儿童胸椎椎弓根数字化测量及导航模板辅助置钉实验研究
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摘要
目的探讨4～12岁儿童胸椎椎弓根形态特征及发育规律,为螺钉置入可行性、螺钉设计及相关生物力学研究提供基础理论依据;探讨个体化导航模板辅助儿童胸椎椎弓根螺钉置入的可行性和准确性。方法1.对60例无胸椎病变的4～12周岁儿童T_1～T_(12)行薄层CT扫描,保存为DICOM格式,运用Mimics13.0软件重建并测量相关数据: (1)椎弓根宽(PW);(2)椎弓根高(PH);(3)椎弓根钉道长度(LS);(4)椎弓根长轴与矢状面夹角(e角);(5)椎弓根长轴与椎体上平面在尾侧形成的夹角(f角)。2.选取4例7～9岁儿童随机分为两组,分别用传统椎弓根内固定法和导航模板辅助法进行置钉对比,寻求更适宜儿童胸椎后路固定的手术方法。结果1. PW T_5最窄、T_(12)最宽,T_1～T_5逐渐减小,而T_6～T_(12)又逐渐增大;PH T_1～T_(12)逐渐增大;LS T_1最短、T_(12)最长,T_1～T_(12)总体呈增大趋势;e角T_1最大、T_(10)最小,T_1～T_(10)逐渐减小;而T_(11)、T_(12)为负角; f角T_1～T_(12)呈递减趋势;2.置钉准确率传统法58.3%;而个体化数字导航模板法为81.3%。结论:1.利用Mimics软件对儿童胸椎重建,可客观再现胸椎真实形态,为儿童胸椎形态特征及发育规律提供理论依据;2.处于生长发育期的儿童行椎弓根内固定术,尤应观测螺钉直径、长度、进钉方向,准确的椎弓根参数更凸显其重要性;3.个体化导航模板辅助置入椎弓根螺钉可应用于4～12岁儿童,但应注意个体差异。
Objective To investigate the children aged 4 to 12 thoracic pedicle for imaging observations, to grasp characteristics of children change in different periods of the pedicle for the clinical application of children's fixation of pedicle screws provide a theoretical basis; 4 cases of children's group was given traditional home body nails and navigation template assisted pedicle screw, of individual children's home in the thoracic pedicle screw fixation in the accuracy and feasibility. Methods 60 patients without thoracic lesions in children 4 to 12 years of age were thin T_1 ~ T_(12) CT scan, save for the DICOM format, the use of Mimics13.0 software to read and measure the required data: (1) pedicle width (PW) ; (2) pedicle height (PH); (3) pedicle screw path length (LS); (4) and the sagittal pedicle axis angle (e angle); (5) pedicle vertebra on the horizontal axis and the angle formed at the caudal (f angle); selected 4 cases 7 to 9-year-old children were randomly divided into two groups with traditional pedicle screw fixation and navigation template assisted method for pedicle screw contrast, the search for more suitable for children Posterior fixation of thoracic surgical methods. Results 1. PW T_5 narrowest, T_(12) widest, T_1 ~ T_5 decreases, while T_6 ~ T_(12) and gradually increased; PH T_1 ~ T_(12) increases; LS T_1 minimum, T_(12) longest, T_1 ~ T_(12) overall tended to increase; e maximum angle of T_1, T_(10) minimum, T_1 ~ T_(10) decreases; and T_(11), T_(12) as a negative angle; f angle T_1 ~ T_(12) showed a decreasing trend; 2. pedicle screw accuracy of traditional France 58.3%; and individual digital navigation template of 81.3%. Conclusion MIMICS software and observing children's thoracic reconstruction, can objectively reflect the real shape of thoracic, thoracic vertebrae to understand children's growth and development of morphological characteristics and provide a theoretical basis; in the growth and development of children pedicle fixation, particular attention to screw diameter, length, direction into the screw to provide an accurate parameter to highlight the importance of the pedicle; individual navigation template assisted pedicle screw used in children's high success rate, broad application prospects.
Objective To investigate the children aged 4 to 12 thoracic pedicle for imaging observations, to grasp characteristics of children change in different periods of the pedicle for the clinical application of children's fixation of pedicle screws provide a theoretical basis; 4 cases of children's group was given traditional home body nails and navigation template assisted pedicle screw, of individual children's home in the thoracic pedicle screw fixation in the accuracy and feasibility. Methods 60 patients without thoracic lesions in children 4 to 12 years of age were thin T_1 ~ T_(12) CT scan, save for the DICOM format, the use of Mimics13.0 software to read and measure the required data: (1) pedicle width (PW) ; (2) pedicle height (PH); (3) pedicle screw path length (LS); (4) and the sagittal pedicle axis angle (e angle); (5) pedicle vertebra on the horizontal axis and the angle formed at the caudal (f angle); selected 4 cases 7 to 9-year-old children were randomly divided into two groups with traditional pedicle screw fixation and navigation template assisted method for pedicle screw contrast, the search for more suitable for children Posterior fixation of thoracic surgical methods. Results 1. PW T_5 narrowest, T_(12) widest, T_1 ~ T_5 decreases, while T_6 ~ T_(12) and gradually increased; PH T_1 ~ T_(12) increases; LS T_1 minimum, T_(12) longest, T_1 ~ T_(12) overall tended to increase; e maximum angle of T_1, T_(10) minimum, T_1 ~ T_(10) decreases; and T_(11), T_(12) as a negative angle; f angle T_1 ~ T_(12) showed a decreasing trend; 2. pedicle screw accuracy of traditional France 58.3%; and individual digital navigation template of 81.3%. Conclusion MIMICS software and observing children's thoracic reconstruction, can objectively reflect the real shape of thoracic, thoracic vertebrae to understand children's growth and development of morphological characteristics and provide a theoretical basis; in the growth and development of children pedicle fixation, particular attention to screw diameter, length, direction into the screw to provide an accurate parameter to highlight the importance of the pedicle; individual navigation template assisted pedicle screw used in children's high success rate, broad application prospects.
引文
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