脊柱椎弓根定位数字化导航模板的设计

目的 利用逆向工程原理和快速成型技术为脊柱椎弓根定位提供一种新方法.方法 C3单关节交锁伴关节突骨折患者CT连续扫描数据集,将断层扫描数据导入Amira 3.1软件,三维重建C3椎体模型,以.stl格式导出模型.在Imageware 12.0平台打开三维重建模型,定位三维参考平面.利用逆向工程原理寻找椎弓根的最佳进钉钉道.提取椎板的表面解剖学形态,建立与椎体后部解剖学形态一致的模板.拟合模板和椎弓根孔道成定位模板,将椎体和定位模板通过激光快速成形技术生产出实物模板. 结果 建立了制作个体化导航模板的方法,通过快速成型技术生产出的带椎弓根的导航模板具有较好的准确性. 结论 利用逆向工程原理和快速成型技术为椎弓根的定位和置钉提供了一种新的方法,具有较大的应用前景.     

数字化脊柱椎弓根导航模板在胸腰椎骨折中的应用

目的 利用逆向工程(RE)原理和快速成型(RP)技术设计一种新的胸腰椎椎弓根定位的方法.方法 取患者CT连续扫描数据集,应用三维重建软件Amira 3.1建立胸腰椎三维模型,以.stl格式导出模型.在Imageware 12.0平台打开三维重建模型,定位三维参考平面,利用RE原理寻找椎弓根的最佳进钉钉道.提取椎板的表面解剖学形态,建立与椎体后部解剖学形态一致的模板.拟合模板和椎弓根孔道成定位模板,将椎体和定位模板通过激光RP技术生产出实物模板,手术时利用建立的定位模板与椎体的后部结构相吻合,通过导航孔进行胸腰椎椎弓根的定位,置入椎弓根螺钉.术后根据X线片和CT扫描评价椎弓根螺钉的位置.结果 建立了制作个体化导航模板的方法,通过RP技术生产出的导航模板具有较好的准确性,适用于胸腰椎椎弓根螺钉的导航定位. 结论 利用RE原理和RP技术为胸腰椎椎弓根定位提供了一种新的方法,具有较大的应用前景.     

数字化导航模板在上颈椎椎弓根定位中的初步临床应用

目的 观察数字化导航模板在上颈椎椎弓根定位中的初步临床应用.方法 对患者进行CT连续扫描,三维重建软件Amira 3.1建立上颈椎三维模型,以STL格式导出模型.在UG Imageware 12.0平台打开三维重建模型,定位三维参考平面.利用RE原理寻找椎弓根的最佳进钉钉道.提取椎板的表面解剖学形态,建立与椎体后部解剖学形态一致的模板.拟合模板和椎弓根孔道成定位模板,将椎体和定位模板通过激光RP技术生产出实物模板,手术时利用建立的定位模板与椎体的后部结构相吻合,通过导航孔进行上颈椎椎弓根的定位,置入椎弓根螺钉.术后根据X线片和CT扫描评价椎弓根螺钉的位置.结果 通过3例患者建立了制作个体化导航模板的方法,术后CT扫描显示椎弓根螺钉的位置准确,未出现相关椎弓根钉置入并发症.结论 利用RE原理和RP技术生产出的导航模板具有较好的准确性,为上颈椎椎弓根置钉提供了一种新的方法,具有较大的应用前景.     

计算机辅助导航模板在下颈椎椎弓根定位中的临床应用

目的 利用逆向工程(reverse engineering,RE)原理和快速成型(rapid prototyping,RP)技术设计一种新的下颈椎椎弓根定位的方法,并探讨其临床应用.方法 采用患者CT连续扫描数据集,三维重建软件Amira 3.1建立颈椎三维模型,以STL格式导出模型.在UG Imageware 12.0平台打开三维重建模型,定位三维参考平面.利用RE原理寻找椎弓根的最佳进钉钉道.提取椎板的表面解剖学形态,建立与椎体后部解削学形态一致的模板.拟合模板和椎弓根孔道成定位模板,将椎体和定位模板通过激光Rp技术生产出实物模板,手术时利用建立的定位模板与椎体的后部结构相吻合,通过导航孔进行下颈椎椎弓根的定位,植入椎弓根螺钉.术后根据X线片和CT扫描评价椎弓根螺钉的位置.结果 建立了制作个体化导航模板的方法,通过RP技术生产出的导航模板具有较好的准确性,适用于颈椎椎弓根螺钉的导航定位.结论 利用RE原理和RP技术为颈椎椎弓根的定位提供了一种新的方法,该方法为下颈椎椎弓根螺钉植入提供了一种新的方法,具有较大的应用前景.     

