摘要
目的:探索一种三维可视化图像引导的枢椎椎弓根螺钉置钉方法。方法:选取8具成人颅-颈椎标本,应用改良四柱式定位框架固定于枕颈,使颅-颈-肩形成统一刚体,保持空间位置恒定,行CT薄层扫描获取枢椎三维定位信息,Aero-tech立体定向手术规划系统三维建模,以枢椎椎弓根和侧块做"图像容积重建",在重建的骨性"容积块"中调节钉道的轨迹,确保其完全走行在椎弓根"容积块"内,并避开脊髓和椎动脉,形成可视化、个体化的置钉路径,然后在导向弓把持下置入导向钢针,复查CT评价置钉的准确性。结果:共置入16个枢椎椎弓根钢针,15个精确达到预设深度和方向;方向出现偏差者(横突孔突破)1个,失败率为6.25%。结论:目标椎弓根的容积三维重建、置钉路径可视化设计和虚拟演示,操作过程简单、直观而精确。加上导向抓持装置提供的稳定性,可视化图像引导置钉技术有较好的发展前景。
Objectlve：To investigate a new method of axis pedicle screws placement by three-dimension visualized image-guiding.Method：Eight adult cranio-cervical cadavers were immobilized by ameliorated four-column stereotaxis frame,cranio-cervical-scapular moulding was made as an uniform rigid body,spacial position was kept stable.Thin-slice CT scan provided spacial information of axial vertebral,Aero-tech surgical plan software assisted construction of three-dimension model.Aimed axis pedicle and lateral mass to make ＂image volume reconstruction＂ , modulated the screws path inside reconstructed ＂bone volume mass＂ to make sure the path absolutely tracking inside ＂volume mass＂ , avoiding the spinal cord and vertebral artery.Achieved visualized individual inserting path.Guide-arch hold the accurate direction to placer guidewire,the placement veracity was assessed by CT-countercheck.Result：One inserting divergence of guidewire（6.25%） appeared breaches of transverse foramen in 16 axis pedicle screw placement.Conclusion：Volume-reconstruction of aimed pedicle. visualized design and virtual maneuvering of inserting path made surgical process simplified.intuitionistic and rigorous,In addition to guide-holding equipment providing stability,visualized image guided pedicle screw placement shows better future.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2007年第10期769-772,I0002,共5页
Chinese Journal of Spine and Spinal Cord
关键词
枢椎
椎弓根螺钉
可视化
立体定向
图像引导
Axial vertebral
Pedicle screws
Visualization ： Stereotaxis
Image-guided
