CN106308919B - Navigation template manufacturing method for assisting thoracic vertebra pedicle screw implantation and navigation template - Google Patents
Navigation template manufacturing method for assisting thoracic vertebra pedicle screw implantation and navigation template Download PDFInfo
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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
- A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
- A61B17/921—Impactors or extractors, e.g. for removing intramedullary devices for intramedullary devices
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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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- 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
- A61B17/68—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
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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
- A61B2017/00526—Methods of manufacturing
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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
- A61B2017/564—Methods for bone or joint treatment
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Abstract
The invention relates to a method for manufacturing a navigation template for assisting the placement of a pedicle screw of a thoracic vertebra, which is characterized in that a thoracic vertebra is scanned by using a spiral CT (computed tomography) to obtain a tomographic image of the thoracic vertebra in an operation-simulated region; importing the image data into software to carry out three-dimensional reconstruction to obtain a thoracic vertebra three-dimensional model; placing virtual screws at the pedicle parts of the targeted thoracic vertebrae, confirming that the screws are in ideal positions on the cross section, the sagittal plane and the coronal plane respectively, and further adjusting on a three-dimensional view to ensure that the screws meet the actual requirements of the operation; generating a virtual screw channel around the virtual screw; extracting anatomical information of a bony structure behind the thoracic vertebra to generate a navigation template substrate; combining the virtual nail placing channel with the navigation template substrate, adding an arc-shaped supporting structure on the navigation template substrate around the spinous process, and adding connecting rods between the arc-shaped supporting structure and the virtual nail placing channel and between the virtual screw channels to generate a virtual navigation template; and manufacturing a physical navigation template by using a rapid prototyping machine. The invention can manufacture an individualized navigation template which is placed behind the thoracic vertebrae of the corresponding segment and can guide the accurate placement of the pedicle screws.
Description
Technical Field
The invention relates to the field of a manufacturing method of a navigation template for operation, in particular to a manufacturing method of a navigation template for assisting in placement of thoracic vertebra pedicle screws and the navigation template.
Background
The spine includes cervical, thoracic, lumbar, sacral, and coccygeal vertebrae. In the field of spinal surgery, the pedicle screw technology has become a standard technology for treating diseases such as spinal trauma, inflammation, tumor, deformity and the like, the accuracy of the position and the angle of the pedicle screw is embedded, the operation effect is influenced to a great extent, and the poor position of the pedicle screw can cause complications such as the damage of important organs such as pleura, spinal cord, aorta, trachea, esophagus and the like. Most surgeons rely on anatomical landmarks seen during surgery to infer screw placement location and angle, and have summarized the general rule through a number of practices. However, there are individual differences between patients and some differences between different spinal segments of each patient, resulting in a long learning curve for accurate screw placement, with the thoracic spine most difficult and most risky. If the thoracic vertebra is deformed and the anatomical landmarks depending on positioning are correspondingly changed, the judgment of the screw placement position is particularly difficult, the proportion of the screw position failure can reach about 35 percent, and even a doctor with rich experience can avoid the judgment error with a larger probability. Therefore, accurate placement of thoracic pedicle screws is a significant challenge in spinal surgery.
Aiming at the problems, the current popular computer-aided navigation technology in developed countries in Europe and America provides a reliable auxiliary means for the implantation of thoracic vertebra pedicle screws, and can ensure that the screw implantation accuracy rate reaches more than 95 percent, but in thoracic vertebra malformation cases, the accuracy rate is less than 65 percent, and related equipment is complex in operation, high in cost, long in learning curve and not suitable for large-scale popularization.
The learner puts forward and applies a navigation template to assist the placement of the pedicle screws, namely, the optimal screw position of each section is obtained through the computer simulation screw placement, and an ideal screw feeding channel is generated based on the optimal screw position; meanwhile, extracting anatomical information of the bony sign behind the spine to generate a substrate matched with the anatomical information; the nail feeding channel is combined with the substrate to generate a virtual navigation template, the navigation template is produced by using a rapid prototyping machine, and when the navigation template is applied in the operation, the navigation template is placed behind the corresponding section, and theoretically, the screw can be accurately placed along the nail feeding channel.
