计算机辅助模拟置钉技术在寰椎侧块螺钉中应用的精准性研究

发布时间：2018-06-24 04:25

  本文选题：寰椎 + 侧块螺钉　； 参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨计算机辅助模拟置钉技术在寰椎侧块螺钉精准置钉中应用的可行性。方法回顾性分析2014年1月至2016年1月在河南省人民医院骨科二病区行寰椎侧块螺钉内固定技术治疗的寰枢椎不稳患者共51例,其中男性28例、女性23例,年龄31-54岁,平均年龄42.7岁。术前使用BOHOLO外科手术模拟器设计置钉参数模拟置钉的共27例,定义为实验组,其中陈旧性齿状突骨折7例,先天齿状突发育不全12例,新鲜齿状突骨折(Anderson IIC型)8例;未使用BOHOLO外科手术模拟器术前规划进行手术的共24例,定义为对照组,其中陈旧性齿状突骨折6例,先天齿状突发育不全10例,新鲜齿状突骨折(Anderson IIC型)8例。实验组术前CT数据导入BOHOLO软件设计寰椎侧块最佳钉道,定义参数(进钉点到椎管最外侧缘即椎弓根内缘的距离L1、到寰椎正中矢状面距离L2、钉道长度D、钉道水平面角TSA、矢状面角SSA),并用BOHOLO软件测量实验组术后实际钉道参数,与术前规划参数进行比较,同时比较两组手术时间(min),术中出血量(ml),调取两组患者术后CT,通过BOHOLO多平面重组成像在CT轴位与冠状位观察比较两组螺钉位置,在轴位上划分侧块置钉可靠区:上关节面在侧块内的投影区,该区域内螺钉固定安全且强度最可靠,可靠区以外区域置钉强度不可靠且有损伤脊髓或椎动脉风险。依据术后有无并发症,术前以及末次随访时的JOA评分、VAS评分以及融合率来评价疗效。结果所有患者术中均未出现椎动脉以及神经损伤的情况,且均获得随访,随访时间7~13个月,平均9个月,术后6个月时,均获得骨性融合,且无螺钉松动、移位、断裂的情况发生。两组患者基线资料以及病历组成均无统计学差异。实验组共置入寰椎侧块螺钉54枚,均位于可靠区内,占100%,测得最佳钉道参数L1(左侧5.00±0.92mm、右侧5.19±0.83mm),L2(左侧19.22±1.19mm、右侧18.96±1.09mm),D(左侧20.67±1.62mm、右侧20.26±1.53mm),TSA(左侧12.11±1.40°、右侧11.93±1.47°),SSA(左侧19.82±1.33°、右侧19.56±1.31°),实际钉道参数L1’(左侧4.74±0.71mm、右侧5.11±0.97mm),L2’(左侧18.96±1.16mm、右侧19.04±1.06mm),D’(左侧20.48±1.55mm、右侧20.48±1.81mm),TSA’(左侧12.19±1.57°、右侧12.22±1.48°),SSA’(左侧19.74±1.29°、右侧19.41±1.22°),规划与实际参数之间差异无统计学意义(P0.05)。对照组共置入螺钉48枚,其中42枚螺钉位于可靠区内,占87.5%,与实验组存在差异(P0.05);两组手术时间分别为(107.22±12.96min、116.88±16.73min),术中出血量分别为(403.70±101.61ml、484.58±138.00ml),差异存在统计学意义(P0.05);两组术前JOA评分分别为(6.89±1.65、7.33±1.58),VAS评分分别为(3.67±0.73、3.46±0.59),末次随访时JOA评分分别为(13.15±2.54、12.58±2.62),VAS评分分别为(1.70±0.61、1.54±0.66),差异组内比较均具有显著意义(P0.05),而组间差异无统计学意义(P0.05)。结论计算机辅助模拟置钉技术可以辅助术中实施准确置钉,并且有助于提高置钉的准确率,减少术中出血,缩短手术时间。
[Abstract]:Objective to investigate the feasibility of the application of computer aided nailing technique in the accurate placement of atlantoaxial screws. Methods a retrospective analysis of 51 cases of atlantoaxial instability in the two ward of Henan Province People's Hospital from January 2014 to January 2016 was performed in two cases of atlantoaxial instability, including 28 males, 23 females, age, and age. 54 years old, with an average age of 42.7 years. Before operation, 27 cases of nail parameter simulation were designed by BOHOLO surgical simulator, which were defined as experimental group, including old odontoid fracture in 7 cases, congenital odontoid dysplasia in 12 cases, and fresh odontoid fracture (Anderson IIC type) in 8 cases. The preoperative planning of the BOHOLO surgery simulator was not used for operation. A total of 24 cases were defined as the control group, including 6 old odontoid fractures, 10 congenital odontoid dysplasia and 8 fresh odontoid fractures (Anderson IIC type). The CT data of the experimental group were introduced into the BOHOLO software to design the best nail path of the atlas side block and define the parameters (the distance to the nailed point to the lateral margin of the vertebral canal, the distance L1 of the pedicle edge, to the atlas positive. " The median sagittal distance was L2, the length of the nail path was D, the horizontal angle TSA of the nail path, the sagittal angle SSA), and the parameters of the