特发性脊柱侧凸手术治疗的临床研究及计算机模拟椎弓根螺钉置入的初步应用
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摘要
研究背景:
脊柱侧凸是指脊柱的侧向偏离曲度达到10°以上的畸形,常见于青少年儿童,严重影响患者的身心健康。其中特发性脊柱侧凸最为常见,发病机制尚不明确。随着椎弓根螺钉等第三代矫形内固定系统的不断改进,及三维矫形技术理论的广泛应用,脊柱侧凸畸形得到了有效的治疗。然而,部分患者术后出现了失代偿现象,这使人们意识到需要一种全面有效的分型系统用以指导手术。King、Lenke、PUMC分型系统的相继出现,有效地指导了矫形手术治疗。3种分型有其各自的应用特点,亦有相互联系之处。如何应用分型区分畸形的特点,如何选择正确的融合范围,是矫形手术的关键。
脊柱椎弓根内固定系统的研制极大地促进了脊柱外科技术的发展,使脊柱侧凸畸形等严重疾病得到了有效的矫治。矫形手术过程中,三维畸形的脊柱容易引起内固定失败,错误的置钉会带来严重的并发症。计算机辅助手术导航系统的应用提高了内固定物置入的效率及安全性。但由于价格较昂贵,目前在国内尚未能推广。因此,需要一种准确、简单、实用的测量椎弓根钉道参数的方法辅助手术。应用计算机三维重建模型,可在术前设计手术方案及模拟手术,将可视化技术与脊柱外科技术进行有效地结合。
目的:
1.回顾分析手术矫正治疗特发性脊柱侧凸的临床效果。
2.探讨King、Lenke、PUMC分型系统的应用价值及比较3种分型对矫形手术的指导意义。
3.探讨选择性胸椎融合矫正主胸弯(LenkeⅠ型)患者的临床效果,分析远端融合椎的选择对术后躯干平衡的影响。
4.探索应用计算机三维重建模拟椎弓根螺钉置入及钉道参数测量的方法。
5.初步探讨该技术在脊柱畸形手术中的应用价值。
方法:
1.收集自2001年～2006年在我院行矫形手术的80例青少年特发性脊柱侧凸患者资料,男27例,女51例,年龄10岁～18岁,平均15.4岁;术后随访1-5年,平均28个月。根据患者术前、术后及随访时的X线片,对冠状面的Cobb角、顶椎偏距(apical vertebrae translation,AVT)、躯干偏移距离(shift of head,SH)进行测量,评价整体治疗效果。
2.所有病例分别采用King、Lenke、PUMC分型系统进行分型,根掘手术方法是否严格符合3种分型各自的指导原则,分6组进行分析,评价各组术后躯干平衡的情况,比较各组术后躯干失平衡的概率。
3.根据38例LenkeⅠ型患者行选择性胸椎融合时,远端融合椎(distal fusion level,DFL)位于旋转中立椎(neutral rotated vertebrae,NV)的上下不同位置,分为NV+组(低于中立椎)、NV组(中立椎)、NV-组(高于中立椎),比较各组术后的失平衡概率及SH差异。
4.将38例LenkeⅠ型病例分为术后躯干平衡组与失平衡组,比较两组胸弯、腰弯的矫正情况,及两组NV至DFL相对距离的差异。
5.数据来源于4例脊柱畸形病人术前及术后畸形节段的螺旋CT连续容积图像。扫描条件:电压120kv,层厚0.625 mm,512×512矩阵,每个断面图像dicom数据大小为515 kb。将采集的dicom格式图像导入计算机Mimics 10.01软件进行三维重建。通过重组图像及测量钉道数据,模拟椎弓根螺钉三维体置入,三维测量模拟螺钉的三维角度、最大直径和长度。
6.术前按所测数据设计合适的螺钉规格,术中按设计的参数置钉,比较模拟辅助置钉组(10枚螺钉)与常规置钉对照组(10枚螺钉)术后的置钉成功率,比较术后实际置入与术前模拟置入的椎弓根螺钉央角(transverse sectionpedicle screw angle,TSPA)。
结果:
1.术前主弯冠状面Cobb角平均56.1°,术后平均残留22.3°,矫正率59%:终末随访平均丢失4.7°;术前AVT平均5.5cm,术后平均2.4cm,矫正率57%,终末随访平均丢失0.5cm;术前SH平均2.8cm,共计40例躯干失平衡,术后SH平均1.2cm,终末随访时平均1.4cm,仍有23例失平衡。
2.可用King分型的共70例,有10例无法应用King分型,所有病例均可应用Lenke、PUMC分型。手术方法符合King分型者48例(68.6%),符合Lenke分型者63例(81.7%),符合PUMC分型者57例(74%),对应术后躯干失平衡的概率分别为14.5%、14.3%、7%,三者之间无统计学差异(P＞0.05)。
3.38例LenkeⅠ型术后共出现8例失平衡,NV-组(42.9%)术后失平衡概率大于NV+组(0%)和NV组(13.3%);NV-组术后SH(1.88cm)大于NV+组(0.64cm)和NV组(0.92cm),均有统计学差异(P＜0.05)。
4.38例LenkeⅠ型病例中,失平衡组的NV-DFL(0.88)高于平衡组(0),有统计学差异(P＜0.05):失平衡组术后残留的腰弯Cobb(22.5°)大于平衡组(14.8°),有统计学差异(P＜0.05)。
5.通过计算机三维重建模拟,获得畸形椎体椎弓根的真实轴面及钉道参数。
6.术后模拟辅助置钉组无1例置钉失败,成功率100%,常规置钉对照组出现4例置钉失败,成功率60%,两者间有统计学差异(P＜0.05)。术后实际置入与术前模拟的TSPA分别为17.1°和17.7°,两者间无统计学差异(P＞0.05),有较高的一致性。
结论:
1.三维矫形内固定手术能有效地改善特发性脊柱侧凸畸形。
2.特发性脊柱侧凸King、Lenke、PUMC分型系统均能有效地指导矫形手术治疗;正确分型的基础上,选择正确的融合范围进行适度的矫正,是手术成功的关键。
3.主胸弯侧凸进行选择性融合时,远端融合椎以中立椎为选择基础,术后矫正效果良好,选择位置过高易导致术后失平衡。
4.计算机三维重建模拟椎弓根螺钉置入脊柱畸形椎体,可获得准确的钉道参数,为计算机辅助模拟脊柱外科手术提供简单实用的新方法。
5.计算机模拟辅助置入螺钉比常规置钉方法更加安全有效。
Backgrouds:
Scoliosis is a lateral curvature deformity of spine with a curve angle more than 10°.It is common in young children,and has seriously affected the physical and mental health of patients.The idiopathic scoliosis is the maximal proportion of cases of scoliosis,which's pathogenesis is not yet clear.With the improvement of the third internal fixation instrument and the application of the three-dimensional correction, the scoliosis patients could be gain good correction outcomes.However,some cases sufferd decompensation after surgery.Most surgeon considered that a comprehensive and effective classification should be developed to guide the correction surgery.The King,Lenke,PUMC classification could guide the correction surgery effectually in the treatment of idiopathic scoliosis.The three classification have characteristics respectively,and have a correlation among them.How to distinguish the characteristics of the deformity with idiopatic scoliosis classification and select the exact range of fusion,is the criticality of the surgery.
The development of pedicle screw instrument improved the spinal surgery significantly and promoted the treatment of serious spinal diseases such scoliosis effectively.Three-dimensional deformity of the spine easily lead to fixation failure, and the wrong screw insertion would lead to serious complications.The Application of Computer Assisted Navigation System increased the efficiency and safety of implanting placement.However,the application could not be extented because of its high price.Therefore we need a precise,simple and practical method of measuring pedicle channel parameters in order to assist surgery.Three-dimensional (3D)reconstruction using computer can be applied to design and mimic the procedure of operation,which combined the visualization technique and the spinal surgery.
Objectives:
1.A retrospective study was performed to evaluate the outcomes of correction surgery for idiopathic scoliosis.
2.To discuss the application of King、Lenke、PUMC classification and compare the significance of guiding correction surgery among three classifications.
3.To evaluate the outcome of selective thoracic fusion and fixation in major thoracic(Lenke I type) idiopathic scoliosis,and analyze the influence of distal fusion level(DFL) on postoperative trunk balance.
4.To explore the technique of mimicing implanting pedicle screw and the accurately measurement of pedicle channel parameters based on Three-dimensional reconstruction using computer.
5.To evaluate it's preliminary clinical application in spinal orthopaedics surgery.
Methods:
1.Eighty patients with adolescent idiopathic scoliosis were treated with correction surgery from 2001 to 2006.There were 27 males and 53 females with the average age of 15.4 years(range 10 to 18 years).The Cobb angles、apical vertebra translation(AVT) and shift of head(SH) of the major curve,were measured and analyzed in the preoperative、postoperative and the last follow-up X-ray radiographies.
2.All cases were divided into six groups according to whether the surgery technique were strictly in agreement to the guiding principle of the three classifications and trunck balance after surgery,and were compared the rates of postoperative trunk imbalance among groups.