The theoretical basis of accurate nail placement of the navigation template is good matching with the posterior bony structure of the spine, namely 'position uniqueness'. However, a great deal of practice shows that the navigation template has great problems and disadvantages: firstly, due to the existence of a certain amount of soft tissue on the surface of a bony structure, particularly the tip of the spinous process, the navigation template cannot be well matched with the back of the thoracic vertebra, so that the accuracy rate of the navigation template is influenced; secondly, the substrate of the navigation template is in a two-dimensional curved surface configuration, and is easy to deviate when placed behind a corresponding thoracic vertebra, so that the position uniqueness is difficult to realize; thirdly, the position of the navigation template can not be effectively fixed at the back of the thoracic vertebra, and when the electric drill is applied in the operation and the nail is placed along the channel of the navigation template, the electric drill is influenced and is easy to move. The three reasons all cause the accuracy of the auxiliary nail placing of the navigation template in practical application to be questioned.
Therefore, how to keep the advantages of the original navigation template and improve the defects thereof from the clinical requirement is an important subject of the current navigation template technology, so that the method can be close to the practical application.
Disclosure of Invention
The invention aims to provide a method for manufacturing a navigation template for assisting in the placement of pedicle screws of thoracic vertebrae, which can manufacture an individualized navigation template which is placed behind the thoracic vertebrae of a corresponding segment and can guide the precise placement of the pedicle screws.
The invention comprises a method for manufacturing a navigation template for assisting in implanting thoracic vertebra pedicle screws, which comprises the following steps: scanning the thoracic vertebra by using spiral CT to obtain a tomographic image of the thoracic vertebra in the surgical region; importing the image data into software to carry out three-dimensional reconstruction to obtain a thoracic vertebra three-dimensional model; placing virtual screws at the pedicle parts of the targeted thoracic vertebrae, confirming that the screws are in ideal positions on the cross section, the sagittal plane and the coronal plane respectively, and further adjusting on a three-dimensional view to ensure that the screws meet the actual requirements of the operation; generating a virtual screw channel around the virtual screw; extracting anatomical information of a bony structure behind the thoracic vertebra to generate a navigation template substrate; combining the virtual nail placing channel with the navigation template substrate, adding a support structure on the navigation template substrate around the spinous process, and adding connecting rods between the support structure and the virtual nail placing channel and between the virtual screw channels to generate a virtual navigation template; and manufacturing a physical navigation template by using a rapid prototyping machine.
Preferably, the virtual screws are placed in such a way that the tail end of each virtual screw is exposed out of the bony structure by 2cm, and the tail ends of the screws on the left side and the right side form a smooth curve respectively when the virtual screws are adjusted on the three-dimensional view, so that the connecting rod is more convenient to install in an operation.
Preferably, the virtual nail placing channel is cylindrical, the inner diameter is 4mm, the outer diameter is 8mm, and the wall thickness is 2 mm.
Preferably, the anatomical information of the bony structures posterior to the thoracic vertebrae would include the majority of the lamina, the dorsal transverse process and the 0.5cm turn up, down, and out over the edges thereof, and the root of the spinous process, not the tip of the spinous process.
Preferably, the support structure is arc-shaped, and connects the root of the bilateral spinous processes and avoids the tip of the spinous processes.
Preferably, the connecting rod is a cylindrical connecting rod which is added between the supporting structure and the two virtual nail placing channels on the two sides.
The invention also discloses a navigation template for assisting the placement of the pedicle screws of the thoracic vertebrae, which is placed behind the thoracic vertebrae of the corresponding section and can guide the precise placement of the pedicle screws.
The navigation template comprises a navigation template substrate, a nail placing channel, a supporting structure and a connecting rod. The navigation template is attached to a thoracic vertebra posterior bony structure and comprises a nail placing channel.
