摘要
目的探讨"椎弓根-横突通道"的存在,及通过此通道植入椎弓根螺钉的可行性。方法选取30个正常成年人行全胸椎CT扫描,根据其CT扫描资料,进行三维重建、mimics、Geomagic Studio、Magics技术,通过精确的平面测量及三维测量形态学指标,并辅以三维成像,剖析椎弓根内部松质骨延伸至横突的内在关系;在三维图像上模拟置钉过程,验证经椎弓根-横突通道置钉的可行性。结果胸椎椎弓根内部松质骨延伸至相邻横突,形成以松质骨填充的骨性通道,即"椎弓根-横突通道";通过对椎弓根-横突通道的三维重建及测量,发现椎弓根内矢径普遍大于其横径,所有的椎弓根-横突距离小于相应参照椎弓根内横径,胸椎椎弓根内横径、椎弓根-横突距离测值不受年龄、性别影响。根据椎弓根的外展角、头倾角、椎弓根钉长的距离,在骨通道的引导可模拟实行置钉。结论胸椎椎弓根与横突之间有一内部松质骨相连的通道;此通道可以作为置钉的辅助通道,进入后可顺利到达椎弓根,实行置钉。
Objective To investigate existence of"pedicle of vertebral arch-transverse pathway"and feasibility of implanting pedicle screws through this pathway.Methods CT scan for whole thoracic vertebra was performed for 30 normal adults.Three-dimensional reconstruction,mimics,Geomagic Studio and Magics techniques were performed according to their CT scan data.Internal relationship between cancellous bone in pedicle of vertebral arch extending to transverse process was analyzed through morphological indexes of accurate planar measurement and three-dimensional measurement and three-dimensional imaging.Nail placement procedure was simulated on three-dimensional image to verify feasibility of pedicle of vertebral arch-transverse pathway.Results Cancellous bone in thoracic pedicle of vertebral arch extended to adjacent transverse process,and an ossicular pathway filled with cancellous bone was formed,and it was named the"pedicle of vertebral arch-transverse pathway".Three-dimensional reconstruction and measurement of pedicle of vertebral arch-transverse pathway showed that internal radius vector of pedicle of vertebral arch was generally larger than its transverse diameter and all distance of pedicle of vertebral arch-transverse pathway was smaller than referenced transverse diameter,and values of internal transverse diameter of thoracic pedicle of vertebral arch and pedicle of vertebral arch-transverse pathway distance did not be affected by age and gender.Nails placement could be simulated performed under guidance of bone pathway according to abduction angle,head tilt angle and pedicle screw length.Conclusion There is a pathway connecting internal cancellous bone between pedicle of vertebral arch and transverse process of thoracic vertebra.This channel can be used as an auxiliary channel for nail placement,and pedicle of vertebral arch can be successfully reached after entering in order to place the nail.
作者
钟晖
陆声
陈建明
张成程
李占清
ZHONG Hui;LU Sheng;CHEN Jian-ming;ZHANG Cheng-cheng;LI Zhan-qing(Department of Spine Surgery,926 Hospital of PLA,Kaiyuan,Yunnan 661600,China;Osteopathic Hospital Affiliated to 920 Hospital of PLA,Kunming 650000,China)
出处
《解放军医药杂志》
CAS
2019年第2期81-85,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
关键词
外科手术
计算机辅助
胸椎
计算机模拟
可行性研究
Surgery,computer-assisted
Thoracic vertebrae
Computer simulation
Feasibility studies