个体化导航模板辅助腰椎椎弓根螺钉置钉准确性实验研究

目的:探讨个体化导航模板辅助腰椎椎弓根螺钉置入的准确性.方法:根据10具尸体腰椎(L1～L4)标本术前CT资料,利用逆向工程原理及快速成型技术设计制造出个体化导航模板,在尸体标本上进行个体化导航模板辅助腰椎椎弓根螺钉的置入手术,术后行CT断层扫描评价螺钉在椎弓根及椎体内的位置.结果:共应用40个个体化导航模板,辅助置入腰椎椎弓根螺钉80枚.CT扫描发现所有螺钉进钉点准确,进钉方向适当:全部螺钉均准确置入相应椎弓根及椎体内,无穿破椎弓根皮质及椎体前方的螺钉.结论:个体化导航模板辅助腰椎椎弓根螺钉置钉准确性高,操作简单,为腰椎椎弓根螺钉的准确置入提供了一种新的可供选择的方法.     

快速成形个体化导航模板辅助枢椎椎板螺钉的植入

目的 观察快速成形(rapid prototyping,RP)个体化导航模板在C2椎板螺钉植入中的初步临床应用.方法 对患者行上颈椎CT连续扫描,三维重建软件Amira 3.1建立C2三维模型,以STL格式导出模型.在UG Imageware 12.0平台打开三维重建模型.利用逆向工程(reverse engineering,RE)原理寻找C2椎板螺钉的最佳进钉钉道.提取椎板的表面解剖学形态,建立与椎体后部解剖学形态一致的模板.拟合模板和椎板孔道成定位模板,将椎体和定位模板通过激光RP技术生产出实物模板,手术时利用实物导航模板与椎体的后部结构相吻合,通过导航孔进行C2椎板螺钉的定位,植入椎板螺钉.术后根据X线片和CT扫描评价椎板螺钉的位置.结果 采用RP导航模板为5例患者植入C2椎板螺钉,术后CT扫描显示椎板螺钉的位置准确,未出现相关C2椎板螺钉植入的并发症.结论 利用RE原理和RP技术生产出的导航模板具有较好的准确性,为C:椎板螺钉的置钉提供了一种新的方法 ,具有较大的应用前景.     

数字化技术在脊柱畸形手术中的应用

目的 介绍利用数字化技术为脊柱畸形手术提供更好的术前设计和术中实施措施.方法 2006年11月至2011年8月利用三维可视化技术进行脊柱畸形术前计划,并采用个体化导航模板辅助置钉进行脊柱畸形纠正手术58例,男 21例,女37例;年龄3～68岁,平均21岁.先对脊柱畸形部位行三维CT扫描,图像以dicom格式保存,然后转换到Mimics软件里生成需要的脊柱三维重建模型,通过术前脊柱畸形三维可视化研究进行手术规划;通过建立与椎体后部解剖学形态一致的模板设计虚拟的导向模板,将椎体和定位模板通过快速成型技术生产出实物导航模板,通过导航模板辅助畸形椎体的置钉 . 结果 通过虚拟三维模型的术前规划为手术的准确实施提供了良好参考在术中通过建立的导航模板准确地完成了各种螺钉的精确置入,每枚螺钉的置入时间0.7～1.2min,平均1.03 min,未出现与置钉相关的并发症. 结论 利用数字化技术提高了对脊柱畸形的一进步认识,并为脊柱畸形手术各种内固定螺钉的置入提供了一种新的方法.     

快速成型个体化导航模板辅助胸椎椎弓根螺钉置入可行性研究

[目的]通过尸体标本实验的方法探讨个体化导航模板辅助胸椎椎弓根螺钉置入的准确性及可行性.[方法]对6具胸椎尸体标本进行CT扫描,根据CT扫描资料,利用逆向工程原理及快速成型技术设计制造出个体化导航模板,利用个体化导航模板在尸体标本上辅助置入胸椎椎弓根螺钉,所有螺钉的置入由同一位具有腰椎椎弓根螺钉置钉经验但无胸椎椎弓根螺钉置钉经验的骨科医师进行操作,随后采用大体解剖的方法肉眼观察置钉的准确性;并根据螺钉是否穿破椎弓根、穿出距离及穿破方向进行分级.[结果]共设计制作了72个个体化导航模板辅助置入胸椎椎弓根螺钉144枚,132枚(91.7%)螺钉完全在椎弓根内;12(8.3%)枚螺钉穿破椎弓根,其中2枚螺钉穿破椎弓根内侧壁(穿破距离分别为0.6、0.8 mm),10枚螺钉穿破椎弓根外侧壁(9枚螺钉穿出距离<2 mm,1枚螺钉穿出距离为2.5 mm);没有椎弓根上方、下方及椎体前方穿破的螺钉.所有穿破椎弓根壁的螺钉均在安全可接受的范围内.[结论]快速成型个体化导航模板辅助胸椎椎弓根螺钉置入准确率高,对术者无特别的经验要求,手术操作简单、安全,可避免术中放射性损伤,为胸椎椎弓根螺钉的置入提供了一种新的可行方法,尤其适用于初学者.     

