【正文】 77。 （177。 （177。自1994年頸椎椎弓根螺釘內(nèi)固定技術(shù)的應(yīng)用被報道以來[4]，它以其獨特的三維立體穩(wěn)定優(yōu)勢，在臨床應(yīng)用越來越廣泛。但是，其他的臨床應(yīng)用均報道導(dǎo)航技術(shù)降低了置釘過程中椎弓根壁的損傷率[1213]，驗證了該技術(shù)的有效性。當然，該手術(shù)方法在臨床上還處于探索階段，臨床運用的病例數(shù)少，隨訪時間短，目前還不足以充分證明其優(yōu)點。因此，利用Mimics對椎體進行三維重建，可以準確地反映標本的實際解剖結(jié)構(gòu)，用其來設(shè)計個體化置釘方案是完全可靠的。該長度可以避免螺釘過長穿出椎體損傷周圍重要組織，且不會影響螺釘?shù)膹姸?，因為椎弓根螺釘?shù)姆€(wěn)定性主要依賴于椎弓根部分骨質(zhì)[16]。雖然CT三維重建圖像能展示椎體的各個部位，但最終還是以二維圖像的形式呈現(xiàn)，缺乏實體模型的直觀感、可觸摸性和可視性。參考文獻:[1] 羅飛，許建中，王序全，等．三種頸椎前路內(nèi)固定裝置對術(shù)后脊柱穩(wěn)定性的作用[J]．中國臨床康復(fù)，2003，7(20)：28302831.[2] Liu G Y, Xu R M, Ma W H, et al. Biomechanical parison of cervical transfacet pedicle screws versus pedicle screws[J]. Chin Med J (Engl), 2008, 121(15):13901393.[3]Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation[J]. Spine (Phila Pa 1976), 2012, 37(5):E349E356.[4] Abumi K, Itoh H, Taneichi H, et al. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report[J]. J Spinal Disord, 1994, 7(1):1928.[5]Gautschi O P, Schatlo B, Schaller K, et al. Clinically relevant plications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws[J]. Neurosurg Focus, 2011, 31(4):E8.[6]Nakashima H, Yukama Y, Imagama S, et al. Complication of cervical pedicle screw fixation for nontraumatic lesion: a multicenter study of 84 patients[J]. J Neurosurg Spine, 2012, 16(3):238247.[7] Miller R M, Ebraheim N A, Xu R, et al. Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches[J]. Spine (Phila Pa 1976), 1996, 21(20): 23172322.[8] 田偉，劉亞軍，劉波，等． 計算機導(dǎo)航系統(tǒng)和C臂機透視引導(dǎo)頸椎椎弓根螺釘內(nèi)固定技術(shù)的臨床對比研究[J] .中華外科雜志, 2006, 44(20): 13991402.[9] Ito Y, Sugimoto Y, Tomioka M, et al. Clinical accuracy of 3D fluoroscopyassisted cervical pedicle screw insertion[J]. J Neurosurg Spine, 2008, 9(5): 450453.[10] Ludwig S C, Kramer D L, Balderston R A,et al. Placement of pedicle screws in the human cadaveric cervical spine: parative accuracy of three techniques[J]. Spine (Phila Pa 1976), 2000, 25(13):16551667.[11] Liu Y J, Tian W, Liu B, et al. Comparison of the clinical accuracy of cervical (C2C7) pedicle screw insertion assisted by fluoroscopy, puted tomographybased navigation, and intraoperative threedimensional Carm navigation[J].Chin Med J (Engl), 2010, 123(21):29952998.[12] Zhang H L, Zhou D S, Jiang Z S. Analysis of accuracy of puterassisted navigation in cervical pedicle screw installation[J]. Orthop Surg, 2011, 3(1):5256.[13] Gelalis I D, Paschos N K, Pakos E E, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies paring free hand, fluoroscopy guidance and navigation technique[J]. Eur Spine J, 2012, 21(2):247255.[14] 劉洋，權(quán)正學(xué)，覃煒，等. Mimics及快速成型技術(shù)在寰樞椎椎弓根個體化置釘中的應(yīng)用[J]. 中華創(chuàng)傷雜志，2010,26(9):817821.[15] 解京明，張漾杰，魯寧，等. 下頸椎經(jīng)椎弓根螺釘內(nèi)固定相關(guān)解剖學(xué)觀察[J].脊柱外科雜志，2006,4(6):354358.[16]Ito Z, Higashino K, Kato S, et al. Ped