3.38 cases of Lenke I type were grouped according to the DFL with reference to the neutroal rotated vertebrae(NV),including NV+(lower than NV) group, NV(exactly NV) group,and NV-(higher than NV) group.The trunk shift and the rates of postoperative trunk imbalance were compared among groups.
4.38 cases of Lenke I type were divided into trunck balance group and trunk imbalance group,the correction outcome of thoracic curve,lumber curve,and the NV-DFL were compared between groups.
5.Preoperative and postoperative spiral CT scan of deformity levels were performed in 4 spinal deformity patients in our hospital.Scan condition include tube tension 120kv,slice increment 0.625mm,matrix 512×512.All the images were saved as dicom format(515kb) and imported into the personal computer. Mimics10.01 software was used to recombinate data,reconstruct 3D model of spine and mimic implanting the 3D model of pedicle screw.It's calculated the angles,maximal length and diameter of the pedicle channel and screw model.
6.Pedicle screws were strictly implanted according to the parameters of preoperative design with the measurement of pedicle channel and model.The success rate of pedicle screw placement were compared between the group(10 screws) of computer-aided mimicing and the group(10 screws) of routine way. TSPA(transverse section pedicle screw angle) were compared between the group of preoperative mimicing implanting and the group of actually implanting.
Results:
1.The average preoperative coronal Cobb angles was 56.1°,the average postoperative Cobb angles was 22.3°,as the correction was 59%,and the lost of angles at last follow-up was 4.7°.The average preoperative AVT was 5.5cm,the postoperative AVT was 2.4cm,as the correction was 57%,and the lost of distance at the last follow-up was 0.5cm.The average preoperative SH were 2.8cm with 40 cases of trunk imbalance,the postoperative SH was 1.2cm,and the SH at last follow-up was 1.4cm with 23 cases of trunk imbalance.
2.All the cases could be classified using the Lenke and PUMC classification;Only 70 cases could be classified using King classification.The patients that were treated strictly in agreement to classification were 48 cases(68.6%)according to King classification,63 cases(81.7%) according to Lenke classification,57(74%) cases according to PUMC classification respectively.The rates of postoperative trunk imbalance from them were 14.5%、14.3%and 7%respectively,there were no statistical significance among the difference of them(P＞0.05).
3.There were 8 cases of trunk imbalance in 38 cases Lenke I type.The rate of postoperative trunk imbalance in NV- group(42.9%) was higher than NV+ group(0%) and NV group(13.3%) with statistical significance(P＜0.05);The postoperative trunk shift in NV- group(1.88cm) was higher than NV+ group (0.64cm) and NV group(0.92cm) with statistical significance(P＜0.05).
4.The NV-DFL in trunk imbalance group(0.88) was more than in trunk balance group(0) with statistical significance(P＜0.05);The lumber curve Cobb angle in trunk imbalance group(22.5°) was more than in trunk balance group(14.8°) with statistical significance(P＜0.05).
5.The parameters and the real axis section from the pedicle of the deformity vertebrae arch can be obtained through 3D reconstruction technique by computer.
6.The group of computer-aided mimicing had no case of failing pedicle screw placement,while the group of routine way had 4 cases.The success rates of them are 100%and 60%respectively,and the difference between them were statistical significance(P＜0.05).The TSPA in preoperative mimicing implanting group and actually implanting group were 17.1°and 17.7°respectively,there were no statistical significance(P＞0.05) and high consistency between them.
Conclusions:
1.The three-dimensional correction surgery can gain good correction outcomes in the treatment for idiopathic scoliosis.
2.The King,Lenke,PUMC classification could guide the correction surgery effectually in the treatment of idiopathic scoliosis.Appropriate correction according to the right selection of fusion area should be based on the characteristic of curve,which is the criticality of the surgery.
3.The major thoracic idiopathic scoliosis could gain good correction outcomes by selective thoracic fusion that is based on NV as the DFL.Trunk may be imbalance if the DFL is too high.
4.The technique of mimicing implanting pedicle screw with 3D reconstruction can provide the accurate parameters from pedicle channel of the deformity vertebrae arch,which could provide simple and practical new methods for the computer-aided mimesis of spinal surgery.
5.The computer-aided technique is more safe and effictive than the rountin way in implanting pedicle screw.
