寰枢椎椎弓根钉个体化置入技术在寰枢椎骨折脱位治疗中的应用

Application of Atlantoaxial Pedicle Screw Placement in Individual Treatment of Atlantoaxial Fracture Dislocation

目的探讨寰枢椎椎弓根钉个体化置入技术在寰枢椎骨折脱位治疗中的临床价值。方法对5例成人寰枢椎标本行CT扫描,将扫描数据导入Mimics软件对标本进行三维重建,并利用Mimics相关功能在三维重建图像上寻找寰枢椎椎弓根螺钉置入的最佳轴线并测量相关数据。然后以重建的椎体三维图形为模板,以寰椎后弓及枢椎棘突为解剖标志设计螺钉置入导向模块,将重建椎体模型及导向模块图像以STL格式导入三维打印机,制作出椎体模型及导向模块,并借助导向模块行术中椎弓根螺钉置入。结果成功建立了与标本相似度极高的寰枢椎三维重建图像和实物模型,并制作了置钉导向模块,于置钉导向模块辅助下对5例患者共置入10枚椎弓根螺钉,CT扫描显示螺钉位置满意。结论利用Mimics软件对寰枢椎进行三维立体重建,并以其为标本制作置钉导向模块来辅助置钉,是一种寰枢椎椎弓根螺钉置入的个体化方法,可明显提高置钉安全性。

Objective To investigate the effectiveness of application of atlantoaxial pedicle screw placement in individual treatment of atlantoaxial fracture dislocation.Methods Mimics software and rapid prototyping technology to design a new atlantoaxial pedicle screw placement in the individual,and to investigate its clinical significance.CT scan was performed in the specimens of 5 atlantoaxial adults to collect and import data into Mimics software for three-dimensional reconstruction of the specimen.And the related functions of Mimics were used to find the atlantoaxial pedicle screw axis in the threedimensional reconstruction figure and measure the best correlation data.Then,the reconstructed threedimensional vertebrae graphics were taken as a template.The posterior arch of atlas and spinous process were taken as anatomical landmarks to design the screw placement guide module.It guided the reconstruction of vertebral models and images in STL format into 3D printer to produce a vertebral model and guide module.And with the guide,the intraoperative pedicle screw placement was performed.Results The atlantoaxial reconstruction image and the physical model with high similarity to the specimen were successfully established.And the pedicle screw and guide module were produced.With the aid of screw placement guide module,10 pedicle screws were placed in 5 patients.CT images showed satisfactory screw locations.Conclusion Mimics software was used to promote atlantoaxial three-dimensional reconstruction.And its position was taken as a taxidermy to make guide module so as to assist pedicle screw.It provided a personalized approach for atlantoaxial pedicle screw placement,which could obviously improve the safety of pedicle screws.