中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
11期
840-843
,共4页
李鑫%张强%赵昌松%袁征%蔡娟
李鑫%張彊%趙昌鬆%袁徵%蔡娟
리흠%장강%조창송%원정%채연
脊柱侧凸%骨钉%治疗,计算机辅助
脊柱側凸%骨釘%治療,計算機輔助
척주측철%골정%치료,계산궤보조
Scoliosis%Bond nails%Theraoy,computer-assisted
目的 探讨应用椎弓根导航导板技术螺钉置入在严重脊柱侧凸手术中的作用和意义.方法 回顾性分析首都医科大学附属北京地坛医院骨科2010至2013年收治的脊柱侧凸患者的临床资料.8例患者中男5例,女3例,平均年龄18(9 ～23)岁,包括先天性脊柱侧凸5例,特发性脊柱侧弯3例.应用三维CT断层扫描脊柱,将DICOM数据输入计算机处理,然后进行脊柱畸形区域的数字化三维重建和快速成型,根据快速成型脊柱模型制作椎弓根导航导板并将其应用于临床.选择匹配的未做脊柱模型的8例脊柱侧凸患者作为对照研究.结果 8例患者按计划成功完成了手术,无脊髓、神经、血管损伤手术并发症,术后效果满意,术中所见与术前数字化三维重建模型的形状和测量结果完全一致,椎弓根导航导板效果良好,术后X线和CT复查显示椎弓根螺钉位置正确.脊柱侧凸矫正率为60％.两组的平均手术时间比较差异有统计学意义(186 min比225 min,t=-6.18,P＜0.01).两组的平均失血量比较差异有统计学意义(460 ml比500 ml,t=-3.38,P＜0.01).两组的平均透视次数比较差异有统计学意义(4次比30次,t=-26.21,P＜0.01).结论 应用快速成型脊柱模型椎弓根导板导航术中置入螺丝钉技术治疗严重脊柱侧凸准确、安全,不需要特殊的手术经验,并且可以缩短手术时间,减少术中出血,减少或避免手术中透视.
目的 探討應用椎弓根導航導闆技術螺釘置入在嚴重脊柱側凸手術中的作用和意義.方法 迴顧性分析首都醫科大學附屬北京地罈醫院骨科2010至2013年收治的脊柱側凸患者的臨床資料.8例患者中男5例,女3例,平均年齡18(9 ～23)歲,包括先天性脊柱側凸5例,特髮性脊柱側彎3例.應用三維CT斷層掃描脊柱,將DICOM數據輸入計算機處理,然後進行脊柱畸形區域的數字化三維重建和快速成型,根據快速成型脊柱模型製作椎弓根導航導闆併將其應用于臨床.選擇匹配的未做脊柱模型的8例脊柱側凸患者作為對照研究.結果 8例患者按計劃成功完成瞭手術,無脊髓、神經、血管損傷手術併髮癥,術後效果滿意,術中所見與術前數字化三維重建模型的形狀和測量結果完全一緻,椎弓根導航導闆效果良好,術後X線和CT複查顯示椎弓根螺釘位置正確.脊柱側凸矯正率為60％.兩組的平均手術時間比較差異有統計學意義(186 min比225 min,t=-6.18,P＜0.01).兩組的平均失血量比較差異有統計學意義(460 ml比500 ml,t=-3.38,P＜0.01).兩組的平均透視次數比較差異有統計學意義(4次比30次,t=-26.21,P＜0.01).結論 應用快速成型脊柱模型椎弓根導闆導航術中置入螺絲釘技術治療嚴重脊柱側凸準確、安全,不需要特殊的手術經驗,併且可以縮短手術時間,減少術中齣血,減少或避免手術中透視.
목적 탐토응용추궁근도항도판기술라정치입재엄중척주측철수술중적작용화의의.방법 회고성분석수도의과대학부속북경지단의원골과2010지2013년수치적척주측철환자적림상자료.8례환자중남5례,녀3례,평균년령18(9 ～23)세,포괄선천성척주측철5례,특발성척주측만3례.응용삼유CT단층소묘척주,장DICOM수거수입계산궤처리,연후진행척주기형구역적수자화삼유중건화쾌속성형,근거쾌속성형척주모형제작추궁근도항도판병장기응용우림상.선택필배적미주척주모형적8례척주측철환자작위대조연구.결과 8례환자안계화성공완성료수술,무척수、신경、혈관손상수술병발증,술후효과만의,술중소견여술전수자화삼유중건모형적형상화측량결과완전일치,추궁근도항도판효과량호,술후X선화CT복사현시추궁근라정위치정학.척주측철교정솔위60％.량조적평균수술시간비교차이유통계학의의(186 min비225 min,t=-6.18,P＜0.01).량조적평균실혈량비교차이유통계학의의(460 ml비500 ml,t=-3.38,P＜0.01).량조적평균투시차수비교차이유통계학의의(4차비30차,t=-26.21,P＜0.01).결론 응용쾌속성형척주모형추궁근도판도항술중치입라사정기술치료엄중척주측철준학、안전,불수요특수적수술경험,병차가이축단수술시간,감소술중출혈,감소혹피면수술중투시.
Objective To evaluate the surgical efficacy and significance of pedicle drill template navigation technology for severe complicated scoliosis.Methods Retrospective analyses were performed for 8 patients with complicated spinal scoliosis during 2010-2013.There were 5 males and 3 females with an average age of 18 (9-23) years.There were congenital (n =5) and idiopathic (n =3) scoliosis.A three-dimensional spinal computed tomography (CT) scan was performed.And the data were acquired and transferred via a DICOM network to a computer workstation.Three-dimensional reconstruction and rapid prototype were obtained.The navigation drill template was manufactured by rapid prototyping for clinical operation.Eight matched patients without navigation drill template were selected into a control group.Results Eight patients were successfully operated as planned without any complication of spinal cord,nerve or blood vessel injury.And their post-operative outcomes were satisfactory.The intra-operative findings were the same as pre-operative impressions and measurements by digital spinal three dimensional reconstructions.The results of pedicle drill template navigation were excellent and the position of pedicle screws was accurate as evaluated by postoperative radiology and CT scan.The correction rate of scoliosis was 60％.Navigation drill template group:the average operating duration was 186 min,average volume of blood loss 460 ml and frequency of radiation by C arm 4 times.Control group:the average operating duration was 225 min,average volume of blood loss 550 ml and frequency of radiation by C arm 30 times.The average operative duration between two groups was statistically significant (P ＜ 0.01,t-test).And so were average volume of blood loss and frequency of radiation.Conclusion The rapid prototyping of pedicle drill template navigation technology is a new method for accurate intra-operative insertion of pedicle screws.It has a high surgical accuracy and safety for spinal scoliosis.The application of pedicle drill template navigation is simple without special experience requirements for operators.It can shorten the operative duration and reduce blood lose.The exposure of operators to radiation may be reduced or avoided during fluoroscopy.
