【作者】 张少杰；

【导师】 李志军； 赵建民；

【作者基本信息】 内蒙古医学院 ， 人体解剖学与组织胚胎学， 2011， 硕士

【摘要】 目的探讨4～12岁儿童颈椎椎弓根形态特征及发育规律,为螺钉置入可行性、螺钉设计及相关生物力学研究提供基础理论依据;探讨个体化导航模板辅助儿童颈椎椎弓根螺钉置入的可行性和准确性。方法1.选取无颈椎外伤及畸形的4～12岁儿童颈椎CT扫描资料60例,将原始数据以DICOM格式导入Mimics三维重建软件进行相关指标测量,并按年龄组及节段进行统计分析。2.选取儿童尸体4具,随机分为2组。一组根据其CT扫描资料行三维重建模拟螺钉置入,并测量相关参数,制定手术方案后行徒手置钉实验;另一组根据其CT扫描资料,利用计算机辅助设计及快速成型技术设计并制作出相应颈椎椎弓根螺钉置入个体化导航模板,行该模板辅助下置钉实验。每组分别置入28枚螺钉,采用CT扫描后观察的方法比较其成功率及优良率并行统计分析。结果1.椎弓根宽（PW）、椎弓根高（PH）、椎弓根骨通道全长（TL）及外偏角（e角）总体随年龄呈递增趋势,尾偏角（f角）则变化较小但在不同颈椎角度变化较大。C₁的I值（PW/PH）随年龄变化无差异,且均大于1.0;C₂的I值在各年龄组间变化亦无差异,且均小于1.0;C₃^C₇各年龄组I值由大于1.0渐变为小于1.0。C₁、C₂及C₃～7椎弓根具有不同特征。2.徒手置钉组（D组）共置入28枚螺钉,其中优级11枚（39.3%）、良级10枚（35.7%）、差级7枚（25.0%）;个体化导航模板辅助下置钉组（E组）共置入28枚螺钉,其中优级19枚（67.9%）、良级6枚（21.4%）、差级3枚（10.7%）。两组置钉成功率没有差异（P>0.05）,但两组置入为优级的螺钉有差异（P<0.05）,E组较D组高。结论1.通过数字三维重建技术对4¹2岁儿童颈椎椎弓根进行观测,椎弓根各径线及角度总体随年龄呈递增趋势。不同颈椎节段椎弓根具有不同特征,其发育规律性明显, 4岁以上儿童各颈椎椎弓根形态上具有置入最小3.5mm直径椎弓根螺钉的可行性。2.利用Mimics软件三维重建模拟椎弓根螺钉置入并测量相关参数,应用于临床指导螺钉置入,可提高螺钉置入成功率,但需技术经验积累。3.个体化导航模板辅助儿童颈椎椎弓根螺钉置入术具有良好的成功率,该方法操作简单、易于掌握,充分体现了儿童置钉个体化原则。更多还原

【Abstract】 Objective To investigate the children aged 4 to 12 pedicle morphology and development law, provide the basic theory basis for the feasibility of screw insertion, screw design and related biomechanical study; To discuss the feasibility and accuracy of transpedicular screw placement assisted by the individualized navigation templates in cadaveric children cervical spines. Method 1. Selected the non-cervical spine trauma and deformity of the children aged 4 to 12 of 60 cases of cervical CT scan data, to importe three-dimensional reconstruction software Mimics as DICOM format and measure the parameters of pedicles of 3D model, then to statistically analyze by age group and segments. 2. 4 children cadavers were randomly divided into 2 groups .One group firstly imitated screw placement in the three-dimensional reconstruction and related parameters was measured,then with the measure results implanted pedicle screw by bare-handed method;the other group based on their CT scan data, using computer-aided design and rapid prototyping technology designed the corresponding individual navigation template of cervical pedicle screw placement, implanted pedicle screw by this template. Each group implanted 28 pieces screws .Observed by CT scan and comparison the accuracy and quality of two methods to statistical analysis. Results: 1.PW, PH, TLand e angle increased gradually with age, f angle changes a little but in different cervical spine angle changes larger. I value of C₁ changes with age no significant differences ,and all more than 1.0; I values of C₂ changes in all age groups no difference, and all less than 1.0; I value of C₃ C₇ changes in each age group from the more than 1.0 to less than1.0. C₁, C₂ and C3 7 pedicle have different characteristics. 2. The bare-handed group （D group） were inserted 28 screws, in which the optimal grade 11 （39.3%）, the fine grade 10 pieces （35.7%） and the poor grade 7 pieces （25.0%）; the navigation template group （E group） were also placed 28 pieces screws, in which the optimal grade 19 pieces （67.9%）, the fine grade 6 pieces （21.4%） and poor grade 3 pieces （10.7%）. The two groups did not differ between the success rate of pedicle screws （P> 0.05）, but the optimal grade rote in screws placed were different （P <0.05）, E group more than D group. Conclusion 1. By digital three-dimensional reconstruction techniques in children aged 4 to 12 were observed cervical spine, pedicle angle of the line and the overall diameter increased gradually with age. Cervical pedicle different segments with different characteristics, its development has a certain regularity, children over 4 years on the morphology of the cervical pedicle have the feasibility with a minimum 3.5mm diameter screws to inserte.2.Using Mimics software simulation of pedicle screw placement in three-dimensional reconstruction and measurement parameters, applicate to clinical ,it can guide screw placement, and increase the success rate of screw placement, but it need certain degree of technical experience accumulation. 3. The method of children cervical pedicle screw placement assisted by individual navigation template has a good success rate, it’s simple, easy to master, fully embodies the individual principle .更多还原