三维影像处理技术在脊柱后凸截骨矫形手术设计中的应用

目的用三维影像处理软件对脊柱后凸畸形患者的术前影像学资料处理分析，对脊柱的矫形手术进行术前设计和模拟操作，指导脊柱矫形手术操作。方法利用三维处理软件对我科自2004年4月至2006年7月的30例脊柱后凸患者的连续断层CT扫描结果进行三维重建，在矢状重建片上分别测量中矢位后凸Cobb角、经双侧椎弓根后凸Cobb角、分别经双侧椎弓根截骨所能获得的矫正角、畸形椎上下相邻两个椎体椎弓根横径，据此设计截骨方案，模拟脊柱后凸截骨。结果30例脊柱后凸患者中胸椎后畸形8例，腰椎后凸畸形22例，其中陈旧骨折后凸畸形24例，结核性后凸3例，半椎体畸形1例，侧弯后凸畸形1例，性质不明1例，年龄为18岁至66岁。所有患者术后慢性胸腰背痛和神经功能障碍均较术前有明显改善。术前脊椎后凸畸形的角度（Cobb法）：10°～60°，平均26．4°；行脊椎后凸矫形术后Cobb角为0°～35°，平均14．7°。利用三维处理软件能更加直观地对后凸脊椎行三维观察，有助于脊柱后凸患者截骨矫形的术前设计。结论螺旋CT扫描能充分获得病变部位的信息．计算机技术的发展，使得运算速度越来越快，通过三维影像处理软件，重建获得矢状位、冠状位以及三维立体图像，使得脊柱后凸的术前设计更加精确直观，有利于手术中截骨方案的实施。

Application of Three-dimension Image Manipulation Techniques in Kyphosis Reshaping Design

Objective The preoperation image data of kyphosis patients were analysed by 3-dimension image manipulation software. Preoperation design and surgery simulation were done to spine reshaping. Methods Radiology image data of kyphosis patients from April, 2004 to July, 2006 were got and analysed by 3-dimension manipulation software.The series CT scan data were 3-dimensional reconstructed. The Cobb angle through median sagittal plan, the cobb angle through bilateral pedicle of vertebral arch, bilateral reshaping angle through pedicle of vertebral arch and transverse diameter of adjacent pedicle of vertebral arch were measured on sagittal reconstruction plan. Using these data kyphosis reshaping plan was designed and simulated. Results Thirty patients of kyphosis were enrolled and including eight patients of thoracic vertebral kyphosis and twenty two patients of lumbar vertebral kyphosis. There were twenty four patients of old fracture, three patients of tuberculosis, one patient of hemivertebrae, one case of undetermined. The ages were from eighty to sixty six. The symptoms of back pain and neural dysfunction of all the patients improved significantly after operation. Preoperational Cobb angles of the kyphosis vertebrae were 10°- 60°, average angle 26.4°. Postoperational Cobb angles are 0° - 35°, average angle 14.7°. Direct-viewing of kyphosis vertebrae could be got by 3-dimension manipulation software and could help preoperation design of kyphosis patients surgery. Conclusions Sufficient information of diseased region can be got through spiral CT scanning. With the development of computer techniques, the calculation speed becomes more and more rapid. With 3-dimension reconstruction, sagittal plan and coronal plan and 3-dimensional image can be got, which can make kyphosis reshaping preoperaion design more accurate and direct-viewing, and can help the perform of operative reshaping plan.