脊柱侧凸是指脊柱的侧向偏离曲度达到10°以上的畸形,常见于青少年儿童,严重影响患者的身心健康。其中特发性脊柱侧凸最为常见,发病机制尚不明确。随着椎弓根螺钉等第三代矫形内固定系统的不断改进,及三维矫形技术理论的广泛应用,脊柱侧凸畸形得到了有效的治疗。然而,部分患者术后出现了失代偿现象,这使人们意识到需要一种全面有效的分型系统用以指导手术。King、Lenke、PUMC分型系统的相继出现,有效地指导了矫形手术治疗。3种分型有其各自的应用特点,亦有相互联系之处。如何应用分型区分畸形的特点,如何选择正确的融合范围,是矫形手术的关键。
脊柱椎弓根内固定系统的研制极大地促进了脊柱外科技术的发展,使脊柱侧凸畸形等严重疾病得到了有效的矫治。矫形手术过程中,三维畸形的脊柱容易引起内固定失败,错误的置钉会带来严重的并发症。计算机辅助手术导航系统的应用提高了内固定物置入的效率及安全性。但由于价格较昂贵,目前在国内尚未能推广。因此,需要一种准确、简单、实用的测量椎弓根钉道参数的方法辅助手术。应用计算机三维重建模型,可在术前设计手术方案及模拟手术,将可视化技术与脊柱外科技术进行有效地结合。
目的:
1.回顾分析手术矫正治疗特发性脊柱侧凸的临床效果。
2.探讨King、Lenke、PUMC分型系统的应用价值及比较3种分型对矫形手术的指导意义。
3.探讨选择性胸椎融合矫正主胸弯(LenkeⅠ型)患者的临床效果,分析远端融合椎的选择对术后躯干平衡的影响。
4.探索应用计算机三维重建模拟椎弓根螺钉置入及钉道参数测量的方法。
5.初步探讨该技术在脊柱畸形手术中的应用价值。
方法:
1.收集自2001年～2006年在我院行矫形手术的80例青少年特发性脊柱侧凸患者资料,男27例,女51例,年龄10岁～18岁,平均15.4岁;术后随访1-5年,平均28个月。根据患者术前、术后及随访时的X线片,对冠状面的Cobb角、顶椎偏距(apical vertebrae translation,AVT)、躯干偏移距离(shift of head,SH)进行测量,评价整体治疗效果。
2.所有病例分别采用King、Lenke、PUMC分型系统进行分型,根掘手术方法是否严格符合3种分型各自的指导原则,分6组进行分析,评价各组术后躯干平衡的情况,比较各组术后躯干失平衡的概率。
3.根据38例LenkeⅠ型患者行选择性胸椎融合时,远端融合椎(distal fusion level,DFL)位于旋转中立椎(neutral rotated vertebrae,NV)的上下不同位置,分为NV+组(低于中立椎)、NV组(中立椎)、NV-组(高于中立椎),比较各组术后的失平衡概率及SH差异。
4.将38例LenkeⅠ型病例分为术后躯干平衡组与失平衡组,比较两组胸弯、腰弯的矫正情况,及两组NV至DFL相对距离的差异。
5.数据来源于4例脊柱畸形病人术前及术后畸形节段的螺旋CT连续容积图像。扫描条件:电压120kv,层厚0.625 mm,512×512矩阵,每个断面图像dicom数据大小为515 kb。将采集的dicom格式图像导入计算机Mimics 10.01软件进行三维重建。通过重组图像及测量钉道数据,模拟椎弓根螺钉三维体置入,三维测量模拟螺钉的三维角度、最大直径和长度。
6.术前按所测数据设计合适的螺钉规格,术中按设计的参数置钉,比较模拟辅助置钉组(10枚螺钉)与常规置钉对照组(10枚螺钉)术后的置钉成功率,比较术后实际置入与术前模拟置入的椎弓根螺钉央角(transverse sectionpedicle screw angle,TSPA)。
结果:
1.术前主弯冠状面Cobb角平均56.1°,术后平均残留22.3°,矫正率59%:终末随访平均丢失4.7°;术前AVT平均5.5cm,术后平均2.4cm,矫正率57%,终末随访平均丢失0.5cm;术前SH平均2.8cm,共计40例躯干失平衡,术后SH平均1.2cm,终末随访时平均1.4cm,仍有23例失平衡。
2.可用King分型的共70例,有10例无法应用King分型,所有病例均可应用Lenke、PUMC分型。手术方法符合King分型者48例(68.6%),符合Lenke分型者63例(81.7%),符合PUMC分型者57例(74%),对应术后躯干失平衡的概率分别为14.5%、14.3%、7%,三者之间无统计学差异(P＞0.05)。
3.38例LenkeⅠ型术后共出现8例失平衡,NV-组(42.9%)术后失平衡概率大于NV+组(0%)和NV组(13.3%);NV-组术后SH(1.88cm)大于NV+组(0.64cm)和NV组(0.92cm),均有统计学差异(P＜0.05)。
4.38例LenkeⅠ型病例中,失平衡组的NV-DFL(0.88)高于平衡组(0),有统计学差异(P＜0.05):失平衡组术后残留的腰弯Cobb(22.5°)大于平衡组(14.8°),有统计学差异(P＜0.05)。
5.通过计算机三维重建模拟,获得畸形椎体椎弓根的真实轴面及钉道参数。
6.术后模拟辅助置钉组无1例置钉失败,成功率100%,常规置钉对照组出现4例置钉失败,成功率60%,两者间有统计学差异(P＜0.05)。术后实际置入与术前模拟的TSPA分别为17.1°和17.7°,两者间无统计学差异(P＞0.05),有较高的一致性。
结论:
1.三维矫形内固定手术能有效地改善特发性脊柱侧凸畸形。
2.特发性脊柱侧凸King、Lenke、PUMC分型系统均能有效地指导矫形手术治疗;正确分型的基础上,选择正确的融合范围进行适度的矫正,是手术成功的关键。
3.主胸弯侧凸进行选择性融合时,远端融合椎以中立椎为选择基础,术后矫正效果良好,选择位置过高易导致术后失平衡。
4.计算机三维重建模拟椎弓根螺钉置入脊柱畸形椎体,可获得准确的钉道参数,为计算机辅助模拟脊柱外科手术提供简单实用的新方法。
5.计算机模拟辅助置入螺钉比常规置钉方法更加安全有效。
Backgrouds:
Scoliosis is a lateral curvature deformity of spine with a curve angle more than 10°.It is common in young children,and has seriously affected the physical and mental health of patients.The idiopathic scoliosis is the maximal proportion of cases of scoliosis,which's pathogenesis is not yet clear.With the improvement of the third internal fixation instrument and the application of the three-dimensional correction, the scoliosis patients could be gain good correction outcomes.However,some cases sufferd decompensation after surgery.Most surgeon considered that a comprehensive and effective classification should be developed to guide the correction surgery.The King,Lenke,PUMC classification could guide the correction surgery effectually in the treatment of idiopathic scoliosis.The three classification have characteristics respectively,and have a correlation among them.How to distinguish the characteristics of the deformity with idiopatic scoliosis classification and select the exact range of fusion,is the criticality of the surgery.