Preferably, the nail placing channel is cylindrical, the inner diameter is 4mm, the outer diameter is 8mm, and the wall thickness is 2 mm.
Preferably, the navigation template base should cover the majority of the lamina, the dorsal transverse process and the lateral process are turned 0.5cm up, down, outward over their edges, and the root of the spinous process, not including the tip of the spinous process.
Preferably, the support structure is arc-shaped, and connects the root of the bilateral spinous processes and avoids the tip of the spinous processes.
Preferably, the connecting rod is a cylindrical connecting rod which is added between the supporting structure and the two virtual nail placing channels on the two sides.
Compared with the prior art, the invention has the following advantages:
firstly, the navigation template substrate avoids the spinous process tip, and the support structure is adopted to connect the two side parts, so that the navigation template can be well matched with the back of the thoracic vertebra, and the accuracy can be improved by applying the navigation template substrate to place the nail; secondly, the navigation template substrate is of a three-dimensional curved surface structure, has good stability in six degrees of freedom in a three-dimensional space, is not easy to deviate when placed behind a corresponding thoracic vertebra, and can realize 'position uniqueness'; thirdly, the bearing structure and the connecting rod of the navigation template enable the whole navigation template to form a three-dimensional structure similar to a triangular pyramid, the space stability is improved, the operation can be more convenient to press and fix the navigation template, and when the electric drill is applied to the operation and the nail is placed along the channel of the navigation template, the electric drill is not easy to influence and move.
FIG. 1 is a flow chart of a method for making a navigation template for assisting in placement of thoracic vertebral pedicle screws according to the present invention;
FIG. 2 is a schematic diagram of a thoracic three-dimensional reconstruction model according to the present invention;
FIG. 3 is a schematic view of the placement of a virtual screw in the thoracic spine of the present invention;
FIG. 4 is a schematic diagram of the virtual screw channel generated by the present invention;
FIG. 5 is a schematic diagram of the present invention for extracting anatomical information of the posterior bony structure of the thoracic vertebrae;
FIG. 6 is a diagram illustrating the generation of a navigation template substrate according to the present invention;
FIG. 7 is a diagram illustrating the generation of a navigation template according to the present invention;
FIG. 8 is a schematic view of the present invention showing a navigation template placed behind the thoracic vertebrae for pinning.
Detailed Description
In order to make the aforementioned objects, features and advantages of the present invention comprehensible, embodiments accompanied with figures are described in detail below.
According to the invention, by using the technical principle of reverse engineering, a thoracic vertebra sectional image of a section to be operated is obtained through spiral CT scanning, a thoracic vertebra three-dimensional model is reconstructed, a virtual screw is placed on a target thoracic vertebra, and a virtual screw placing channel is generated around the virtual screw; extracting anatomical information of a bony structure behind the thoracic vertebra to generate a navigation template substrate; combining the virtual nail placing channel with the navigation template substrate, adding an arc-shaped supporting structure on the navigation template substrate around the spinous process, and adding connecting rods between the arc-shaped supporting structure and the virtual nail placing channel and between the virtual screw channels to generate a virtual navigation template; and manufacturing a physical navigation template by using a rapid prototyping machine.
