CN104224306B - The threedimensional model of the optimal access point of pedicle screw is inserted for finding - Google Patents
The threedimensional model of the optimal access point of pedicle screw is inserted for finding Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7091—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/90—Guides therefor
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- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
- A61B2034/101—Computer-aided simulation of surgical operations
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
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Abstract
The method for inserting the optimal access point of pedicle screw is found the invention discloses a kind of utilization three-dimensional modeling, step is：First determine the optimal channel plane that pedicle screw is inserted, the best safety passage that pedicle screw is inserted is determined again, finally determine the optimal access point that pedicle screw is inserted, access point is positioned using this method, X-ray need not be contacted, wound is reduced, operating time is saved, no matter whether the pedicle of vertebral arch of patient centrum makes a variation or many Big mutation rates with articular process, and the accuracy rate that it disposably inserts pedicle screw is high, success rate is high.
Description
Technical field
The present invention relates to field of spinal surgery, it is optimal that pedicle screw is inserted in more particularly to a kind of utilization three-dimensional modeling searching
The method of access point.
Background technology
A variety of diseases of backbone and fracture, need to rebuild the stability of backbone, vertebra using pedicle screw in operation
Pedicle screw is being popularized in the application of spinal surgery, and its conventional method for posting has anatomic landmark is free-hand after positioning to insert method, C arms
Perspective etc., these methods respectively have advantage and disadvantage, and some produce serious complication, and such as neurologic defict causes lower limb and size
Just dysfunction, Great Vascular Injury jeopardize the life of patient, cancer generation of x-ray infringement etc., how to improve pedicle screw and put
The accuracy entered and the success rate disposably inserted, the target that always spinal surgery circle is pursued.
Free-hand method of inserting is current most popular method, and it is, by the use of articular process anatomical landmarks as access point, to enter point location
Mistake is to cause pedicle screw to insert the primary factor of failure and most common factor, the generations of consecutive complications some be this
The continuity of mistake and inevitable outcome, it is front and rear to have causality, and generally access point determines that method is following 4 kinds：
Roy-camille methods：Under facet joint central vertical line intersection point above and below the horizontal line of both sides transverse process and connection
At 1mm；
Weinstein methods：The friendship of lateral border and vertical line of the horizontal line of two point of two transverse process with being connected centrum processus articular superior
Point；
Mager methods：Processus articular superior outer rim vertical line and the horizontal intersection point of transverse process；
Louis methods：Through 1mm above processus articular superior articular surface lower edge on horizontal line, vertical line be joint space in sagittal then
It is in such as volume shape through joint space outer most edge, then takes articular process outer 1/3rd.
It is free-hand after above method positioning access point to insert screw, had an X-rayed mainly by feel plus C arms.Respectively dissected on corpus vertebrae
Structure often causes variation because of congenital or acquired disposition, and most common variation has：
1st, the variation of articular process：Processus articular superior and anapophysis where pedicle screw access point position, it occur frequently that hyperplasia,
Loose, cohesion, causes normal morphology to disappear, zygapophysial joint gap disappears, free-hand to search out normal solution when inserting method
Mark is cutd open, access point cannot disposably or be accurately found, often to expand and appear transverse process, compare to judge access point with transverse process,
While wound is increased with operating time, still there is higher mortality.
2nd, pedicle of vertebral arch also often has a variety of variations, and such as pedicle diameter diminishes or even pulp cavity disappears, and pedicle of vertebral arch is interior on axial plane
Variable pitch is big or diminishes, the cohesion angle of cephalad is variable big on coronal-plane（Both sides pedicle of vertebral arch is in eight words）Or reduce（Both sides
Pedicle of vertebral arch is parallel）, the form of pedicle of vertebral arch is all not oval on coronal-plane, also have in up-small and down-big drops, it is upper it is big under
Small exclamation mark shape, up and down identical I shape, circle etc., these pedicles of vertebral arch make a variation with access point, often result in find repeatedly access point,
Repeatedly puncture, pedicle screw trajectory worn out, screw hold decline and there may be spinal nerve and injury of blood vessel it is serious simultaneously
Disease is sent out, or even jeopardizes patients ' lives.
