三维重建技术在上胸椎和颈椎椎弓根螺钉植入的临床应用

目的通过应用三维重建技术辅助椎弓根螺钉的植入,评价其在上胸椎和颈椎置钉中的准确性和安全性。方法 2013年1月至2013年11月,对12例需要行上胸椎、颈椎椎弓根螺钉植入手术的患者术前通过Mimics三维重建图像设计进钉通道并获取相关参数,术中辅助植入上胸椎、颈椎椎弓根螺钉共50枚,术后CT扫描评价螺钉位置,记录有无与螺钉植入的相关并发症。结果通过Mimics三维重建植入的50枚椎弓根螺钉,47枚完全在椎弓根内,3枚穿破椎弓根壁,椎弓根穿破率为6%,植钉准确率为94%,所有穿破椎弓根壁的螺钉的穿出距离均小于2 mm,螺钉位置可接受率为100%。无一例出现螺钉植入有关的神经、血管损伤等并发症。结论 Mimics三维重建技术辅助上胸椎、颈椎椎弓根螺钉植入的置钉准确性高、安全,且明显缩短手术时间。

Clinical Application of Three Dimensional Reconstruction Technique for Upper Thoracic and Cervi-cal Vertebra Screw Placement

Objective To calculate the accuracy and safety of upper thoracic and cervical vertebra screw placement by u-sing three-dimensional reconstruction technique. Methods From January 2013 to November 2013,12 patients′upper thoracic and cervical pedicle parameters and inserting pedicle screws pathways were directly measured before operation by Mimics 10. 1. 50. Screws were inserted during the operation according to the designed pedicle screws pathways. After surgery,the positions of the pedicle screws were evaluated by CT scan. The complications related to screws placement were recorded. Results 47 of the 50 screws located in the pedicle,while 3 screws were noted to break the pedicle. The unintended perforation rate was 6%. The accurate rate of upper thoracic and cervical screw placement was 94%,and overall acceptable screw ratio（ ＆lt;2 mm breach is safe）was 100%. No neurovascular and visceral injury related-complications was noted. Conclusion Upper thoracic and cervical screw placement assisted by patient-specific pedicle pathways under the three-dimensional reconstruction by using Mimics software is safe and reliable.