增强现实技术辅助3D打印儿童上颈椎模型椎弓根螺钉植入的实验研究  

Upper cervical pedicle screw implantation assisted by augmented reality in 3D-printed pediatric models:an experimental study

作　　者：刘柏麟 裴延军 陈亮[3] 靳俊功 李张珂 贺世明 Liu Bolin;Pei Yanjun;Chen Liang;Jin Jungong;Li Zhangke;He Shiming(Department of Neurosurgery,Xi’an International Medical Center Hospital,Xi’an 710100,China;Department of Neurosurgery,Southern University of Science and Technology Hospital,Shenzhen 518055,China;Chang’an University,Xi’an 710043,China)

机构地区：[1]西安国际医学中心医院神经外科,710100 [2]南方科技大学医院神经外科,深圳518055 [3]长安大学,西安710043

出　　处：《中华神经外科杂志》2021年第9期903-907,共5页Chinese Journal of Neurosurgery

摘　　要：目的评估增强现实(AR)技术辅助下,在3D打印的儿童上颈椎模型椎弓根植入螺钉模拟内固定技术的可行性和准确性。方法随机调取2019年12月至2021年3月在西安国际医学中心医院神经外科因颈椎疾病行手术治疗的8例患儿和2例颈椎正常患儿的颈椎CT资料,根据颈椎CT资料3D打印制备实体颈椎模型。并将CT数据导入Mimics软件,模拟重建3D模型并设计进针点及针道。AR设备辅助下在10具3D打印颈椎模型双侧C_(1)~C_(2)椎弓根植入螺钉模拟内固定操作。术后行CT扫描,采用Gertzbein-Robbins分级标准评估螺钉植入的准确性(A级和B级为准确植入)。结果共植入40枚椎弓根螺钉,螺钉植入的准确率为100%。螺钉植入后CT扫描显示螺钉位置均良好,完全在椎弓内部,其中Gertzbein-Robbins分级A级37枚,B级3枚。3枚螺钉穿破椎弓根(均<2.0mm),其中穿破内侧壁1枚,穿破下内侧壁1枚,穿破下外侧壁1枚。8具有颈椎病变的颈椎模型共植入32枚螺钉,其中Gertzbein-Robbins分级A级30枚;2具正常颈椎模型共植入8枚螺钉,其中Gertzbein-Robbins分级A级7枚,两者差异无统计学意义(P=0.498)。结论AR技术辅助3D打印儿童上颈椎模型椎弓根植入螺钉模拟内固定操作技术的成功率和植入准确性均高,但其安全性和有效性还有待于进一步临床研究证实。Objective To evaluate the technical feasibility and accuracy of augmented reality(AR)-assisted upper cervical pedicle screw implantation in 3D-printed pediatric models.Methods We randomly collected the cervical spine CT data of 8 children who underwent surgical treatment for cervical spine diseases at the Department of Neurosurgery of Xi'an International Medical Center Hospital from December 2019 to March 2021 and 2 children with normal cervical spine.The cervical spine model was 3D printed and made based on the cervical spine CT data.We imported the CT data into Mimics software to simulate and reconstruct the 3D model and design the needle entry point and trajectory.With the aid of AR equipment,103D printed cervical spine models were implanted with screws on both sides of C_(1)-C_(2)pedicles to simulate internal fixation.CT scan was performed after operation,and the accuracy of screw implantation was evaluated by Gertzbein-Robbins grading standard(level A and B revealed accurate implantation).Results A total of 40 pedicle screws were implanted,and the accuracy of screw implantation was 100%.CT scans after screw implantation showed that the screws were in good positions and were completely inside the vertebral arch.Among them,37 were grade A in Gertzbein-Robbins grade and 3 were grade B.Three screws penetrated the pedicle(all<2.0 mm),of which one penetrated the medial wall,1 penetrated the inferomedial wall,and 1 penetrated the inferolateral wall.A total of 32 screws were implanted in 8 cervical spine models with cervical disorders,including 30 in Gertzbein-Robbins grade A;2 normal cervical spine models were implanted with a total of 8 screws,of which 7 were in Gertzbein-Robbins grade A.There are no statistical differences between the two(P=0.498).Conclusion The success rate and accuracy of AR technology-assisted pedicle screw implantation in 3D printed children's upper cervical spine model simulating internal fixation operation are high,while its safety and effectiveness need to be confirmed by further clinical

关 键 词：颈椎 儿童 增强现实 椎弓根螺钉固定术 模型 

分 类 号：R726.8[医药卫生—儿科]