Due to inserting method using free-hand after anatomic landmark positioning, often because pedicle of vertebral arch variation in itself, the variation of articular process and
Failure, therefore inserting for lower carry out pedicle of vertebral arch only is guided using C arm X-ray perspectives, to improve its accuracy, it has the disadvantage doctor
Suffering from both sides will all be damaged by X-ray to human body, and particularly medical worker is long-term can be caused various cancers to send out by the infringement of x-ray
It is raw.
The content of the invention
The purpose of the present invention is in view of the deficienciess of the prior art, providing a kind of found using three-dimensional modeling inserts vertebral arch
The method of the optimal access point of root screw, access point is positioned using this method, it is not necessary to contact X-ray, and the X that reduction doctor and patient is subject to is penetrated
Infringement of the line to human body, reduces wound, saves operating time, no matter the pedicle of vertebral arch of patient centrum and articular process whether make a variation or
Many Big mutation rates, it is high that it disposably inserts the accuracy rate height of pedicle screw, success rate.
The object of the present invention is achieved like this：A kind of utilization three-dimensional modeling is found and inserts the optimal access point of pedicle screw
Method, comprises the following steps：
1) centrum dicom data are chosen and centrum threedimensional model is set up in three-dimensional reconstruction software；
2) the optimal channel plane that pedicle screw is inserted is determined：Partition tools are chosen in three-dimensional reconstruction software, according to
Optimal channel flat normal determines the optimal channel plane that pedicle screw is inserted, and the optimal channel plane using determination is divisional plane
By centrum be divided into above and below two parts, optimal channel flat normal be the plane be located at centrum it is upper, in 1/3 intersection, and and vertebra
Soleplate is parallel above and below body；
3) the best safety passage that pedicle screw is inserted is determined：The upper part of centrum is hidden in three-dimensional reconstruction software,
The optimal channel plane of centrum is manifested, CAD cylindrical tool is chosen, left and right two is set in the optimal channel plane of centrum
Root cylinder, two cylinders are located at two pedicle of vertebral arch narrowest position of centrum respectively, as follows to this two cylinder adjustment：First
Adjust body diameter：Make the circumferential wall of cylinder respectively with the lateral border of cortex on the inside of pedicle of vertebral arch narrowest position, lateral cortex
Lateral margin is contacted, and the maximum gauge of pedicle screw is inserted when the body diameter now obtained is operation；Secondly body length is adjusted
Degree：Cylinder front end is reached the 75-80% in centrum sclerotin, cylinder rear end is contacted with articular process sclerotin, the forward and backward two ends of cylinder it
Between distance for operation when insert the maximum length of pedicle screw；Adjust cylinder and median sagittal plane of the centrum through spinous process
Angular relationship：Premised on cylinder total length is all in sclerotin, make the lateral border of cortex on the inside of cylinder and pedicle of vertebral arch narrowest position, outer
The interior lateral margin contact of side cortex, the cylinder now obtained is optimal introversion angulation with the maximum leaning angle of the median sagittal plane through spinous process
Relation；Adjust the overlying relation of cylinder and spinous process：Make cylinder parallel with soleplate up and down, now by left and right cylinder axle center
The plane of line, as step 2）The optimal channel plane of determination, pedicle of vertebral arch screw is judged according to the infall of this plane and spinous process
The head of nail inclines degree；Adjustment through above-mentioned steps, the best safety that pedicle screw is inserted when cylinder position is operation
Passage；
4) the optimal access point that pedicle screw is inserted is determined：Find the axle for the best safety passage that pedicle screw is inserted
Heart line, the axial line and the optimal access point that the left and right processus articular superior cortex joining of centrum is that pedicle screw is inserted.
Step 4）In look for the method for axial line of best safety passage that pedicle screw inserts to be：In three-dimensional reconstruction software
In duplication in situ is carried out to left and right two cylinders, and change into other color marks, two body diameters after duplication changed
For the axial line of the cylinder of 1mm diameters, as the best safety passage that pedicle screw is inserted, now, the cylinder of 1mm diameters with
Best safety passage outside it is two concentric cylinders.
Step 4）In by virtually being had an X-rayed to centrum, whether the axial line of two cylinders of observation and cylinder in left and right
In pedicle of vertebral, and there is certain introversion；It is whether parallel with soleplate up and down.
CT scannings are carried out to centrum, its dicom data is obtained, its dicom data is imported in three-dimensional reconstruction software and carried out
Reconstructing three-dimensional model.
