mimics及脊柱模型用于下頸椎椎弓根個體化置釘?shù)膽?yīng)用研究-wenkub
2024-10-06 01 本頁面
【正文】 g MIMICS reverse engineering software Mimics to generate establish cervical three dimensional (3D) reconstruction images which saved as STL files. Then these STL files were used to manufacture produce cervical physical models using rapid prototyping technique. The optimal trajectory pedicle was explored and marked on 3D images using puter assistant aided design module of Mimics, and the related parameters of cervical pedicle were measured using measurement tools of Mimics. So the individualized surgery plan of pedicle screw fixation was determined according to the location of pedicle trajectory and parameters. The trajectory pins were drilled into physical model to supervise the entry point and orientation of pedicle screw. With the visualized guidance of physical model, pedicle screws were inserted in cadaveric specimens in strict accordance with individualized surgery plan determined previously. Pedicle screw fixation was performed in two 2 patients with cervical disorders requiring instrumentation using this individualized surgery method as mentioned above. Results The cervical 3D image and physical model were found to be anatomically similar with each other and of great assistance in designing individualized surgery plan and supervising placement of pedicle screw. There were pP148 pedicle screws were inserted in the 16 cervical specimens,. Among them, 140 were inserted in the pedicle cortical, and the left 8only one of them breached the pedicle cortical mildly. CT scanning indicated that the 10 pedicle screws were satisfyingly inserted in the 2 patients. Conclusion Combination of 3D image by Mimics and intuitive guidance of physical model by rapid prototyping technique improve the accuracy and safety of lower cervical stereotaxy.[Key words] cervical vertebra。MIMICS對患者置入10枚椎弓根螺釘，CT示螺釘位置滿意。置釘后標(biāo)本行CT掃描，判斷置入準(zhǔn)確性。 方法 對16例成人下頸椎標(biāo)本行CT掃描收集數(shù)據(jù)，導(dǎo)入Mimics軟件對標(biāo)本進(jìn)行三維重建。利用Mimics相關(guān)功能在三維重建圖像上尋找下頸椎椎弓根最佳軸線并測量椎弓根相關(guān)參數(shù)，制定椎弓根螺釘個體化置入方案。利用上述方法對2例患者進(jìn)行個體化置釘，術(shù)后通過CT掃描驗證螺釘位置準(zhǔn)確性。結(jié)論 用Mimics軟件對下頸椎進(jìn)行三維重建，制定個體化置釘參數(shù)，同時配合實物模型的直觀指導(dǎo)，提供了一種下頸椎椎弓根釘個體化置釘?shù)姆椒?，利用該法能提高置釘安全性。a workstation running pedicle screw。 pedicle screw。development頸椎內(nèi)固定是實現(xiàn)這些目的的有效手段。1 資料與方法 標(biāo)本制備 成人尸體標(biāo)本16例（重慶醫(yī)科大學(xué)解剖教研室與貴陽醫(yī)學(xué)院解剖教研室提供），從C2/C3及C7/T1水平離斷，收集C3～C7節(jié)段頸椎標(biāo)本。運用閾值選取技術(shù)(Thresholding)，獲得頸椎原始蒙罩（Mask）后，在運用三維區(qū)域增長技術(shù)(3D Region Growing)對原始蒙罩進(jìn)行修改，得到新蒙罩。 下頸椎實體模型的制作將頸椎的STL文件導(dǎo)入Dimension三維打印機（成都泰捷系統(tǒng)工程公司），運用熔融堆積成型技術(shù)，采用丙烯腈丁二烯苯乙烯共聚物為材料對下頸椎實體模型進(jìn)行快速成型制作。利用軟件的測量工具測量椎弓根軸線長度L、椎弓根最窄處截面上下皮質(zhì)骨高度H、椎弓根最窄處截面兩側(cè)皮質(zhì)骨寬度W、椎弓根軸線在橫斷面上投影與椎體冠狀面垂線成的內(nèi)傾角α、椎弓根軸線在矢狀面投影與椎體冠狀面垂線所成的頭/尾傾角β（圖1B）。置入后將重建圖像實體化，觀察虛擬螺釘是否穿破椎弓根（圖1A）。將頸椎標(biāo)本固定在操作臺上，暴露側(cè)塊后緣骨皮質(zhì)，通過比對標(biāo)本和已實體模型確定標(biāo)本進(jìn)釘點。兩例患者術(shù)前均行CT掃描，收集Di數(shù)據(jù)。A、B:患者下頸椎模型在術(shù)中與實體比對。將實體模型與已暴露側(cè)塊后緣骨皮質(zhì)的標(biāo)本相比較，二者的后部的尺寸和形態(tài)亦完全一致。 mm即為個體化螺釘直徑參考值；椎弓根軸線長度減去該軸線在椎體內(nèi)長度的1/2即為螺釘長度參考值；椎弓根軸線的α和β角即為個體化置釘角度。 177。C4 177。 177。 177。C6 177。 177。 177。表 2 頸椎三維重建圖像椎弓根角度測量結(jié)果(177。 177。 177。 （177。 （177。 （177。 臨床應(yīng)用結(jié)果本組2例患者，置入頸椎椎弓根螺釘10
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