm、(8.64±1.46)mm及(6.11±1.48)mm,且随年龄增长呈递增趋势(P<0.05)。枕骨髁内倾角与年龄相关性不明显(P>0.05)。枕骨髁解剖学参数左右侧及男女性别间比较,差异均无统计学意义(P>0.05)。获得可置入螺钉枕骨髁169侧,均成功置入直径3.5 mm螺钉,总置钉成功率为81.3%,双侧枕骨髁同时置钉成功率为75.6%,高年龄组具有较高的置钉成功率,男性置钉成功率与双侧同时置钉成功率均显著高于女性(P<0.05),但置钉成功率左右侧对比差异无统计学意义(P>0.05)。置钉参数男女性别间及左右侧对比,差异均无统计学意义(P>0.05)。进钉长度随年龄增长存在正相关性(P<0.05)。寰枕距离与枕骨髁高之间、钉道长度与枕骨髁长及枕骨髁内倾角与螺钉内倾角之间呈正相关性(r=0.838,P<0.05;r=0.944,P<0.05;r=0.347,P<0.05)。结论直径3.5 mm螺钉可安全置入寰枕距离>4 mm的3~12岁儿童枕骨髁,且置钉成功率随年龄增长呈递增趋势。数字化三维重建及模拟置钉技术可优化测量置钉参数从而合理设计置钉方案。Objective To evaluate the feasibility of screw placement for occipital condyle through morphological measurements of occipital condyle process in children using digital three-dimensional reconstruction technique.Methods A total of 104 children received computed tomography of upper cervical spine from December 2016 to June 2019.There were 61 boys and 43 girls with an age range of 3-12 years.They were divided into 5 age groups.The original data were imported into the Mimics software and anatomical parameters measured under three-dimensional views.And then the structures of occipital bone and atlas were reconstructed and screw placement of occipital condyle was simulated.The success rate of screw placement in different age groups was calculated and parameters of screw placement were measured with 3-Matic software.The parametric differences between anatomy of occipital condyle and screw placement were compared.Results The length,width,height and atlanto-occipital distance of occipital condyle were(18.91±1.70),(9.75±1.19),(8.64±1.46),(6.11±1.48)mm respectively and there was a trend of rising with advancing age(P<0.05).No significant differences existed in medial angulation of occipital condyle among different age groups(P>0.05).No significant difference existed in anatomical parameters of sideness or gender.A total of 169 sides of occipital condyle were successfully implanted with 3.5 mm screw.The total success rate of screw placement was 81.25%.The higher age group had a greater success rate of screw placement.Boys achieved a higher success rate of screw placement than that of girls(P<0.05).However,no significant difference of success rate existed between sideness and no significant difference existed in screw placement parameters between gender or sideness(P>0.05).Screw length increased with age(P<0.05).A positive correlation existed between atlanto-occipital distance and occipital condyle height,screw length and occipital condyle length,medial angulation of occipital condyle and medial angulation of screw(r=0.8

关 键 词：成像 三维 枕骨髁 骨螺丝 解剖学 

分 类 号：R726.8[医药卫生—儿科]