CT sweep parameters are：Scan slice thickness is 0.75-1.5mm, voltage 120kV, obtains dicom data.
The pedicle screw inserted when the diameter for the best safety passage that pedicle screw is inserted is more than or equal to operation
Diameter, the length for the best safety passage that pedicle screw is inserted is more than or equal to the length for the pedicle screw inserted during operation
Degree.
Such scheme is employed, makes the present invention that there is advantages below：
1）The present invention first finds optimal channel on centrum threedimensional model and put down by setting up centrum threedimensional model on computers
Face, finds best safety passage and optimal access point that pedicle screw is inserted, best safety passage in optimal channel plane
And optimal access point is to be configured by studying the pedicle of vertebral arch of each patient with zygapophysial joint, no matter the vertebral arch of patient centrum
Whether root makes a variation or many Big mutation rates with articular process, and the accuracy rate that it disposably inserts pedicle screw is high, success rate is high.
2）As long as inserting pedicle screw from optimal access point during operation, make the pedicle screw inserted all the time in best safety
In passage, it is possible to avoid pedicle of vertebral arch inside and outside wall from being the worse for wear, reduce hold；Avoid wearing out and section is damaged after pedicle of vertebral arch outer wall
Section blood vessel or big blood vessel, the generation for even jeopardizing patients ' lives；Avoid producing spinal nerve after wearing out pedicle of vertebral arch inwall.
3）Transverse process need not be appeared in art, only appeared a little on the outside of processus articular superior, operating time is greatly shortened, reduce wound with
Bleeding, it is not necessary to transfuse blood and reduce surgery cost.
4）Because by this method, no matter whether the pedicle of vertebral arch of patient centrum makes a variation or many Big mutation rates with articular process, can
It is enough accurately to find the optimal access point that pedicle screw is inserted, it is no longer necessary to repeatedly to be had an X-rayed by C arms, doctors and patients without contacting X-ray,
Avoid increasing carcinogenic chance.
5）Access point is positioned using this method, with easy to learn, it is not necessary to longer learning curve, it is not necessary to which expensive sets
Standby and special operation apparatus.
The invention will be further described with reference to the accompanying drawings and examples.
Brief description of the drawings
Fig. 1 is three-dimensional modeling figure of the invention；
Fig. 2 is the front view of the divisional plane of the segmentation screw way of the present invention；
Fig. 3 is Fig. 2 right view；
Fig. 4 is Fig. 2 left view；
Fig. 5 is the schematic diagram of the cut-off rule of the segmentation screw way of the present invention；
The schematic diagram that Fig. 6 shows for two parts different colours above and below the centrum of the present invention；
Fig. 7 is partial schematic diagram under the centrum of the present invention；
Fig. 8 is the left view of the centrum optimal channel plane of the present invention；
Fig. 9 is the schematic diagram that best safety passage is set in the optimal channel plane of the present invention；
Figure 10 is the schematic diagram that best safety passage and axial line are set in the optimal channel plane of the present invention；
Figure 11 is the schematic diagram for the axial line that best safety passage is set in the optimal channel plane of the present invention；
Figure 12 only shows the schematic diagram of best safety passage for the present invention on complete cone；
Figure 13 is Figure 12 perspective view；
Figure 14 shows the front view of best safety passage and axial line for the present invention simultaneously on complete cone；
Figure 15 is Figure 14 perspective view；
Figure 16 shows the right view of best safety passage and axial line for the present invention simultaneously on complete cone；
Figure 17 is Figure 16 perspective view；
Figure 18 is the front view for the axial line that best safety passage is only shown on complete cone under fluoroscopy of the invention；
Figure 19 is Figure 18 right view；
Figure 20 is the schematic diagram of the optimal access point of the present invention；
Figure 21 is positioned into point methods and the existing comparison diagram positioned into point methods for the present invention's；
Figure 22 is Figure 21 perspective view；
Figure 23 be using the present invention position into point methods with it is existing position into point methods insert screw simulation illustrate
Figure；
Figure 24 is Figure 23 perspective view；
The display of Figure 25,26,27 is inserted nail after screw and has been worn out pedicle of vertebral arch inwall using Weinstein methods, Mager methods
Schematic diagram；
Figure 28 displays insert the schematic diagram that nail after screw has worn out pedicle of vertebral arch inwall using Roy-Camille methods；
Figure 29 is Figure 28 perspective view；
Figure 30 is the schematic diagram of whole backbone.
