颈段脊柱前路手术相关结构的三维可视化

Three-dimensional visualization of the structures related to the anterior cervical segment approach

目的寻求建立颈段脊柱前路手术相关结构的数字模型及三维可视化方法。方法选取健康志愿者头颅中部至第3胸椎下缘连续CTA动脉造影,MR脊髓造影(MRM)及臂丛神经薄层MRI连续扫描断层图像,Mimics软件基于不同组织阈值对骨骼,动脉,静脉,脊髓等组织用半自动方法进行分割和重建,神经管道编辑器和MedCAD(医学计算机辅助设计)模块对颈丛,臂丛神经,颈肌进行重建,三维化显示颈段脊柱前路手术相关解剖结构。结果建立颈段脊柱前路手术相关结构的三维可视化模型,显示骨性结构、主动脉、上腔静脉、甲状腺、舌骨、喉软骨、气管、肺、12组颈肌和脊髓、脊神经、颈丛、臂丛神经、颈椎间盘等解剖结构的位置关系。结论在颈前部解剖结构三维模型基础上,参照解剖学层次逐层显示该手术相关重要结构,为解剖教学、手术培训提供医疗教学平台。

Objective To establish a digital model allowing three-dimensional visualization of the structures involved in the anterior cervical segment approach.Methods Based on the imaging data obtained from CT angiography （CTA）,magnetic resonance myelography （MRM） and continuous magnetic resonance imaging （MRI） of a healthy volunteer （scanning from the center of the head to the inferior border of the T3 level）,image segmentation and reconstruction for the skeleton,arteries,veins,and spinal cord was conducted semi-automatically using the Mimics software according to the different thresholds of the tissues.The cervical plexus,brachial plexus and muscles of the neck were reconstructed with the Nerves pipe editor and the Med CAD module to establishing the three-dimensional model for displaying the structures involved in the anterior cervical segment approach.Results A three-dimensional digital model of the structures involved in the anterior cervical segment anterior approach was established,which allowed the display of anatomical relations of the skeletal structure,aorta,superior vena cava,thyroid gland,hyoid bone,laryngeal cartilages,trachea,lung,12 neck muscle groups,as well as the spinal cord,spinal nerves,cervical plexus,brachial plexus,and intervertebral disk of the neck.Conclusion The three-dimensional model established can allow the visualization of the important structures for the anterior cervical segment approach,and provides a medical teaching platform for anatomy and surgical training.