actual nail path after the operation were measured by BOHOLO software and compared with the preoperative planning parameters. At the same time, the operation time (min) and the amount of bleeding (ML) were compared between the two groups, and the postoperative CT of the two groups of patients was transferred to the CT axis and the crown by the BOHOLO multiplane recombination imaging. The position of two groups of screws was observed, and a reliable area of the side block was divided on the axial position: the projection area of the upper articular surface in the side block, the screw fixation and the most reliable strength in this area, the unreliable nail strength outside the reliable area and the risk of injury to the spinal cord or the vertebral artery. JOA score, VAS score and fusion rate were used to evaluate the curative effect. Results all patients had no vertebral artery and nerve injury during the operation, and all the patients were followed up for a period of 7~13 months, mean 9 months, and 6 months after the operation, all of them were fused without screw loosening, displacement and fracture. The baseline data of the two groups of patients, There were no statistical differences in the composition of the medical records. In the experimental group, 54 screws were placed in the lateral mass of the atlas, which were all located in the reliable area, accounting for 100%. The optimum nail path parameters L1 (left 5 + 0.92mm, right 5.19 + 0.83mM), L2 (left 19.22 + 1.19mm, right 18.96 1.09mm), D (left 20.67 + 1.62mm, right 20.26 + 1.53mm), TSA (left 12.11 + 1.40 degrees, right 11.93 + 1.4) 7 degrees), SSA (left 19.82 + 1.33 degrees, right 19.56 + 1.31 degrees), actual nail channel parameters L1 '(left 4.74 + 0.71mm, right 5.11 + 0.97mm), L2' (left 18.96 + 1.16mm, right 19.04 + 1.06mm), D '(left 20.48 + 1.55mm, right 20.48 + 1.81mm), TSA' (left 12.19 + 1.57 degrees, right left-hand degrees), SSA ' There was no statistically significant difference between the planning and the actual parameters (P0.05). 48 screws were inserted in the control group, of which 42 screws were located in the reliable area, accounting for 87.5%, and the difference between the experimental group (P0.05) and the two groups (107.22 + 12.96min, 116.88 + 16.73min), respectively (403.70 + 101.61ml, 484.58 + 138.00ml), respectively. There were statistical significance (P0.05); the preoperative JOA scores in the two groups were (6.89 + 1.65,7.33 + 1.58), VAS scores were (3.67 + 0.73,3.46 + 0.59), and JOA scores were (13.15 + 2.54,12.58 + 2.62) at the last follow-up, and VAS scores were (1.70 + 0.61,1.54 + 0.66) respectively. The differences in the groups were significant (P0.05), but there was no statistical difference between the groups. Study significance (P0.05). Conclusion computer aided simulation nail placement can assist in the accurate placement of nail, and help to improve the accuracy of nail placement, reduce intraoperative bleeding and shorten the operation time.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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本文编号：2060008