Embodiment
The invention will be further described with reference to the accompanying drawings and examples：
A kind of utilization three-dimensional modeling finds the method for inserting the optimal access point of pedicle screw, comprises the following steps：
1）Referring to Fig. 1, choose backbone dicom data and centrum threedimensional model is set up in three-dimensional reconstruction software：To disease
Become the CT scannings that section backbone carries out standard position, sweep parameter：Scan slice thickness is 0.75-1.5mm, voltage 120kV, acquisition
Dicom data.Mimics10-17 version softwares are opened, the dicom data obtained are imported, a range of threshold values is selected（Most
Low valve valve is can show outside limbus corticalis in pedicle of vertebral arch, and highest threshold values takes peak after automated import of data）, select software default
Best in quality carry out three-dimensional reconstruction, obtain spinal three-dimensional model.
2）Determine the optimal channel plane that pedicle screw is inserted：Partition tools are chosen in three-dimensional reconstruction software, referring to
Fig. 2-4, and divisional plane is adjusted up and down, spinal vertebral is rotated, determines that pedicle screw is put according to optimal channel flat normal
The optimal channel plane entered, by divisional plane of the optimal channel plane of determination by centrum be divided into above and below two parts, optimal channel
Flat normal be the plane be located at centrum it is upper, in 1/3 intersection, it is and parallel with soleplate above and below centrum.
3）Determine the best safety passage that pedicle screw is inserted：Referring to Fig. 5, segmentation plane is hidden, cut-off rule, ginseng is observed
See Fig. 6, it is of the invention centrum be divided into above and below two parts shown with different colours, it is hidden in three-dimensional reconstruction software referring to Fig. 7
The upper part of centrum is hidden, the optimal channel plane of centrum is manifested, referring to Fig. 8, adjustment shows optimal channel plane, referring to Fig. 9,
CAD cylindrical tool is chosen, left and right two cylinders are set in the optimal channel plane of centrum, two cylinders are located at vertebra respectively
Two pedicle of vertebral arch narrowest position of body are as follows to this two cylinder adjustment：Body diameter is adjusted first：Make the circumferential wall of cylinder
Contacted respectively with the lateral border of cortex, the interior lateral margin of lateral cortex on the inside of pedicle of vertebral arch narrowest position, the diameter now obtained is
The diameter of pedicle screw.Secondly body length is adjusted：Cylinder front end is set to reach the 75-80% in centrum sclerotin, cylinder rear end
Contacted with articular process sclerotin, the distance between two be pedicle screw length.Cylinder is adjusted with centrum through spinous process
The angular relationship of median sagittal plane：Premised on ensureing cylinder total length all in sclerotin, make cylinder and pedicle of vertebral arch narrowest position
The interior lateral margin contact of the lateral border, lateral cortex of inner side cortex, the cylinder now obtained is maximum with the median sagittal plane through spinous process
Leaning angle is optimal introversion angular relationship, it is determined that the leaning angle that pedicle screw is inserted during operation.Adjust cylinder and spinous process
Overlying relation：Left and right cylinder axial line is set to be respectively positioned on step 2）In the optimal channel plane of determination, and make cylinder with it is upper
Lower soleplate is parallel, judges that the head of pedicle screw inclines degree according to the infall of this plane and spinous process.Referring to Figure 30, dotted line generation
Table optimal channel plane, the plane is parallel with soleplate on the centrum 1 of waist 5, but for whole backbone, this plane is to head
Side is inclined, so, it is had to intersect with the spinous process 3 of the i.e. centrum 2 of waist 4 of upper lumbar vertebrae, and the spinous process of the centrum of waist 4 is divided into
Lower two half parts, here it is the inclined angle [alpha] of cephalad, this angle can be in art directly according to optimal channel plane and spine
Prominent intersection is judged.It need to be pointed out that：Left side is the caudal of backbone in figure, and right side is the rostral of backbone.
Adjustment through above-mentioned steps, cylinder position is the best safety passage that pedicle screw is inserted；
Criterion of the cylinder in optimal pedicle channel be：
Body diameter be defined as cylinder just with the lateral border of cortex on the inside of pedicle of vertebral arch narrowest position, lateral cortex
Lateral margin contact is limited.
Its front end that is defined as of body length reaches that 75-80% in centrum sclerotin, rear are contacted with articular process sclerotin and be
Limit.