The development of pedicle screw instrument improved the spinal surgery significantly and promoted the treatment of serious spinal diseases such scoliosis effectively.Three-dimensional deformity of the spine easily lead to fixation failure, and the wrong screw insertion would lead to serious complications.The Application of Computer Assisted Navigation System increased the efficiency and safety of implanting placement.However,the application could not be extented because of its high price.Therefore we need a precise,simple and practical method of measuring pedicle channel parameters in order to assist surgery.Three-dimensional (3D)reconstruction using computer can be applied to design and mimic the procedure of operation,which combined the visualization technique and the spinal surgery.
Objectives:
1.A retrospective study was performed to evaluate the outcomes of correction surgery for idiopathic scoliosis.
2.To discuss the application of King、Lenke、PUMC classification and compare the significance of guiding correction surgery among three classifications.
3.To evaluate the outcome of selective thoracic fusion and fixation in major thoracic(Lenke I type) idiopathic scoliosis,and analyze the influence of distal fusion level(DFL) on postoperative trunk balance.
4.To explore the technique of mimicing implanting pedicle screw and the accurately measurement of pedicle channel parameters based on Three-dimensional reconstruction using computer.
5.To evaluate it's preliminary clinical application in spinal orthopaedics surgery.
Methods:
1.Eighty patients with adolescent idiopathic scoliosis were treated with correction surgery from 2001 to 2006.There were 27 males and 53 females with the average age of 15.4 years(range 10 to 18 years).The Cobb angles、apical vertebra translation(AVT) and shift of head(SH) of the major curve,were measured and analyzed in the preoperative、postoperative and the last follow-up X-ray radiographies.
2.All cases were divided into six groups according to whether the surgery technique were strictly in agreement to the guiding principle of the three classifications and trunck balance after surgery,and were compared the rates of postoperative trunk imbalance among groups.
3.38 cases of Lenke I type were grouped according to the DFL with reference to the neutroal rotated vertebrae(NV),including NV+(lower than NV) group, NV(exactly NV) group,and NV-(higher than NV) group.The trunk shift and the rates of postoperative trunk imbalance were compared among groups.
4.38 cases of Lenke I type were divided into trunck balance group and trunk imbalance group,the correction outcome of thoracic curve,lumber curve,and the NV-DFL were compared between groups.