Referring to fig. 1, the method for making the navigation template for assisting the placement of the pedicle screw of the thoracic vertebra according to the present invention is shown, and the specific steps are as follows:
step S101, carrying out tomography scanning on a target thoracic vertebra by using spiral CT to obtain CT data in a DICOM format;
step S102, using the Mimics 17.0 software to perform threshold segmentation, image segmentation, three-dimensional reconstruction, wrapping and fairing processing on the CT data to obtain a three-dimensional model of the target thoracic vertebra, as shown in FIG. 2. Wherein, 1 and 2 are respectively a left lateral process and a right lateral process, 3 is an apex of a spinous process, and 4 and 5 are a left vertebral plate and a right vertebral plate;
and S103, placing a virtual screw in the pedicle of the target thoracic vertebra, wherein the virtual screw is cylindrical, the diameter of the virtual screw is 4mm, and the length of the virtual screw is determined according to actual needs. The ideal position of the screw is confirmed in the transverse, sagittal and coronal planes, respectively, and further adjusted in a three-dimensional view. The tail end of each virtual screw is exposed out of the bony structure by 2cm, and the tail ends of the screws on the left side and the right side form a smooth curve respectively when being adjusted on a three-dimensional view, so that the connecting rod is more convenient to install in an operation, as shown in figure 3. Wherein 6 and 7 are left and right virtual screws, respectively;
step S104, importing the data into 3-Matic 9.0 software, and generating a virtual nail placing channel around the virtual screw, wherein the virtual nail placing channel is cylindrical in shape, the inner diameter is 4mm, the outer diameter is 8mm, and the wall thickness is 2mm, as shown in figure 4. Wherein 8 and 9 are respectively a left virtual nail placing channel and a right virtual nail placing channel;
step S105, extracting anatomical information of the posterior bony structure of the thoracic vertebra, which includes most of the vertebral plate, the dorsal transverse process and the spinous process which are turned upwards, downwards and outwards by 0.5cm respectively beyond the edge, and the root of the spinous process, excluding the tip of the spinous process, as shown in FIG. 5. Wherein the transverse process site anatomical information range includes transverse process edge upward portions (10 and 11), outward portions (12 and 13), and downward portions (14 and 15). Generating a navigation template substrate based on the anatomical information, and setting the thickness of the navigation template substrate to be 2mm, as shown in fig. 6, wherein 16 and 17 are the left part and the right part of the navigation template substrate respectively;
step S106, combining the virtual nail placing channel with the navigation template substrate, adding an arc-shaped supporting structure on the navigation template substrate around the spinous process, and adding cylindrical connecting rods between the arc-shaped supporting structure and the virtual nail placing channel and between the virtual screw channels to generate a virtual navigation template, as shown in FIG. 7. Wherein 16 and 17 are left and right parts of the navigation template substrate, 18, 19 and 20 are connecting rods between the arc-shaped supporting structure and the virtual nail placing channel and between the virtual screw channels, and 21 is the arc-shaped supporting structure;
step S107, manufacturing a solid navigation template by using a rapid prototyping machine;
when the device is applied in an operation, the navigation template of the entity is placed behind the thoracic vertebra and is fixed on the bony structure by pressing the connecting rod, as shown in figure 8. The precise positioning of the screws can be achieved by applying electric drill bits 22 and 23 along the nail placing channels 8 and 9, respectively, for the nail placing operation.
As is well known, CT examination can provide detailed internal osseous anatomy information of the thoracic vertebra, and the individualized navigation template obtained by analyzing and designing by combining with imaging data and adopting engineering software can accurately assist the screw setting operation of the pedicle screws of the thoracic vertebra instead of positioning and orienting according to the measured results of anatomical measurement reported in documents, wherein the latter is generalized processing, certain errors exist in specific cases, and the errors are larger in cases with spinal deformity. In addition, on the basis of improving the nail placing accuracy, the long-term effect of the thoracic vertebra operation can be improved, and the complication rate is reduced.
The above description is only a preferred embodiment of the present invention, and is not intended to limit the scope of the present invention. Any modification, equivalent replacement, and improvement made within the spirit and principle of the present invention should be included in the scope of the claims of the present invention.