The inside inclination angle of cylinder（With the angulation of the median sagittal plane through spinous process）It is defined as screw just most narrow with pedicle of vertebral arch
The lateral border of cortex, the interior lateral margin contact of lateral cortex are limited on the inside of narrow place.
Inclination angle from cylinder to side end to end（Actually optimal channel plane when its plane be defined with spinous process intersection）It is determined that
It is limited to be parallel with soleplate up and down.
Above-mentioned every determination, be in software by adjust repeatedly simulation pedicle screw upper and lower, left and right, it is interior,
Flare and rotate centrum come it is real.
The pedicle screw inserted when the diameter for the best safety passage that pedicle screw is inserted is more than or equal to operation
Diameter, the length for the best safety passage that pedicle screw is inserted is more than or equal to the length for the pedicle screw inserted during operation
Degree, as long as inserting pedicle screw from optimal access point during operation, makes the pedicle screw inserted all the time in best safety passage,
Just pedicle of vertebral arch inside and outside wall can be avoided to be the worse for wear, reduce hold；Avoid damaging segmental vessels after wearing out pedicle of vertebral arch outer wall
Or big blood vessel, the generation for even jeopardizing patients ' lives；Avoid producing spinal nerve after wearing out pedicle of vertebral arch inwall.Best safety passage
And optimal access point is to be configured by studying the pedicle of vertebral arch of each patient with zygapophysial joint, no matter the vertebral arch of patient centrum
Whether root makes a variation or many Big mutation rates with articular process, and the accuracy rate that it disposably inserts pedicle screw is high, success rate is high, and carries
High safety factor.Clinically usually used nail diameter is 5.5mm, 6.0mm, 6.5mm, and the most frequently used nail is both rear.
4) the optimal access point that pedicle screw is inserted is determined：Find the axle for the best safety passage that pedicle screw is inserted
Heart line, the axial line and the optimal access point that the left and right processus articular superior cortex joining of centrum is that pedicle screw is inserted.Referring to figure
10, in three-dimensional reconstruction software choose CAD cylindrical tool, respectively generation step 3) in two cylinders axial line.Step 4）
In look for the method for axial line of best safety passage that pedicle screw inserts to be：To left and right two in three-dimensional reconstruction software
Cylinder carries out duplication in situ, and changes into other color marks, two body diameters after duplication is revised as the circle of 1mm diameters
The axial line for the best safety passage that post, as pedicle screw are inserted, now, the cylinder of 1mm diameters and the optimal peace outside it
Full tunnel is two concentric cylinders.The setting of 1mm diameters is manually set, and representing us usually can just visually see
Structure is limited.
Step 4）In by virtually being had an X-rayed to centrum, whether the axial line of two cylinders of observation and cylinder in left and right
In pedicle of vertebral, and there is certain introversion；It is whether parallel with soleplate up and down.
Concretely comprise the following steps：Referring to Figure 11, two cylinders are hidden, retain the axial line of two cylinders, it is soft by three-dimensional reconstruction
The whole centrums of part display, referring to Figure 12 and Figure 13, show cylinder, hide axial line, then carry out virtual fluoroscopic observation circle to centrum
Whether post is in the pedicle of vertebral of standard, referring to Figure 14 and Figure 15, while showing cylinder and axial line, then centrum is carried out virtual
Perspective, whether two cylinders of observation and axial line are in the pedicle of vertebral of standard, referring to Figure 16 and Figure 17, rotate centrum, appoint
Whether the axial line that angle of anticipating observes two cylinders is parallel with soleplate up and down, referring to Figure 18, shows axial line, hides cylinder, then
Virtual fluoroscopic observation axial line is carried out to centrum whether in the pedicle of vertebral of standard, referring to Figure 19, centrum, any angle is rotated
Whether the axial line for observing two cylinders is parallel with soleplate up and down, referring to Figure 20, is virtually had an X-rayed if so, cancelling, now two circles
The axial line of post is respectively the optimal access point that pedicle screw is inserted with the left and right processus articular superior cortex joining of centrum.