5.Preoperative and postoperative spiral CT scan of deformity levels were performed in 4 spinal deformity patients in our hospital.Scan condition include tube tension 120kv,slice increment 0.625mm,matrix 512×512.All the images were saved as dicom format(515kb) and imported into the personal computer. Mimics10.01 software was used to recombinate data,reconstruct 3D model of spine and mimic implanting the 3D model of pedicle screw.It's calculated the angles,maximal length and diameter of the pedicle channel and screw model.
6.Pedicle screws were strictly implanted according to the parameters of preoperative design with the measurement of pedicle channel and model.The success rate of pedicle screw placement were compared between the group(10 screws) of computer-aided mimicing and the group(10 screws) of routine way. TSPA(transverse section pedicle screw angle) were compared between the group of preoperative mimicing implanting and the group of actually implanting.
Results:
1.The average preoperative coronal Cobb angles was 56.1°,the average postoperative Cobb angles was 22.3°,as the correction was 59%,and the lost of angles at last follow-up was 4.7°.The average preoperative AVT was 5.5cm,the postoperative AVT was 2.4cm,as the correction was 57%,and the lost of distance at the last follow-up was 0.5cm.The average preoperative SH were 2.8cm with 40 cases of trunk imbalance,the postoperative SH was 1.2cm,and the SH at last follow-up was 1.4cm with 23 cases of trunk imbalance.
2.All the cases could be classified using the Lenke and PUMC classification;Only 70 cases could be classified using King classification.The patients that were treated strictly in agreement to classification were 48 cases(68.6%)according to King classification,63 cases(81.7%) according to Lenke classification,57(74%) cases according to PUMC classification respectively.The rates of postoperative trunk imbalance from them were 14.5%、14.3%and 7%respectively,there were no statistical significance among the difference of them(P＞0.05).
3.There were 8 cases of trunk imbalance in 38 cases Lenke I type.The rate of postoperative trunk imbalance in NV- group(42.9%) was higher than NV+ group(0%) and NV group(13.3%) with statistical significance(P＜0.05);The postoperative trunk shift in NV- group(1.88cm) was higher than NV+ group (0.64cm) and NV group(0.92cm) with statistical significance(P＜0.05).
4.The NV-DFL in trunk imbalance group(0.88) was more than in trunk balance group(0) with statistical significance(P＜0.05);The lumber curve Cobb angle in trunk imbalance group(22.5°) was more than in trunk balance group(14.8°) with statistical significance(P＜0.05).
5.The parameters and the real axis section from the pedicle of the deformity vertebrae arch can be obtained through 3D reconstruction technique by computer.
6.The group of computer-aided mimicing had no case of failing pedicle screw placement,while the group of routine way had 4 cases.The success rates of them are 100%and 60%respectively,and the difference between them were statistical significance(P＜0.05).The TSPA in preoperative mimicing implanting group and actually implanting group were 17.1°and 17.7°respectively,there were no statistical significance(P＞0.05) and high consistency between them.
Conclusions:
1.The three-dimensional correction surgery can gain good correction outcomes in the treatment for idiopathic scoliosis.
2.The King,Lenke,PUMC classification could guide the correction surgery effectually in the treatment of idiopathic scoliosis.Appropriate correction according to the right selection of fusion area should be based on the characteristic of curve,which is the criticality of the surgery.
3.The major thoracic idiopathic scoliosis could gain good correction outcomes by selective thoracic fusion that is based on NV as the DFL.Trunk may be imbalance if the DFL is too high.
4.The technique of mimicing implanting pedicle screw with 3D reconstruction can provide the accurate parameters from pedicle channel of the deformity vertebrae arch,which could provide simple and practical new methods for the computer-aided mimesis of spinal surgery.
5.The computer-aided technique is more safe and effictive than the rountin way in implanting pedicle screw.
引文
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[10]张诗雷,张志愿,沈国芳,等.基于CT的三维正颌手术仿真模拟平台的建 立.中国口腔颌面外科杂志[J],2004,2(2):95-98.
[11]于海龙,雷伟,朱锦宇,等.三维CT重建模拟三种腰椎椎弓根螺钉胃入方法的安全性分析[J].中国脊柱脊髓杂志,2005,15(10):606-608.
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[23]邱贵兴,于斌,Norbert ventura,等.特发性脊柱侧凸King、Lenke和PUMC 临床分型的应用比较[J].中华骨科杂志,2006,26(3),145-150.
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[1]King H,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracic idiopathic scoliosis[J].J Bone Joint Surg(Am),1983,65:1302-1313.
