复杂性枕颈部畸形损伤三维可视化模型建立及手术模拟

Three-dimensional visualization model and simulation operation of complex occipito-cervical deformity

目的寻求建立复杂性枕颈部畸形三维可视化模型及手术模拟方法。方法取1名颅底凹陷症伴延髓受压,陈旧性寰枢关节脱位病人连续CTA动脉造影和MR脊髓造影断面图像,Mimics软件基于不同阈值对骨骼、动静脉、气管、甲状腺、喉软骨、脊髓等不同组织进行半自动分割和重建,三维化显示枕颈部畸形及周围相关解剖结构。并按经口咽入路寰枢关节松解复位,后路枕颈融合植骨内固定术进行术前模拟。结果建立枕颈部畸形相关结构三维可视化模型,显示颈部重要组织结构三维空间位置关系,成功模拟复杂性枕颈部畸形前后路联合手术,并和临床手术结果得到验证。结论枕颈部畸形三维可视化模型为临床手术提供直观的解剖形态学和术前模拟参考。

Objective To establish a three-dimensional visualization model and simulated operation of a complex occipito-cervical deformity. Methods We used continuous cross-sectional scans from computed tomography angiography and magnetic resonance myelography of a patient to demonstrate basilar invagination, medullary compression, and an old atlantoaxial dislocation. Half-auto cut and reconstruction were undertaken on the skeleton, arteriovenous system, trachea, thyroid, laryngeal cartilage, and spinal cord according to the different tissue thresholds using Mimics sottware. A three-dimensional model of occipito-eervical deformity and its related surrounding local anatomic structures were successfully displayed. Preoperative simulation included releasable reattachrnent of th atlantoaxial joint through the transoral approach and posterior occipital cervical fusion with bone graft and internal fixation was performed. Results A three-dimensional visualization model of the occipito-cervical deformity was established. The three-dimensional spatial relations were successfully displayed. An anteroposterior operation for a complex occipito-cervical deformity was simulated and was verified by the clinical operation. Conclusion A three-dimensional visualization model of an occipito-cervical deformity can provide intuitive anatomical morphology and a preoperative simulation reference for clinical operations.