改良版颈椎前路椎弓根螺钉的影像学研究

发布时间：2018-06-02 04:05

本文选题：颈椎前路椎弓根螺钉 + 导航模板　；参考：《宁波大学》2017年硕士论文

【摘要】：目的:通过对改良版双侧颈椎前路椎弓根螺钉影像学的研究,分析其进针角度的最佳值,同时指导改良版螺钉3D打印导向模板的设计。方法:采集22名健康志愿者(15男7女)的颈椎CT数据,并以DICOM格式导出至Mimics 17.0软件,依次重建颈椎模型,将模型调至半透明模式,并以椎体后缘线正中为中心设立坐标轴,依次以5度为一旋转变量以坐标轴为轴心旋转椎体,使椎体椎弓根骨性通道上在头尾倾和内外倾上呈现出不同的投影(椎弓根投影法),通过Auto CAD软件测量每一实验组椎弓根骨性通道的投影面积大小及最大横纵径,并得出最佳进针角度(对应最大椎弓根投影面积),并以此结果作为参考以指导尸体改良版颈椎椎弓根螺钉导向模板的设计制作及应用。结果:实验得到了全部22名志愿者的颈椎CT数据,同时通过对影像学软件的分析得到了不同角度时椎弓根投影面积,收集每位志愿者每个节段(C3-7)左右侧椎弓根最大投影面积时的角度比进行统计学分析,C3最大椎弓根骨性通道面积为32.87±3.57mm2,最大横径5.47±0.97mm,最大纵径6.99±1.02mm,最佳进针角度为外倾44.71±2.34°,头倾角为4.16±0.67°(上)、11.67±0.41°(下);C4最大椎弓根骨性通道面积为36.65±3.21mm2,最大横径5.73±0.94mm,最大纵径7.34±1.22mm,最佳进针角度为外倾46.13±3.11°,头倾4.43±0.58°(上)、12.38±0.63°(下);C5最大椎弓根骨性通道面积为37.32±2.84mm2,最大横径5.88±0.86mm,最大纵径7.62±1.31mm,最佳进针角度为外倾44.66±4.02°,头倾4.02±0.61°(上)、11.88±0.77°(下);C6最大椎弓根骨性通道面积为40.12±2.84mm2,最大横径6.37±0.86mm,最大纵径7.69±1.19mm,最佳进针角度为外倾43.14±3.71°,头倾3.52±0.39°(上)、10.85±0.82°(下);C7最大椎弓根骨性通道面积为46.12±2.84mm2,,最大横径6.89±1.26mm,最大纵径8.31±1.39mm,最佳进针角度为外倾42.64±2.94°,头倾3.07±0.47°(上)、9.95±0.90°(下)。根据此组数据,我们设计并制作了改良版颈椎前路椎弓根螺钉导向模板120枚,并在尸体标本进行了置钉试验,术后CT显示得到了95.8%的准确率。结论:通过椎弓根骨性通道投影法的测量我们获得了改良版颈椎前路椎弓根螺钉在矢状位和水平位上的在最佳进针角度,C3、C4在外倾角与尾倾角上具有增大的趋势,而C5、C6、C7的进针角度则逐渐的下降。而椎弓根骨性通道投影面积及横纵径则随着颈椎节段的下降越来越大,提示椎弓根的逐渐增粗。同时据此数据设计的颈椎前路椎弓根螺钉导向模板的准确性证明了其最佳进针角度的有效性。
[Abstract]:Objective: to study the imaging of the modified bilateral anterior cervical pedicle screw, and to analyze the optimal angle of the needle, and to guide the design of the modified screw 3D printing guide template. Methods: the CT data of cervical vertebrae were collected from 22 healthy volunteers (15 males and 7 females). The cervical vertebrae model was reconstructed by Mimics 17.0 software with DICOM format. The model was adjusted to translucent model, and the coordinate axis was set up with the center of the posterior margin line of the vertebral body as the center. In turn, 5 degrees as a rotating variable and axis as the axis of rotation of the vertebral body, The projection area and maximum transverse diameter of the bony passage of pedicle in each experimental group were measured by Auto CAD software. The optimal angle of needle entry (corresponding to the maximum pedicle projection area) was obtained, and the results were used as a reference to guide the design and application of the modified cervical pedicle screw guide template. Results: the CT data of all 22 volunteers were obtained, and the projection area of pedicle at different angles was obtained by analyzing the imaging software. The angle ratio of maximum projection area of pedicle of left and right pedicles of each volunteer was analyzed statistically. The maximum pedicle bony passage area of C3 was 32.87 卤3.57 mm 2, the maximum transverse diameter was 5.47 卤0.97 mm, the maximum longitudinal diameter was 6.99 卤1.02 mm, and the best angle of needle entry was 44.71 卤2.34 掳, and the angle of angle was 44.71 卤2.34 掳, the maximum transverse diameter was 5.47 卤0.97 mm, and the maximum longitudinal diameter was 6.99 卤1.02 mm. The angle of head inclination was 4.16 卤0.67 掳(upper angulation 11.67 卤0.41 掳) (the maximum area of bone passage of pedicle C _ 4 was 36.65 卤3.21 mm, the maximum transverse diameter was 5.73 卤0.94 mm, the maximum longitudinal diameter was 7.34 卤1.22 mm), the optimum angle of needle entry was extroverted 46.13 卤3.11 掳, and the angle of cephalic inclination was 4.43 卤0.58 掳(upper trochanter 12.38 卤0.63 掳). The maximum area of bone passage was 32 卤2.84mm2mm, the maximum transverse diameter was 5.88 卤0.86mm, and the maximum longitudinal diameter was 37.88 卤0.86mm. Diameter 7.62 卤1.31 mm, the optimum angle of needle entry is extroverted 44.66 卤4.02 掳, cephalic inclination 4.02 卤0.61 掳(C6) 11.88 卤0.77 掳(area of bone passage of pedicle C6 is 40.12 卤2.84 mm 2, maximum transverse diameter 6.37 卤0.86 mm, maximum longitudinal diameter 7.69 卤1.19 mm, optimum angle of needle entry 43.14 卤3.71 掳, head inclination 3.52 卤0.39 掳(10.85 卤0.82 掳) of pedicle bone passage area of pedicle of lower vertebrae pedicle, maximum transverse diameter 6.37 卤0.86 mm, maximum longitudinal diameter 7.69 卤1.19 mm, optimum angle of needle entry 43.14 卤3.71 掳, head inclination 3.52 卤0.39 掳(10.85 卤0.82 掳). The maximum transverse diameter was 6.89 卤1.26mm, and the maximum longitudinal diameter was 8.31 卤1.39mm. The optimum angle was 42.64 卤2.94 掳outward tilting and 3.07 卤0.47 掳head tilting (9.95 卤0.90 掳). According to the data of this group, we designed and made 120 modified anterior cervical pedicle screw guide templates, and carried out nail placement tests on cadaveric specimens. The accuracy of CT display after operation was 95.8%. Conclusion: the modified anterior cervical pedicle screw in sagittal and horizontal position has the tendency to increase the external inclination and tail inclination by measuring the bony channel projection of the pedicle. However, the angle of C _ (5) C _ (6) C _ (6) C _ (7) decreased gradually. However, the projection area and transverse longitudinal diameter of pedicle bony channel were larger and larger with the decrease of cervical vertebra segment, suggesting that the pedicle was gradually thickening. At the same time, the accuracy of the guide template of anterior pedicle screw designed based on the data proved the validity of the optimal angle of needle entry.
【学位授予单位】：宁波大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3;R816.8

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