导航模板辅助下颈椎皮质骨螺钉置入准确性的研究

doi:10.13418/j.issn.1001-165x.2018.02.004

中国临床解剖学杂志 ›› 2018, Vol. 36 ›› Issue (2): 137-140.doi: 10.13418/j.issn.1001-165x.2018.02.004

导航模板辅助下颈椎皮质骨螺钉置入准确性的研究

彭鹏¹，　朱美松²，　张鑫涛³，　杜冰冉¹，　李文睿¹，　李鉴轶^1，4

1. 南方医科大学人体解剖学教研室　广东省医学生物力学重点实验室，广州 510515； 2. 南方医科大学珠江医院骨科，广州
510515； 3. 南方医科大学第三附属医院影像科，广州 510515；　4. 南方医科大学南海医院，广东佛山 528244

收稿日期:2017-11-14 出版日期:2018-03-25 发布日期:2018-05-04
通讯作者: 李鉴轶，博士，教授，Tel:020-62789091,E-mail:wuxili74@126.com
作者简介:彭鹏（1992-），在读硕士，主要从事数字医学研究，E-mail:1285120479@qq.com
基金资助:
国家自然科学基金（31771330），国家重点研发计划（2017YFC0110602）,广东省省级科技计划项目(2012B091100314，2014A020212200,2015A040404022，2015B010125006，2015B010125005）

Accuracy of patient-specific drill template cervical pedicle screws insertion via cortical bone trajectory

PENG Peng¹, ZHU Mei-song², ZHANG Xin-tao³, DU Bing-ran¹, LI Wen-rui¹, LI Jian-y ^1，4

1. Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou 510515，China; 2. Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282，China; 3. Department of Image, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510282，China; 4. Nanhai Hospital, Southern Medical University, Foshan 528244，Guangdong Province，China

Received:2017-11-14 Online:2018-03-25 Published:2018-05-04

摘要/Abstract

摘要：

目的　探讨基于皮质骨螺钉轨迹入路，导航模板辅助椎弓根螺钉置入的可行性和准确性。方法　获取4具下颈椎标本（C3~7）CT数据,经Mimics软件三维重建后设计椎弓根皮质骨螺钉轨迹，并建立导航模板。随机分成2组,分别采用快速成型（RP）和数控机床技术（CNC）制造出两种材质导航模板并测量其在颈椎椎弓根辅助置钉的精确性。结果　RP、CNC两组在进钉点的水平面上绝对偏差分别为：(0.28±0.24) mm、(0.32±0.23) mm；矢状面上分别为：(0.30±0.20) mm、(0.52±0.44) mm。钉道中点在水平面上分别为：(0.26±0.22) mm、(0.39±0.32) mm；矢状面上分别为：(0.37±0.29) mm、(0.49±0.50) mm。螺钉安全分级，RP组1级螺钉20枚；CNC组1级螺钉19枚，2级1枚。两组的绝对偏差值、安全分级差异均无统计学意义（P＞0.05）。结论　CNC导航模板经皮质骨螺钉轨迹辅助置钉是可行的，为下颈椎椎弓根置钉提供了一种全新、安全的方法。

关键词: , 皮质骨螺钉轨迹, 　数控机床, 　导航模板, 　下颈椎, 　椎弓根钉

Abstract:

Objective　To validate the security and accuracy of cervical pedicle screws insertion (CPSI) with the assistance of patient-specific drill templates (PDTs) via cortical bone trajectory.　Methods Four normal cervical spine specimens（C3~7） were selected and randomly divided into two groups. All specimens received CT scan. After images processing, the individual guide templates with cortical bone trajectory (CBT) were designed and subsequently produced by rapid prototyping (RP) and computer numerical control (CNC) technology, respectively. Then, their security and accuracy were evaluated in facilitating CPSI.　Results　The absolute deviations at the entry point were (0.28±0.24) mm in group RP and (0.32±0.23) mm in group CNC on the transverse plane, and were (0.30±0.20) mm in group RP and (0.52±0.44) mm in group CNC on the sagittal plane. The absolute deviations at the midpoint of the pedicle were (0.26±0.22) mm in group RP and (0.39±0.32) mm in group CNC on the transverse plane, and were (0.37±0.29) mm in group RP and (0.49±0.50) mm in group CNC on the sagittal plane. For the screw position, 20 screws position were in grade 1 in group RP; 19 screws position were in grade 1 and 1 was in grade 2 in group CNC. No statistically significant difference existed (P>0.05) in deviation and screw position between the two groups.　Conclusion　CNC-PDTs via cortical bone trajectory are viable in facilitating CPSI with good feasibility and accuracy. It is a new alternative method to lower cervical pedicle insertion.

Key words: Cortical bone trajectory;　CNC;　Guide templates;　Lower cervical, 　Pedicle screws

彭鹏,朱美松,张鑫涛,杜冰冉,李文睿,李鉴轶. 导航模板辅助下颈椎皮质骨螺钉置入准确性的研究[J]. 中国临床解剖学杂志, 2018, 36(2): 137-140.

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导航模板辅助下颈椎皮质骨螺钉置入准确性的研究

Accuracy of patient-specific drill template cervical pedicle screws insertion via cortical bone trajectory

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