[2]McCance SE,Denis F,Lonstein JE,et al.Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King Ⅱ curve pattern.A review of 67 consecutive cases having selective thoracic arthrodesis[J].Spine,1998,23(19):2063-2073.
[3]Benli IT,Tuzuner M,Akalin S,et al.Spinal imbalance and decompensation problems in patients treated with Cotrel-Dubousset instrumentation[J].Eur Spine J,1996,5(6):380-386.
[4]Lenke LG,Betz RR,Harms J,et al.Adolescent idiopathic scoliosis:a new classification to determine extent of spinal arthrodesis[J].J Bone Joint Surg Am,2001,83(8):1169-1181.
[5]Rolando MP,Ki-Chan A,Raquel LP,et al.Treatment Recommendations for Idiopathic Scoliosis An Assessment of the Lenke Classification[J].Spine,2003,28(18):2102-2115.
[6]Lenke LG,Betz RR,Clements D,et al.Curve prevalence of a new classification of operative adolescent idiopathic scoliosis:does classification correlate with treatment[J].Spine,2002,27(6):604- 611.
[7]Richards BS,Sucato DJ,Konigsberg DE,et al,Comparison of reliability between the Lenke and King classification systems for adolescent idiopathic scoliosis using radiographs that were not premeasured[J].Spine.2003 Jun 1;28(11):1148-1156.
[8]Lenke LG,Betz RR,Haher TR,et al.Multisurgeon assessment of surgical decision-making in adolescent idiopathic scoliosis:curve classification,operative approach,and fusion levels[J].Spine.2001,26(21):2347-2353.
[9]邱贵兴,仉建国,王以朋,等.特发性脊柱侧凸的PUMC(协和)分型[J].中华骨科杂志,2003,23(1):1-9.
[10]Suk SI,Lee SM,Chung ER,et al.Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic soliosis[J].Spine,2003,28(5):484-491.
[11]张永刚,王岩,张雪松,等.特发性脊柱侧凸KingⅢ型和Ⅳ型远端融合椎的选择.中国修复重建外科杂志,2006,20(4):387-390.
[12]Cil A,Pekmezci M,Yazici M,et al.The validity of Lenke criteria for defining structural proximal thoracic curves in patients with adolescent idiopathic scoliosis[J].Spine.2005,30(22):2550-2555.
[13]DobbsMB,Lenke LG,Kim YJ,et al.Selective posterior thoracic fusion for adolescent idiopathic scoliosis:comparision of hooks versus pedicle screws[J].Spine,2006,31(20):2400-2404.
[14]Kuklo TR,Lenke LG,Won D,et al.Spontaneous proximal thoracic curve correction following fusion of the main thoracic curve in adolescent idiopathic scoliosis[J].Spine,2001,26(18):1966- 1975.
[15]Bridwell KH,McAllister JW,Betz RR,et al,Coronal decompensation produced by Cotrel-Dubousset “derotation” maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
[16]Thompson JP,Transfeldt EE,BradfordDS,et al.Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis[J].Spine,1990,15(9):927-931.
[17]邱贵兴,徐宏光,王以朋,等.青少年特发性脊柱侧凸术后失代偿原因分析及处理[J].中华骨科杂志,2003,23(7):414-417.
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[20]Lenke LG,Betz RR,Bridwell KH,et al.Intraobserver and interobserver reliability of the classification of thoracic adolescent idiopathic scoliosis[J].J Bone Joint Surg[Am]1998;80(8):1097-1106.
[21]Ogon M,Geisinger K,Behensky H,et al.Interobserver and intraobserver reliability of Lenke's new scoliosis classification system[J].Spine,2002,27(8):858- 862.
[22]邱勇,朱泽章,朱锋,等.青少年特发性脊柱侧凸King、Lenke和PUMC(协和)分型的可信度和可重复性比较及意义[J].中华骨科杂志,2007,27(10),748-752.
[23]邱贵兴,于斌,Norbert ventura,等.特发性脊柱侧凸King、Lenke和PUMC 临床分型的应用比较[J].中华骨科杂志,2006,26(3),145-150.
[2]Asher,Marc A.MD,Min Lai,et al.Further Development and Validation of the Scoliosis Research Society(SRS) Outcomes Instrument[J].Spine,2000,25(18):2381-2386.
[3]Hill D,Raso VJ,Moreau K,et al.Long-term follow-up of surgically treated AIS patients.Stud Health Technol Inform.2002;91:477-480.
[4]邱贵兴,徐宏光,王以朋,等.青少年特发性脊柱侧凸术后失代偿原因分析及处理[J].中华骨科杂志,2003,23(7):414-417.
