MIMICS软件虚拟技术辅助寰枢椎脱位颈1侧块螺钉植入

发布时间：2018-02-26 19:34

本文关键词： 寰枢椎脱位寰枕融合颅底凹陷 C1侧块螺钉 MIMICS软件虚拟技术　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究探索运用MIMICS软件虚拟技术,获得C1侧块螺钉个性化钉道参数,并尝试术中运用模拟参数辅助螺钉植入,同时评估虚拟现实钉道设计技术的临床价值。方法:本研究共纳入寰枢椎脱位患者88例。将所有患者术前进行薄层CT扫描。将原始DICOM文件输入MIMICS工作站。在MIMICS工作站中,建立起参考坐标系,三维重建出寰枕骨质融合体三维图像,再在模拟系统中创建一个直径为3.5毫米的圆柱体,用来模拟成需要植入侧块的螺钉,在三维状态下,调整它的角度(水平轴面的内倾角和矢状面的上倾角),以保证能够避开同侧的椎动脉、舌下神经管等重要结构,然后将模拟螺钉放置到C1侧块上,得出理想的轴向角(内倾角)和矢状角(上倾角),分别测量轴向角和矢状角大小,测量螺钉跨越双皮质后螺钉的长度,进一步确定理想的钉道轨迹、进钉点及出钉点。然后在实际手术中参考术前模拟重建的解剖标记及参数,包括钉道方向、进钉点和螺钉长度,对钻孔进行指导。钻孔后,球探探测钉道的四壁完整性及深度,逐步增加钉道深度至理想深度,球探探测钉道已突破C1侧块腹侧面骨皮质,攻丝沿理想钉道扩通钉道(防止进钉时骨皮质被撑裂),然后沿钉道植入直径3.5毫米的螺钉。所有病人术后再行CT复查,将DICOM图像导入到MIMICS模拟系统,在2维图像评估C1LMS的安全性。结果:一共有176枚螺钉进行了分析。平均理想的轴向内倾角为14.2°±5°,平均理想的矢状上倾角为20.5°±9.1°。理想的钉道长度19.1mm±2.2mm。影像学评估显示,170(96.6%)螺钉理想位置(TypeⅠ),6枚螺钉错位(TypeⅡ)。总体而言,100%个螺丝被评为安全(TypeⅠandⅡ)。结论:术前应个体化设计寰枢椎脱位寰枕融合的颈1侧块螺钉钉道。在虚拟现实技术辅助下,颈1侧块螺钉可以更安全植入。
[Abstract]:Objective: This study is to explore the use of MIMICS software of virtual technology, C1 lateral mass screw screw parameters and try to personalized, auxiliary screws using simulation parameters in the operation, and evaluate the clinical value of virtual reality screw design technology. Methods: This study included 88 cases of patients with atlantoaxial dislocation. All patients with thin layer CT scanning. The original DICOM file input MIMICS workstation. In MIMICS workstation, establishes the reference coordinate system, reconstruction of atlanto occipital bone fusion of 3D images, and then create a cylinder with a diameter of 3.5 mm in the simulation system, to be used to simulate the lateral mass screw implantation, in 3D state. And adjust its angle (horizontal axis plane angle and sagittal angle), in order to avoid the ipsilateral vertebral artery, hypoglossal canal and other important structures, and then simulate screws on the C1 side to block. An axial angle (angle) and sagittal angle (angle), axial and sagittal angles were measured in size, measuring screw across bicortical screw length after, to further determine the ideal screw trajectory, the screw entry point and nail. Based on the preoperative anatomical markers and reconstruction of simulation parameters then in the actual operation, including the direction of screw, screw and screw length, to the direction of the hole. After drilling, nailing walls integrity detection scout road and depth, gradually increase the depth of the nail to the desired depth, scout screw has exceeded C1 detection side block the ventral surface of the bone cortex, tapping along the ideal nail through the expansion screw (to prevent the nail when the bone cortex was breaking, and then along the road) screw implant diameter of 3.5 mm. All patients after CT review, the DICOM image into MIMICS simulation system in safety assessment of C1LMS 2 dimensional images. Results: a total of 176 screws. Are analyzed. The axial average ideal inclination angle is 14.2 degrees plus or minus 5 degrees, the average of the ideal sagittal angle is 20.5 degree. The length of 19.1mm + 9.1 ~ + 2.2mm. radiographic evaluation showed that the ideal nail, 170 screws (96.6%) ideal position (Type 1), 6 screw dislocation (Type II). Overall, 100% screws were rated as safe (Type I and II). Conclusion: preoperative individualized design of atlantoaxial dislocation of atlanto occipital fusion of 1 cervical lateral mass screw. In virtual reality assisted, 1 cervical lateral mass screw implantation can be more secure.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：TP391.9;R687.3

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