CAJ | 학술논문

背景：目前国内外学者已将椎弓根螺钉内固定技术应用于儿童脊柱损伤治疗中，儿童胸椎椎弓根细小，解剖结构变异大、毗邻关系复杂，如将以成人数据为依据的椎弓根螺钉技术简单地应用于处于不断生长发育的儿童，手术风险极大，提高置钉的准确性和降低失误率成为儿童椎弓根内固定技术能否深入开展的关键所在。目的：利用计算机辅助设计与快速成型技术为儿童胸椎椎弓根螺钉置入提供一种个性化、精确化的定位方法。方法：对4例儿童尸体标本CT 扫描后将原始数据利用软件进行三维重建，将标本随机分为2组：一组采用传统椎弓根内固定法，另一组采用逆向工程原理及快速成型技术设计并制造出个体化导航模板，利用个体化导航模板在标本上辅助置入腰椎椎弓根螺钉，随后分别根据CT 扫描评价椎弓根螺钉置钉位置。结果与结论：传统椎弓根内固定法置钉准确率为58%；而个体化数字导航模板法的置钉准确率为81%，置钉成功率优于传统手术组，且经过卡方检验两者之间差异有显著性意义(P<0.05)。提示个体化导航模板辅助儿童胸椎椎弓根螺钉置入具有较高的准确率，充分体现了置钉个体化原则，为儿童胸椎椎弓根螺钉的准确置入提供了一种新的可行的方法。
배경：목전국내외학자이장추궁근라정내고정기술응용우인동척주손상치료중，인동흉추추궁근세소，해부결구변이대、비린관계복잡，여장이성인수거위의거적추궁근라정기술간단지응용우처우불단생장발육적인동，수술풍험겁대，제고치정적준학성화강저실오솔성위인동추궁근내고정기술능부심입개전적관건소재。목적：이용계산궤보조설계여쾌속성형기술위인동흉추추궁근라정치입제공일충개성화、정학화적정위방법。방법：대4례인동시체표본CT 소묘후장원시수거이용연건진행삼유중건，장표본수궤분위2조：일조채용전통추궁근내고정법，령일조채용역향공정원리급쾌속성형기술설계병제조출개체화도항모판，이용개체화도항모판재표본상보조치입요추추궁근라정，수후분별근거CT 소묘평개추궁근라정치정위치。결과여결론：전통추궁근내고정법치정준학솔위58%；이개체화수자도항모판법적치정준학솔위81%，치정성공솔우우전통수술조，차경과잡방검험량자지간차이유현저성의의(P<0.05)。제시개체화도항모판보조인동흉추추궁근라정치입구유교고적준학솔，충분체현료치정개체화원칙，위인동흉추추궁근라정적준학치입제공료일충신적가행적방법。
BACKGROUND:Many scholars at home and abroad have already attempted to apply the technique of the internal fixation pedicle screw placement to cure children’s spinal injuries in recent years, because the children’s thoracic pedicle is more smal , anatomical structure variation is big and adjacent relationship is complicated, so the application of adult’s pedicle screw technology simply to children who was in a continuous growth and development can increase operation risk greatly. Above this, improving the accuracy of nailing and reducing error rate become keys for further development of cervical pedicle fixation. OBJECTIVE:To provide an individualized and accurate positioning method for screw placement in thoracic pedicle of children by computer aided design and rapid prototyping technology. METHODS:After computed tomography scan of four cases of child specimens, the original data were made for three-dimensional reconstruction by the software, then the specimens were randomly divided into two groups:one group used the traditional pedicle internal fixation method, and the other group, first created the individual navigation template using the principle of reverse engineering and rapid prototyping technology. The lumbar pedicle screws were put into the samples by the individual navigation template. The position of the pedicle screws was evaluated according to the computer tomography scan. RESULTS AND CONCLUSION:The accurate rate of screw placement of the traditional pedicle internal fixation method was 58%;and the accurate rate of screw placement of the individual digital navigation template method was 81%. The success rate was better than the traditional surgery group. Furthermore, chi square test showed that there was a significant difference between two groups (P<0.05). These findings suggested that there has a high accuracy of the screw placement in thoracic pedicle of children assisted by the individual navigation template, ful y reflects the principle of individualization of screw placement, and provides a new feasible method for accurate screw placement in thoracic pedicle of children.