[5]Benli IT,Tuzuner M,Akalin S,et al.Spinal imbalance and decompensation problems in patients treated with Cotrel-Dubousset instrumentation[J].Eur Spine J,1996,5(6):380-386.
[6]Arlet V,Marchesi D,Papin P,et al.Decompensation following scoliosis surgery:treatment by decreasing the correction of the main thoracic curve or "letting the spine go"[J].Eur Spine J.2000,9(2):156-160.
[7]King H,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracic idiopathic scoliosis[J].J Bone Joint Surg(Am),1983,65:1302-1313.
[8]Lenke LG,Betz RR,Harms J,et al.Adolescent idiopathic scoliosis:a new classification to determine extent of spinal arthrodesis[J].J Bone Joint Surg Am,2001,83(8):1169-1181.
[9]邱贵兴,仉建国,王以朋,等.特发性脊柱侧凸的PUMC(协和)分型[J].中华骨科杂志,2003,23(1):1-9.
[10]张诗雷,张志愿,沈国芳,等.基于CT的三维正颌手术仿真模拟平台的建 立.中国口腔颌面外科杂志[J],2004,2(2):95-98.
[11]于海龙,雷伟,朱锦宇,等.三维CT重建模拟三种腰椎椎弓根螺钉胃入方法的安全性分析[J].中国脊柱脊髓杂志,2005,15(10):606-608.
[12]章凯,王智运,尹庆水,等.骨科手术导航系统引导腰椎椎弓根螺钉植入的效果[J].第三军医大学学报,2005,27(5),443-444.
[13]李浩宇,许中信,刘贵麟.模拟先天性髋脱位截骨术的研究[J].中国体视学与图像分析,2003,8(1):20-24.
[14]Kalfas IH,Kormos DW,Murphy MA,et al.Application of framless steretaxy to pedicle screw fixation of the spine[J].J Neurosury,1995,83(4):641-647.
[15]Benli IT,Akalin S,Kis M,et al.Frontal and Sagittal Balance Analysis of Late Onset Idiopathic Scoliosis Treated with Third Generation Instrumentation.Koe J Med Sci,2001,47(6):231-253.
[16]Helenius BI,Remes V,Yrj6nen T,et al.Harrington and Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis[J].J Bone Joint Surg Am,2003,85A(12):2303-2309.
[17]邱贵兴,徐宏光,王以朋,等.青少年特发性脊柱侧凸术后失代偿原因分析及处理[J].中华骨科杂志,2003,23(7):414-417.
[18]Benli IT,Tuzuner M,Akalin S,et al.Spinal imbalance and decompensation problems in patients treated with CotreI-Dubousset instrumentation]J].Eur Spine J,1996,5(6):380-386.
[19]Arlet V,Marchesi D,Papin P,et al.Decompensation following scoliosis surgery:treatment by decreasing the correction of the main thoracic curve or "letting the spine go"[J].Eur Spine J.2000,9(2):156-160.
[20]McCance SE,Denis F,Lonstein JE,et al.Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King Ⅱ curve pattern.A review of 67 consecutive cases having selective thoracic arthrodesis[J].Spine, 1998,23(19):2063-2073.
[21]Rolando MP,Ki-Chan A,Raquel LP,et al.Treatment Recommendations for Idiopathic Scoliosis An Assessment of the Lenke Classification[J].Spine,2003,28(18):2102-2115.
[22]邱勇,朱泽章,朱锋,等.青少年特发性脊柱侧凸King、Lenke和PUMC(协和)分型的可信度和可重复性比较及意义[J].中华骨科杂志,2007,27(10),748-752.
[23]邱贵兴,于斌,Norbert ventura,等.特发性脊柱侧凸King、Lenke和PUMC 临床分型的应用比较[J].中华骨科杂志,2006,26(3),145-150.
[24]Lenke LG.Selective anterior instrumentation of thoracolumbar/lumbar AIS.Presented at:7th International Meeting on Advanced Spine Techniques(IMAST)[R];July 6-8,2000;Barcelona,Spain.
[25]Bridwell KH,McAllister JW,Betz RR,et al.Coronal decompensation produced by Cotrel-Dubousset "derotation" maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
[26]Thompson JP,Transfeldt EE,Bradford DS,et al.Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis[J].Spine,1990,15(9):927-931.
[27]Frez R,Cheng JCY,Wong EMC.Longitudinal changes in trunkal balance after selective fusion of King Ⅱ curves in adolescent idiopathic scoliosis[J].Spine,2000,25(11):1352-1359.
[28]Suk SI,Lee SM,Chung ER,et al.Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis:more than 5-year follow-up[J].Spine,2005,30(14):1602-1609.
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