经口咽枢椎椎弓根逆向精确置钉的个性化组合式导航模板的研究

doi:10.13418/j.issn.1001-165x.2018.06.014

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (6): 669-673.doi: 10.13418/j.issn.1001-165x.2018.06.014

经口咽枢椎椎弓根逆向精确置钉的个性化组合式导航模板的研究

朱美松¹，　彭鹏²，　周潇齐¹，　苏泽鑫¹，　李思敬¹，　李鉴轶^{2, 3}，　林荔军¹

1.南方医科大学珠江医院关节骨病外科，广州 510282； 2.南方医科大学基础医学院人体解剖学教研室，
广东省医学生物力学重点实验室，广州 510515； 3.南方医科大学南海医院，佛山 528244

收稿日期:2018-01-31 出版日期:2018-11-25 发布日期:2018-12-29
通讯作者: 林荔军，主任医师，博士生导师, E-mail: gost1@smu.edu.cn
作者简介:朱美松（1991-），男，江西上饶人，硕士研究生，主要从事数字医学研究，E-mail: zhumeisongv@163.com
基金资助:
国家自然科学基金(31771330)；广东省科技计划项目(2014A020212200,2015A040404022,2015B010125006,2015B010125005)；广州市科技计划项目(201704020129, 201704020069)

Experimental study on the grouped individual guide template assisted C2 transoral pedicle placement

ZHU Mei-song¹, PENG Peng², ZHOU Xiao-qi¹, SU Ze-xin¹, LI Si-jing¹,LI Jian-yi ^2,3, LIN Li-jun¹

1.Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China;2.Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medicine Science, Southern Medical University, Guangzhou 510515, China;3.Nanhai Hospital, Southern Medical University, Foshan 528244，China

Received:2018-01-31 Online:2018-11-25 Published:2018-12-29

摘要/Abstract

摘要：

目的　利用CT三维重建、计算机辅助设计与快速成型技术为经口咽枢椎椎弓根逆向置钉设计制作一种新型的组合式个性化精确定位置钉的导航模板。方法　取4具成人颈椎标本进行CT扫描，在Mimics14.11中重建寰枢椎三维模型，将该模型结合经口咽寰枢椎复位钢板（transoral atlantoaxial reduction plate, TARP）导入Solidworks 2014软件，设计经口咽枢椎椎弓根组合式个性化导航模板。采用快速成型技术制备组合式个性化导航模板，经该导航模板辅助在枢椎标本上置入椎弓根钉，根据术后CT数据评价椎弓根钉道位置。结果　使用4个导向模板辅助置入8个枢椎椎弓根钉道，术后CT扫描计算水平面绝对偏差值为（0.85±0.70）mm，矢状面为（0.88±0.53）mm，水平面和矢状面的偏差值均无统计学差异（P>0.05）。在椎弓根螺钉钉道评价分析中，I型螺钉为7枚（87.5%），II型螺钉1枚（12.5%），所有螺钉处于可接受位置。结论　本研究提出了一种新型组合式个性化导航模板用于辅助经口咽枢椎椎弓根螺钉准确置入，其操作简单，准确性高，为经口咽枢椎椎弓根精准置钉提供了一种全新、安全的方法。

关键词: 经口咽寰枢椎复位钢板, 　寰枢椎脱位, 　导航模板, 　经口咽枢椎椎弓根逆向置钉

Abstract:

Objective　Using of 3D reconstruction, computer aided design and rapid prototyping(RP)technology to design and manufacture a novel grouped individual guide template for assisting C2 transoral pedicle placement.　Methods　After CT scanning of 4 adult cadaveric cervical specimens, 3D reconstruction models of upper cervical vertebrae were obtained by Mimics. Then 3D models of C1, C2 and the TARP were imported into Solidworks 2014 to design a grouped individual guide template for AAD. With the technology of rapid prototyping, the grouped individual guide template for AAD was manufactured. The templates were used for C2 transoral pedicle placement in cadavers. Subsequently, CT scan was performed to evaluate the screw position.　Results　All 8 K-wires were inserted into the cervical pedicles. The absolute deviations were (0.85±0.70) mm in axial plane and (0.88±0.53) mm in sagittal plane. No significant differences of the absolute deviations was observed on both the axial and sagittal planes（P>0.05）. In the classification of screw position, 7 screws position were in Type I, and 1 screw was in Type II.　Conclusion　C2 transoral pedicle placement assisted by the grouped individual guide template is highly accurate and simple. It is a new alternative to C2 transoral pedicle placement.

Key words: Transoral atlantoaxial reduction plate, 　Atlantoaxial dislocation, 　Individual guide templates, 　 C2 transoral pedicle placement

朱美松,彭鹏,周潇齐,苏泽鑫,李思敬,李鉴轶,林荔军. 经口咽枢椎椎弓根逆向精确置钉的个性化组合式导航模板的研究[J]. 中国临床解剖学杂志, 2018, 36(6): 669-673.

ZHU Mei-song, PENG Peng, ZHOU Xiao-qi, SU Ze-xin, LI Si-jing,LI Jian-yi, LIN Li-jun. Experimental study on the grouped individual guide template assisted C2 transoral pedicle placement[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(6): 669-673.

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经口咽枢椎椎弓根逆向精确置钉的个性化组合式导航模板的研究

Experimental study on the grouped individual guide template assisted C2 transoral pedicle placement

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