Found using the above-mentioned steps of this method after pedicle screw access point, by modeling centrum, virtual nail designs, sectional drawing
Copy in the lump into operating room computer and display, stand-by on a display screen, instruct the puncture of pedicle nail in art.Outside through way of escape vertebral plate
Or appearing through spatium intermusculare needs the processus articular superior for inserting pedicle screw and crista lambdoidalis a little, it is exposed to preoperative planning and enters to hammer into
Point, without whole articular process or transverse process are revealed.At optimal access point, according to step 3）Sectional drawing judge pedicle of vertebral arch
Screw enters to follow closely direction, inserts pedicle screw；Whether C arms perspective can verify pedicle of vertebral arch in optimal design passage.May be used also
Operated level centrum scanned again, rebuild with postoperative, verify actual metal pedicle screw whether with mimics softwares
The simulation pedicle screw of middle design is consistent.Only need to appear access point during through spatium intermusculare approach, under appearing upper
Articular process and one's own department or unit transverse process, retain the rami posteriores nervorum lumbalium and blood vessel on the outside of zygapophysial joint as far as possible.Using looking at hypograph straight in art
Method for registering determines that into hammering into be a little crucial, enters to hammer into direct-view hypograph method for registering specific operation process in an art：Appear
After articular process or crista lambdoidalis, the binocular visual field of operator is moved on on operating room computer display screen, by the anatomical structure in art with it is aobvious
Entering in display screen hammers into a little and surrounding structure is carefully compared, so as to be accurately determined pedicle nail inlet point.Then to vertebra
Nut is first open opens a way afterwards, during opening open circuit all the time using the angle of virtual awl on display screen and upper spinous process, with it is upper
Position spinous process upper, middle and lower position relationship instructs the practical operation in art, and open circuit is slowly screwed in reference to the feel that awl front end enters
Cone, then with after probe detects the bottom in bone tunnel and four walls are bony structure, be placed into along the tapping of bone tunnel have determined that it is straight
The suitable pedicle nail of electrical path length, other operating procedures are carried out after C arms perspective pedicle nail position is without exception.
The flow of the present invention is as follows：
The dicom formatted datas → being modeled in importing mimics → for collecting patient's centrum CT scan determine left and right pedicle of vertebral arch screw
Follow closely the optimal channel plane → design pedicle screw optimal channel inserted, length, diameter and the median sagittal plane through spinous process
Angulation（Size）Relation, the position with spinous process（Inclined axial plane）The optimal access point and sectional drawing of relation → determine pedicle screw →
Modeling centrum, virtual nail designs, sectional drawing are copied into operating room computer and including on screen in the lump, with practical structures in art
Comparing the optimal access point of determination and copying to appear in operating room computer and on a display screen display, stand-by → art in the lump needs to insert vertebra
The processus articular superior of pedicle screw vertebra → direct-view hypograph registration finds optimal access point（It is exactly to close articular process form in art with modeling
The prominent form of section contrasts and finds access point）→ the optimal channel with reference to pedicle screw at optimal access point designs and by step inserts vertebra
Whether pedicle screw → C arms perspective checking pedicle of vertebral arch is in optimal design passage.
Clinical trial is done using the inventive method：
Case totally 503, wherein male 384, women 119, thoracolumbar fracture 124, degenerative lumbar scoliosis shakiness 83
Example, simple lumbar spinal stenosis 24, lumber spondylolisthesis 128, protrusion of lumber intervertebral disc merge lateral crypt or spinal canal stenosis 126,
Chest vertebrae nodules 18.Thoracic vertebrae 65, lumbar vertebrae 438, pedicle screw sum are 2267：Thoracic vertebrae 160, lumbar vertebrae 2001
Individual, sacral 106.Wherein 318 have the different structures such as articular process, pedicle of vertebral arch, centrum variation.
By applicant's in-depth study and clinical experiments have proved that Thoracolumbar disk modeling after find pedicle screw access point side
Method instructs inserting for pedicle screw, in terms of the once success rate and accuracy of inserting pedicle nail is substantially better than document
The conventional freehand technology of report, is worthy to be popularized.