计算机辅助设计寰枢椎椎弓根内固定数字化导向模板精确置钉

目的 提高寰枢椎后路经椎弓根手术置钉的安全性和准确性.方法 可复性寰枢椎脱位及寰枢椎不稳13例,人院即行螺旋CT薄层扫描,取患者Dicom图像经计算机三维重建后进行后路椎弓根螺钉入路安全三维通道计算机辅助设计,建立椎弓根置钉导向管与三维互补模板.在激光快速成型机上按CAD设计图以聚苯乙烯为原料,利用逆向工程原理制作相应患者个体化的骨骼模型实物和手术辅助导板,外涂树脂固化剂,经高压消毒带进手术室,利用手术导向模板辅助寰枢椎后路椎弓根螺钉置入.结果 13例患者手术顺利,可复性寰枢椎脱位及寰枢椎不稳均解剖复位,固定良好.寰枢椎椎弓根螺钉置钉位置准确,未发生任何并发症.术中出血量平均50～100 ml,手术时间平均2.0～2.5 h,平均随访12个月,5例患儿的骨融合情况仍在随访中.结论 术中在数字化椎弓根内固定导向模板引导下置钉,提高了寰枢椎椎弓根内固定置钉的安全性和准确性.     

个体化三维打印导航模板辅助下颈椎椎弓根置钉的实验研究

[目的]探讨一种基于三维打印成型技术制备个体化下颈椎椎弓根螺钉导航模板的可行性,并对该方法辅助置钉的准确性进行评估。[方法]选取10具成人尸体的颈椎标本,行CT扫描后将原始数据导入Mimics软件,对C3⁷节段行选择性重建,设计与其椎板和棘突相贴合的阴模,利用三维打印技术成型。基于目标椎体三维模型,直视下徒手将阴模制成具有双侧椎弓根螺钉钉道的导航模板,并在其辅助下于各椎体标本置入双侧椎弓根螺钉。术后再次行CT扫描评估螺钉位置。[结果]剔除骨性结构不完整的标本后,共制作62个下颈椎导航模板,辅助置入椎弓根螺钉124枚。CT扫描轴位图像显示121枚螺钉完全位于椎弓根内,3枚部分穿破椎弓根壁;矢状位图像提示除1枚螺钉误入椎间孔外,余钉位准确。[结论]本研究结果表明,基于CT图像,使用Mimics软件能够精确重建下颈椎各节段椎体及其附属结构,并建立其对应阴模。利用三维打印模型所设计的个体化导航模板,辅助置钉准确性高、操作简单,为下颈椎椎弓根螺钉的精确置入提供了一种可供选择的新方法。     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.     

Rapid prototyping drill guide template for lumbar pedicle screw placement

To develop a novel method of spinal pedical stereotaxy by reverse engineering and rapid prototyping techniques, and to validate its accuracy by experimental and clinical studies. Methods: A 3D reconstruction model for the desired lumbar vertebra was generated by using the Mimics 10.11 software, and the optimal screw size and orientation were determined using the reverse engineering software. Afterwards, a drill template was created by reverse engi-neering principle, whose surface was the antitemplate of the vertebral surface. The drill template and its correspond-ing vertebra were manufactured using the rapid prototyping technique. Results: The accuracy of the drill template was con-firmed by drilling screw trajectory into the vertebral biomodel preoperatively. This method also showed its ability to cus-tomize the placement and size of each screw based on the unique morphology of the lumbar vertebra.The drill tem-plate fits the postural surface of the vertebra very well in the cadaver experiment. Postoperative CT scans for controlling the pedicle bore showed that the personalized template had a high precision in cadaver experiment and clinical application. No misplacement occurred by using the per-sonalized template. During surgery, no additional computer assistance was needed.Conclusions: The authors have developed a novel drill template for lumbar pedicle screw placement with good applicability and high accuracy. The potential use of drill templates to place lumbar pedicle screws is promising. Our methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the lumbar spine.