数字化三维重建模拟后路枕骨髁螺钉置钉

发布时间：2018-05-31 23:36

本文选题：数字化 + 枕骨髁　；参考：《中国脊柱脊髓杂志》2017年07期

【摘要】：目的:利用数字化三维重建技术测量枕骨髁螺钉的最佳置钉参数,探讨后路枕骨髁螺钉置入的安全性及各置钉参数间的相关性。方法:选取50例枕颈部形态正常者的上颈椎螺旋CT扫描图像,男25例,女25例,年龄25~60岁(38.5±7.6岁)。排除骨折脱位、感染、肿瘤、畸形及退行性变,将数据导入Mimics软件,对枕骨及寰椎进行三维CT重建,模拟置入直径3.5mm的枕骨髁螺钉,测量枕骨髁长、宽、高、进钉点至枕骨内侧缘和颅底部的距离,并通过3-matic软件测量枕骨髁螺钉进钉长度、头倾角、内倾角及与枕骨切线间的切线角,比较枕骨髁解剖学参数与螺钉置钉参数间的差异。结果:共模拟置入100枚枕骨髁螺钉,三维模型大体观察均无舌下神经管、寰枕关节面和枕骨髁内外侧壁的损伤。男、女枕骨髁解剖学参数及螺钉进钉点参数、置钉后枕骨髁螺钉置钉参数左右两侧比较均无统计学差异(P0.05)。男性枕骨髁解剖学长、宽、高、进钉点距枕髁内侧缘水平距离及距颅底垂直距离分别为22.00±1.67mm、11.27±1.21mm、10.72±1.13mm、5.37±0.10mm及2.95±0.47mm,女性分别为21.07±1.43mm、10.64±0.81mm、9.62±0.95mm、5.05±0.10mm及3.04±0.48mm,女性枕骨髁长、宽、高及进钉点距枕髁内侧缘水平距离均显著性小于男性(P0.05),进钉点距颅底垂直距离与男性无统计学差异(P0.05);置钉后男性头倾角、颅底切线角、内倾角及进钉长度分别为3.90°±2.01°、12.45°±4.73°、28.15°±4.53°、22.47±1.48mm,女性分别4.19°±2.01°、11.25°±4.61°、30.00°±4.70°、21.59±1.62mm,女性进钉长度较男性短(P0.05),头倾角、颅底切线角及内倾角男女性无统计学差异(P0.05)。头倾角与切线角间存在正相关性(r=0.519,P0.05),与其余置钉参数间无相关性(P0.05)。结论 :国人女性枕骨髁解剖学参数与男性存在差异,枕骨髁三维重建下模拟螺钉置入显示男女性枕骨髁均可安全容纳螺钉置入固定,理论上切线角可结合进钉点及内倾角指导枕骨髁螺钉的安全置入。
[Abstract]:Objective: to study the safety of posterior occipital condylar screw placement and the correlation between the parameters of occipital condyle screw placement. Methods: 50 patients with normal occipitocervical shape were selected, 25 males and 25 females, aged 2560 years, 38.5 卤7.6 years old. Excluding fracture and dislocation, infection, tumor, malformation and degenerative change, the data were imported into Mimics software to reconstruct occipital bone and atlas, simulate occipital condylar screw with diameter 3.5mm, and measure the length, width and height of occipital condyle. The distance from the point of entry to the medial margin of occipital bone and the base of skull was measured by 3-matic software. The length of the screw, the angle of head inclination, the angle of internal inclination and the angle of tangent between the occipital condyle and occipital bone were measured by 3-matic software, and the differences between the anatomical parameters of occipital condyle and the parameters of screw insertion were compared. Results: a total of 100 occipital condylar screws were implanted. There were no hypoglossal nerve canal, atlanto-occipital articular surface and lateral wall of occipital condyle. The anatomic parameters of the condyle of the occipital bone and the point of screw entry were not significantly different between the male and the female, and there was no significant difference between the right and left sides of the parameters of the screw insertion of the occipital condyle. The anatomical length, width and height of the occipital condyle in males were 22.00 卤1.67mm and 11.27 卤1.21mm respectively, and 2.95 卤0.47mm, 21.07 卤1.43mm, 9.62 卤0.95mm, 5.05 卤0.10mm and 3.04 卤0.48mm, respectively. The occipital bone length, width and width of the occipital bone in males were 3.04 卤0.48mm and 21.07 卤1.43mm respectively, and those in males were 22.00 卤1.67mm, 10.72 卤1.13mm and 2.95 卤0.47mm, respectively, and those in females were 21.07 卤1.43mm, 9.62 卤0.95mm, 5.05 卤0.10mm and 3.04 卤0.48mm, respectively. The horizontal distance between the height and the point of entry to the medial margin of the occipital condyle was significantly lower than that of the male (P 0.05), and there was no significant difference in the vertical distance between the point and the base of the skull (P 0.05). The inclinations and the length of the nail were 3.90 掳卤2.01 掳/ 12.45 掳卤4.73 掳/ 28.15 掳卤4.53 掳/ 22.47 卤1.48mm, respectively, and 4.19 掳卤2.01 掳/ 11.25 掳卤4.61 掳/ 11.59 卤1.62mm respectively. The length of the nail in female was shorter than that in the male (P 0.05N), and there was no significant difference in the angle of head inclination, the angle of tangent line of skull base and the angle of internal inclination. There was a positive correlation between the head inclination angle and the tangent angle, and there was no correlation between the head inclination angle and the tangent angle. Conclusion: the anatomic parameters of occipital condyle in Chinese women are different from those in men. Under the three-dimensional reconstruction of occipital condyle, the simulated screw placement shows that the occipital condyle of male and female can safely accommodate the screw placement and fixation. Theoretically, tangent angle can be combined with insertion point and inclination angle to guide the safe placement of occipital condylar screw.
【作者单位】：宁波大学医学院;浙江省宁波市第六医院骨科;
【基金】：国家自然科学基金面上项目(81572217) 浙江省医药卫生科技项目(201340612);浙江省医药卫生科技项目(2015112091)
【分类号】：R687.3

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