收稿日期: 2017-11-14
网络出版日期: 2018-05-04
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
Received date: 2017-11-14
Online published: 2018-05-04
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。
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 . DOI: 10.13418/j.issn.1001-165x.2018.02.004
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.
[1] Santoni BG, Hynes RA, McGilvray KC, et al. Cortical bone trajectory for lumbar pedicle screws[J]. Spine J, 2009, 9(5):366-373.
[2] Matsukawa K, Yato Y, Hynes RA, et al. Cortical Bone Trajectory for Thoracic Pedicle Screws: A Technical Note[J]. Clin Spine Surg, 2017, 30(5):E497-E504.
[3] Matsukawa K, Yato Y, Kato T, et al. Cortical bone trajectory for lumbosacral fixation: penetrating S-1 endplate screw technique: technical note[J]. J Neurosurg Spine, 2014, 21(2):203-209.
[4] Lu S, Xu YQ, Chen GP, et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement[J]. Comput Aided Surg, 2011, 16(5): 240-248.
[5] Ma T, Xu YQ, Cheng YB, et al. A novel computer-assisted drill guide template for thoracic pedicle screw placement: a cadaveric study[J]. Arch Orthop Trauma Surg, 2012, 132(1): 65-72.
[6] Kaneyama S, Sugawara T, Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system[J]. Spine (Phila Pa 1976), 2015, 40(6): E341-E348.
[7] Tomasino A, Parikh K, Koller H, et al. The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood[J]. J Neurosurg Spine, 2010, 13(1): 52-60.
[8] 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): 19-28.
[9] Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review[J]. J Neurosurg Spine, 2013, 19(5):614-623.
[10] Ando K, Imagama S, Ito Z, et al. Minimum 5-year follow-up results for occipitocervical fusion using the screw-rod system in craniocervical instability[J]. Clin Spine Surg, 2017, 30(5): E628-E632.
[11]Yukawa Y, Kato F, Ito K, et al. Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope[J]. Eur Spine J, 2009, 18(9): 1293-1299.
[12] Nakashima H, Yukawa Y, Imagama S, et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients[J]. J Neurosurg Spine, 2012, 16(3):238-247.
[13]U?gur HC, Attar A, Uz A, et al. Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures[J]. Neurosurgery, 2000, 47(5):1162~1168, 1168-1169.
[14]Fu M, Lin L, Kong X, et al. Construction and accuracy assessment of patient-specific biocompatible drill template for cervical anterior transpedicular screw (ATPS) insertion: an in vitro study[J]. PLoS One, 2013, 8(1): e53580.
[15]陈国平，陆声， 徐永清，等. 数字化导航模板在下颈椎椎弓根定位定向中的应用[J]. 西南国防医药, 2010(6): 596-598.
[16]白宇哲，李长树，徐楚，等. 数控机床技术在下颈椎个体化导向模板制作中的应用[J]. 中国临床解剖学杂志, 2015(3): 284-287.
/
| 〈 |
|
〉 |
京ICP备08002354号-3