Claims (2)
1. A method for manufacturing a navigation template for assisting in placement of thoracic vertebral pedicle screws is characterized by comprising the following steps:
carrying out tomography scanning on the target thoracic vertebra by using spiral CT to obtain CT data in a DICOM format;
using reverse engineering software to perform threshold segmentation, image segmentation, three-dimensional reconstruction, wrapping and fairing treatment on the CT data to obtain a three-dimensional model of the target thoracic vertebra;
placing a virtual screw in the pedicle of the target thoracic vertebra, wherein the virtual screw is cylindrical, confirming that the screw is in an ideal position on a cross section, a sagittal plane and a coronal plane respectively, and further adjusting the position on a three-dimensional view;
importing the data into forward engineering software, and generating a virtual screw placing channel around a virtual screw, wherein the virtual screw placing channel is cylindrical;
extracting anatomical information of a bony structure behind the thoracic vertebra, and generating a navigation template substrate on the basis of the anatomical information;
combining the virtual nail placing channel with the navigation template substrate, and adding a support structure and a connecting rod to generate a virtual navigation template;
manufacturing a solid navigation template by using a rapid prototyping machine;
the target thoracic vertebra is any one thoracic vertebra;
the support structure is formed by adding an arc-shaped structure around the spinous process on the base of the navigation template;
anatomical information of the posterior bony structure of the thoracic vertebra, which range includes most of the vertebral plate, the back of the transverse process and the upward, downward and outward turning of 0.5cm respectively beyond the edge, and the root of the spinous process, but not the tip of the spinous process;
the connecting rod is characterized in that cylindrical connecting rods are added between the arc-shaped supporting structure and the virtual screw placing channels and between the virtual screw placing channels.
2. A navigation template for assisting in placement of thoracic vertebra pedicle screws comprises a navigation template base, screw channels, a supporting structure and a connecting rod, and is characterized in that the navigation template can be completely attached to a thoracic vertebra posterior bony structure, and the screw placement operation is completed through the screw channels;
the thoracic vertebra is any thoracic vertebra;
the support structure is an arc-shaped structure added on the base of the navigation template around the spinous process;
the coverage area of the vertebral plate comprises most of the vertebral plate, the back of the transverse process and the transverse process which goes beyond the edge of the transverse process are respectively turned by 0.5cm upwards, downwards and outwards, and the root of the spinous process, but not the tip of the spinous process;
the connecting rod means that cylindrical connecting rods are added between the arc-shaped supporting structure and the virtual screw placing channels and between the virtual screw placing channels.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201510376053.8A CN106308919B (en) | 2015-07-01 | 2015-07-01 | Navigation template manufacturing method for assisting thoracic vertebra pedicle screw implantation and navigation template |
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| CN201510376053.8A CN106308919B (en) | 2015-07-01 | 2015-07-01 | Navigation template manufacturing method for assisting thoracic vertebra pedicle screw implantation and navigation template |
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| CN106308919A CN106308919A (en) | 2017-01-11 |
| CN106308919B true CN106308919B (en) | 2019-12-31 |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US11832897B2 (en) | 2021-07-30 | 2023-12-05 | Remex Medical Corp. | Method and system for surgical navigation |
Families Citing this family (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| 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 |
| CN107260306B (en) * | 2017-06-28 | 2020-04-14 | 深圳市鑫君特智能医疗器械有限公司 | Planning method for three-dimensional simulation operation nail placement and surgical operation simulator |
| CN107550608B (en) * | 2017-08-21 | 2019-05-10 | 刘铁龙 | Lumbar vertebral posterior struts the production method and fusion of Minor articulus emerging system, medical instrument |
| CN108852511B (en) * | 2018-04-26 | 2019-06-07 | 北京罗森博特科技有限公司 | The automatic planning and device of implant for into bones optimal location |
| CN111419382A (en) * | 2020-03-12 | 2020-07-17 | 无锡科恩智造科技有限公司 | Spinal pedicle screw placement navigation template |
| CN114259298B (en) * | 2022-02-25 | 2022-04-29 | 博志生物科技(深圳)有限公司 | Digital visualization method for planning posterior internal fixation screw-placing track of vertebral pedicle |
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Cited By (1)
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| US11832897B2 (en) | 2021-07-30 | 2023-12-05 | Remex Medical Corp. | Method and system for surgical navigation |
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Effective date of registration: 20191024 Address after: No. 51 Fucheng Road, Haidian District, Beijing Applicant after: Fourth Medical Center, General Hospital of the Chinese People's Liberation Army Address before: 100048, room 2, unit 6, building 51, Fu Cheng Road, 502, Beijing, Haidian District Applicant before: Zhang Yupeng |
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