It is of the invention position into point methods and the existing comparison diagram positioned into point methods, arrow C referring to Figure 21 and 22
Point to for using Roy-Camille methods determine access point, arrow B point to for using Weinstein methods, Mager methods determine
Access point, arrow A point to for using this method determine access point.The vertebral model selected in figure is the centrum that articular process makes a variation
Model.Referring to Figure 23 to 29, enter point methods for the positioning using the present invention and be respectively implanted screw into point methods with existing position
Simulation comparison diagram, C is the simulation screw using Roy-Camille methods, and B is using Weinstein methods, the simulation of Mager methods
Screw, A is the simulation screw positioned into point methods using the present invention.In from Figure 25 to 26 as can be seen that Weinstein methods,
Pedicle nail subdivision on the left of Mager methods is the worse for wear on the outside of pedicle of vertebral arch on the outside of pedicle of vertebral arch.Can from Figure 27
Go out, even if increasing the inside inclination angle of nail, the pedicle of vertebral arch nail B still parts in left side are on the outside of pedicle of vertebral arch.Referring to Figure 28, Roy-
There are some inclination angles on the inside of Camille normal direction, nail just wears out pedicle of vertebral arch inwall, into canalis spinalis, i.e. C in the pedicle of vertebral arch of right side
Side, can't see this image at all when not breaking through.Referring to Figure 29, whether virtual fluoroscopic observation nail wears out cone nut madial wall：
It is to have some inclination angles on the inside of pedicle of vertebral arch inner lateral boundary, Roy-Camille normal direction between two arrows, nail just wears out pedicle of vertebral arch
Inwall, into canalis spinalis, i.e. C on the inside of the pedicle of vertebral arch of right side, can't see this image at all when not breaking through.And use the present invention
The screw inserted of method do not wear out pedicle of vertebral arch inwall completely.As can be seen from these figures, using entering that this method is determined
Point is inserting the accuracy of screw, in security, hence it is evident that true better than using Roy-Camille methods, Weinstein methods, Mager methods
Fixed access point.
This method focuses on research pedicle of vertebral arch and zygapophysial joint to determine access point, be not as Roy-Camille methods,
Weinstein methods, Mager methods, Louis methods etc. are determined into nail using the position relationship or anatomical landmarks of transverse process and processus articular superior
Access point, the present invention determines access point by studying pedicle of vertebral arch with zygapophysial joint, determines vertebra using this method on model first
After the optimal access point that pedicle screw is inserted, according to the partial structurtes feature of optimal access point position, find centrum in art and enter to hammer into
Without not appearing transverse process in point, art, only appear a little on the outside of processus articular superior, greatly shorten operating time, reduce wound and bleeding,
It need not transfuse blood and reduce surgery cost.
Clinical follow index is the complication related to nail：1st, whether pedicle screw wears out pedicle of vertebral arch inwall, causes
The leakage of cerebrospinal that nerve root injury and dural sac rupture, 2, pedicle screw whether wears out pedicle of vertebral arch and centrum outer wall causes blood vessel
Damage, 3, the accuracy of pedicle screw position.This group of case is not because of the concurrent blood vesssls and nerves injuries of pedicle screw and brain ridge
Liquid leaks.For the accuracy of screw position, mainly judged according to whether wearing out pedicle of vertebral arch inside and outside wall, using wearing for Rao etc.
Broken packet criterion evaluation puts the accuracy of nail：0 grade：Nothing is worn out；1 grade：Wear out ＜ 2mm；2 grades：2mm≤wear out ＜ 4mm；3 grades：Wear
Broken >=4mm.As a result it is 0 grade 2255；1 grade 11；2 grades 1；3 grades 0.Use the inventive method pedicle of vertebral arch do not wear out rate for
99.5%th, disposable success rate of inserting is 87.5 %, and it is 0.5% to wear out incidence.And conventional freehand inserts method its document report
It is 9%~47% to wear out incidence.Most scholars think that inner side is worn out ＜ 2mm and just belonged to " safety zone ".
Method is inserted compared to other pedicle screws and determines method, and the present invention is with easy to learn, need not be longer study
When curve, the equipment for not needing costliness and special operation apparatus, doctor need not contact X-ray, reduce wound, save operation
Between,（No matter whether the pedicle of vertebral arch of patient centrum makes a variation or many Big mutation rates with articular process, and it disposably inserts pedicle screw）
High accuracy for examination, is significantly better than other and enters point methods.
