Mimics及脊柱模型用于下颈椎椎弓根个体化置钉的应用研究.doc

Mimics及脊柱模型用于下颈椎椎弓根个体化置钉的应用研究 王远政1 ，田晓滨1，刘 洋2，李 波1，孙 立1，张 一1，王楠筑1 （550002 贵阳，贵州省人民医院骨科1；400010 重庆，重庆医科大学附属第二医院骨科2） [摘要] 目的 利用快速成型技术及Mimics软件设计一种新的下颈椎椎弓根钉个体化置入技术，并探讨其临床应用意义。 方法 对16例成人下颈椎标本行CT扫描收集数据，导入Mimics软件对标本进行三维重建。利用Mimics相关功能在三维重建图像上寻找下颈椎椎弓根最佳轴线并测量椎弓根相关参数，制定椎弓根螺钉个体化置入方案。然后将三维重建图像以STL格式导入三维打印机，制作出下颈椎的实体模型，根据个体化置钉角度置入导向针。依照制定的个体化指定参数，并配合实体模型的直观指导，在标本上进行置钉。置钉后标本行CT扫描，判断置入准确性。利用上述方法对2例患者进行个体化置钉，术后通过CT扫描验证螺钉位置准确性。 结果 成功建立了与标本相似度极高的下颈椎三维重建图像和实物模型，通过测量结果设计了每个椎弓根的置钉参数。共在标本上置入148枚椎弓根螺钉，140枚位于椎弓根骨皮质之内，8枚稍穿破椎弓根骨皮质。对患者置入10枚椎弓根螺钉，CT示螺钉位置满意。结论 用Mimics软件对下颈椎进行三维重建，制定个体化置钉参数，同时配合实物模型的直观指导，提供了一种下颈椎椎弓根钉个体化置钉的方法，利用该法能提高置钉安全性。 [关键词] 颈椎；椎弓根螺钉；Mimics软件；快速成型；三维重建 [中图法分类号] [文献标志码] A Individualization of lower cervical pedicle screw fixation withApplication of rapid prototyping and MIMICSimics software in lower cervical pedicle screw fixation three-dimensional (3D) reconstruction model was generated with MIMICS a workstation running MIMICS 10.01 software Wang Yuanzheng1, Tian Xiaobin1, Liu Yang2, Li Bo1, Sun Li1, Zhang Yi1, Wang Nanzhu1 (1 Department of Orthopaedics Surgery,Guiz Zhou Provinceial People’s Hospital, Guiyang, Guizhou Province, 550002，China; 2 Department of Orthopaedics Surgery, XinqiaoSecond affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China) [Abstract] Objective To design a new lower cervical pedicle screw placement based on study the application of Mimics software and rapid prototyping technology and evaluate its clinical valuein lower cervical pedicle screw placement, and explore its clinic application. Methods CT scans scanning was performed of on 16 adult cadaveric cervical specimens (C3 to -C7). were performed. The obtained CT data were imported into a workstation running MIMICS reverse engineering software Mimics to generate establish cervical three dimensional (3D) reconstruction images which saved as STL files. Then these STL files were used to manufacture produce cervical physical models using rapid prototyping technique. The optimal trajectory pedicle was explored and marked on 3D images using computer assistant aided design module of Mimics, and the related parameters of cervical pedicle were measured using measurement tools of Mimics. So the individualized surgery plan of pedicle screw fixation was determined according to the location of pedicle trajectory and parameters. The trajectory pins were drilled into physical model to supervise the entry point and orientation of pedicle screw. With the visualized guidance of physical model, pedicle screws were inserted in cadaveric specimens in strict accordance with individualized surgery plan determined previously. Pedicle screw fixation was performed in two 2 patients with cervical disorders requiring instrumentation using this individualized surgery method as mentioned above. Results The cervical 3D image and physical model were found to be anatomically similar with each other and of great assistance in designing individualized surgery plan and supervising placement of pedicle screw. There were pP148 pedicle screws were inserted in the 16 cervical specimens,. Among them, 140 were inserted in the pedicle cortical, and the left 8only one of them breached the pedicle cortical mildly. CT scanning indicated that the 10 pedicle screws were satisfyingly inserted in the 2 patients. Conclusion Combination of 3D image by Mimics and intuitive guidance of physical model by rapid prototyping technique improve the accuracy and safety of lower cervical stereotaxy. [Key words] cervical vertebra; pedicle screw; Mimics; rapid prototyping; three-dimensional reconstruction Supported by the Tackling Project of Scientific and Technology for Social Development of Guizhou Province ([2010]3115). Correspond author: Tian Xiaobin Tel: 86-851-5600978, E-mail:txb6@ [基金项目] 贵州省社会发展科技攻关项目（黔科合SY [2010]3115号） [通信作者] 田晓滨，电话：（0851）5600978， E-mail:txb6@ them breached the pedicle cortical. Conclusions The accuracy of lower cervical stereotaxy can be improved with the help of measurement of 3D image established by Mimics and intuitive guidance of physical model manufactured by rapid prototyping technique. [Key words] cervical vertebra; pedicle screw; Mimics; rapid prototyping; three-dimensional reconstruction Supported by Social development of scientific and technological project in Guizhou Province of China([2010]3115). Correspond author:Tian Xiaobin Tel:86-851-5600978, E-mail:txb6@ 7 下颈椎（C3～C7）伤病严重影响着人类健康，对下颈椎伤病的外科治疗，其目的可归结为:恢复颈椎的解剖序列、神经根或脊髓减压和重建颈椎稳定性。颈椎内固定是实现这些目的的有效手段。其中，颈椎椎弓根螺钉内固定系统在临床上应用越来越广泛，该内固定系统能够提供其他固定方式无法比拟的三维立体稳定性[1-3]，更有利于颈椎术后的稳定和骨性融合。但是，考虑到下颈椎解剖关系复杂，且与血管及神经等重要组织相毗邻，置钉失误可能导致严重后果，因此寻求一种安全的个体化置钉方法一直是临床应用十分关注的问题。本研究利用快速成型 (rapid prototyping，RP) 技术制作的颈椎实体模型和Mimics软件的三维重建、计算机辅助设计（computer assistant design，MeCAD）功能相结合，探索了一种新的下颈椎椎弓根钉个体化置钉方法。 1 资料与方法 1.1 标本制备 成人尸体标本16例（重庆医科大学解剖教研室与贵阳医学院解剖教研室提供），从C2