3D打印辅助颈椎后路椎弓根精准置钉的实验研究

发布时间：2018-05-17 08:34

  本文选题：颈椎椎弓根 + 椎弓根螺钉　； 参考：《福建医科大学》2016年硕士论文

【摘要】：目的:探讨一种基于数字化设计及3D打印技术的颈椎弓根精准置钉方法。方法:12具成人尸体颈椎标本进行薄层CT扫描、三维编辑分离C1-C7独立的椎骨并三维重建。(1)钉道布置:首先以三维切割的方式确定椎弓根置钉面,在置钉面上快速构建兼顾椎骨形态学结构的理想钉道;(2)单、双面导航模块的选择:将C1-C7分为C1、C2、C3-C6及C7四个部分,并根据有无棘突分叉选择单、双面导航模块;(3)高精度的图像配准:根据应用解剖学研究的“骨面可剥离范围”,以三维切割的方式设计并打印单、双面导航模块;(4)现实置钉:在12具尸体标本上实施导航模块辅助颈椎后路椎弓根螺钉置入;(5)三维配准:术后再次薄层CT扫描并三维重建,术后与术前设计的模型进行三维配准,采集术前设计及术后钉道的进、出钉点三维坐标值;(6)统计分析:统计二者差值绝对值不同“等级精度”下的合格钉点,进行卡方检验。结果:(1)共置入颈椎椎弓根螺钉158枚,5枚穿出椎弓根骨质外,穿出幅度均2mm,置钉准确率达到98.1%;(2)卡方检验结果显示,当进钉点精度要求≥1.7mm时,?2=2.279,P0.05,以及出钉点精度要求≥2.7mm时,?2=3.251,P0.05;(3)C3-C7钉道内倾角25°-40°。结论:基于3D打印技术的颈椎后路椎弓根置钉的精度取决于:(1)高精度图像配准,要点为根据“可剥离范围”进行导航模块设计及现实置钉;(2)理想钉道设计,要点为以三维切割的方式快速布置钉道,兼顾颈椎骨形态学结构特点。
[Abstract]:Objective: to explore a method of cervical pedicle nail placement based on digital design and 3D printing. Methods 12 adult cadaveric cervical vertebrae specimens were scanned by thin slice CT, and the C1-C7 independent vertebrae were separated and reconstructed. The choice of a single and double-sided navigation module: the C1-C7 was divided into four parts, C1C2C3-C6 and C7, and the single one was selected according to the bifurcation of spinous process. High precision image registration: according to the applied anatomical study of "bone surface can be stripped off range", design and print a single in the form of three-dimensional cutting. In 12 cadavers, the navigation module was used to assist the posterior cervical pedicle screw placement into the cervical spine. Three dimensional registration was carried out. After the operation, thin slice CT scanning and 3D reconstruction were performed again, and the 3D registration was performed with the pre-operative model. The statistical analysis of pre-operation design and postoperation nail entry and exit point 3D coordinate value was made: the qualified nail points with different grade accuracy were counted and chi-square test was carried out. Results [WT5HZ] A total of 158 pedicle screws were inserted into the vertebral pedicle and 5 screws were inserted out of the pedicle of the cervical vertebrae, with an average puncture amplitude of 2 mm, and the accuracy of screw placement was 98.1 / 2) the chi-square test results showed that, When the precision of the point of entry and nail is 鈮，

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