Claims (3)
1. a kind of be used to find the threedimensional model for inserting the optimal access point of pedicle screw, it is characterised in that：Choose centrum dicom numbers
According to centrum threedimensional model is set up in three-dimensional reconstruction software, centrum threedimensional model, which is provided with, to be used to simulate what pedicle screw was inserted
The cylinder of best safety passage, this is used for the position for simulating the cylinder for the best safety passage that pedicle screw is inserted using as follows
Step is determined：First, partition tools are chosen in three-dimensional reconstruction software, pedicle screw is determined according to optimal channel flat normal
The optimal channel plane inserted, by divisional plane of the optimal channel plane of determination by centrum be divided into above and below two parts, it is optimal logical
Road flat normal be the plane be located at centrum it is upper, in 1/3 intersection, it is and parallel with soleplate above and below centrum；Then, in three-dimensional reconstruction
The upper part of centrum is hidden in software, the optimal channel plane of centrum is manifested, CAD cylindrical tool is chosen, in centrum most
Left and right two cylinders are set in good channel plane, and two cylinders are located at two pedicle of vertebral arch narrowest position of centrum respectively, to this two
The adjustment of root cylinder is as follows：Left and right body diameter is adjusted first：Make the circumferential wall of left and right cylinder respectively with pedicle of vertebral arch narrowest position
The interior lateral margin contact of the lateral border, lateral cortex of inner side cortex, vertebral arch is inserted when the left and right body diameter now obtained is operation
The maximum gauge of root screw；Secondly left and right body length is adjusted：Left and right cylinder front end is set to reach the 75- in centrum sclerotin
80%, left and right cylinder rear end is contacted with articular process sclerotin, and vertebra is inserted when operation is in the distance between left and right forward and backward two ends of cylinder
The maximum length of pedicle screw；Adjust the angular relationship of left and right cylinder and median sagittal plane of the centrum through spinous process：With left and right circle
Premised on post total length is all in sclerotin, make the lateral border of cortex on the inside of left and right cylinder and pedicle of vertebral arch narrowest position, lateral cortex
Interior lateral margin contact, the left and right cylinder now obtained is closed with the maximum leaning angle of the median sagittal plane through spinous process for optimal introversion angulation
System；Adjust the overlying relation of left and right cylinder and spinous process：Left and right cylinder axial line is set to be respectively positioned in optimal channel plane, and
Make left and right cylinder parallel with soleplate up and down；Adjustment through above-mentioned steps, pedicle of vertebral arch when left and right cylinder position is operation
The best safety passage that screw is inserted；
Concentric column is set in cylinder for simulating the best safety passage that pedicle screw is inserted, the concentric column and centrum
The left and right processus articular superior cortex of threedimensional model intersects.
2. threedimensional model according to claim 1, it is characterised in that：For simulating the best safety that pedicle screw is inserted
A diameter of 1mm of the concentric column set in the cylinder of passage.
3. threedimensional model according to claim 1, it is characterised in that：The best safety passage that pedicle screw is inserted it is straight
Footpath is more than or equal to the diameter for the pedicle screw inserted during operation, and the length for the best safety passage that pedicle screw is inserted is big
The length for the pedicle screw inserted when operation.
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| CN104537939B (en) * | 2014-12-31 | 2017-05-03 | 佛山市中医院 | Virtual method and device for pedicle screw implantation |
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| CN106420036A (en) * | 2016-10-25 | 2017-02-22 | 哈尔滨理工大学 | Pedicle screw automatic implantation method |
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| WO2019000270A1 (en) * | 2017-06-28 | 2019-01-03 | 深圳市鑫君特智能医疗器械有限公司 | Method for planning screw placement for three-dimensional simulated operation, and surgical operation simulator |
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| CN109984840A (en) * | 2019-04-17 | 2019-07-09 | 杨圣 | The model and method of short-segment pedicle screw instrumentation and the quasi- treatment thoracolumbar fracture of Schanz dolly set |
| CN110946652B (en) * | 2019-11-29 | 2021-11-12 | 北京工业大学 | Method and device for planning screw path of bone screw |
| CN112022344A (en) * | 2020-07-22 | 2020-12-04 | 自贡市第四人民医院(自贡市急救中心) | Determination and verification method of orthopedic surgery nail placing channel based on three-dimensional modeling |
| CN112185226B (en) * | 2020-08-24 | 2022-08-26 | 自贡市第四人民医院(自贡市急救中心) | Manufacturing method of simulated lumbar model for training low-age-capital orthopedists to find optimal screw feeding point of lumbar pedicle screw |
| USD992114S1 (en) | 2021-08-12 | 2023-07-11 | Mighty Oak Medical, Inc. | Surgical guide |
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