数字化医学技术与脊柱外科的临床应用

背景：随着现代科学技术尤其是计算机技术和医学技术的迅猛发展，现代脊柱外科进入了一个崭新的时代，呈现出数字化、个性化、显微化、精确化和人工智能化的发展趋势。目的：探讨数字化技术在脊柱外科中的应用研究进展。方法：文章检索词为“脊椎(spine)；腰椎(lumbar)；颈椎(cervical)；数字化(digitization)；脊柱外科(spinal surgery)；数字骨科学(digital orthopedics)；有限元模型(the finite element model)；计算机辅助设计(computer assisted design，CAD)；微创技术(minimally invasive technology)；三维重建(three dimensions reconstruction, 3D)；CT；磁共振成像(MRI)；计算机仿真(computer emulation)；内窥镜(endoscope)；椎间盘(intervertebral disc)；经皮内窥镜激光椎间盘切除术(percutaneous endoscopic laser-assisted discectomy, PELD)”，对有限元、计算机导航技术、微创技术以及医学影像在脊柱外科中的应用文献进行深入分析，探讨数字化脊柱外科手术的特点，临床效果以及安全性。结果与结论：数字化医学在有限元模型、计算机导航技术、微创技术、医学影像等领域研究进展的基础上，建立独特的脊柱外科新方法，并将其广泛应用于临床骨科。有限元模型最大的优势在于可以反映集体内部的应力变化情况，有限元分析应用于医学生物力学后，取得了很大的进步与发展。计算机导航技术的工作原理是利用数字化影像信息通过媒介体输入计算机工作站，经运算处理后重建三维模型影像，通过相关软件，在此影像基础上进行术前计划并模拟进程，通过高解像度的显示屏从各个方位观察到当前的手术入路以及各种参数，完成微创手术。微创脊柱外科采用微小切口或穿刺通道，运用特殊的器械或装置在影像仪器监视下或导航技术的引导下进行手术。医学影像分析作为信息科学技术为基础的交叉学科研究，对脊柱外科的临床诊断和观察具有参考价值。数字化医学高效率、高精度、三维立体地了解疾病的分布、形态、结构，最大程度减少手术创伤，在脊柱外科应用中的前景广阔。

The application of digital medical technology in spinal surgery

BACKGROUND:With the rapid development of modern science and technology, especially computer technology and medical technology, modern spinal surgery has entered a new era, showing trends of digitization, personalization, microsurgery, precision and artificial intelligence.OBJECTIVE:To explore the application of digitization in spinal surgery.METHODS:A computer online retrieval was performed by the first author in CNKI and Wanfang database to search papers regarding the application of digitization technology in spinal surgery, using key words of “spine, lumbar, cervical, digitization, spinal surgery, digital orthopedics, the finite element model, computer assisted design, minimally invasive technology, three dimensions reconstruction or 3D, CT, MRI, computer emulation, endoscope, intervertebral disc, percutaneous endoscopic laser-assisted discectomy or PELD”. According to inclusion criteria, papers about the finite element model, computer navigation technology, minimally invasive technology, and medical imaging in spinal surgery were included for further analysis to explore the characteristics of digitized spine surgery, clinical efficacy and safety.RESULTS AND CONCLUSION:The digitization establishes the method of unique digitized spine surgery and widely uses in clinical orthopedics on the basis of the finite element model, computer navigation, minimally invasive technology, medical imaging and other areas of research progress. The biggest advantage of the finite element model is that it can reflect the collective internal stress changes. The analysis of finite element used in medical biomechanics, made a lot of progress and development. Computer navigation technology works using digital image information through the medium of the body to enter a computer workstation. The reconstruction of three-dimensional model of the image after operation processing and related software through high-resolution display observed from all directions to the surgical approach as well as a variety of parameters completed the minimally invasive surgery. Minimally invasive spinal surgery uses a tiny incision or puncture channel, with special equipment or device in imaging instrument under the surveillance. The analysis of medical image as information science and technology-based cross-disciplinary research, clinical diagnosis and observation of spinal surgery has a reference value. Digital medicine with high-efficiency, high-precision, three-dimensional understanding of the distribution of the disease, the morphology, structure, minimizing surgical trauma, spinal has broad prospects.