本文關(guān)鍵詞： 寰樞椎脫位 寰枕融合 顱底凹陷 C1側(cè)塊螺釘 MIMICS軟件虛擬技術(shù)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究探索運用MIMICS軟件虛擬技術(shù),獲得C1側(cè)塊螺釘個性化釘?shù)绤?shù),并嘗試術(shù)中運用模擬參數(shù)輔助螺釘植入,同時評估虛擬現(xiàn)實釘?shù)涝O(shè)計技術(shù)的臨床價值。方法:本研究共納入寰樞椎脫位患者88例。將所有患者術(shù)前進(jìn)行薄層CT掃描。將原始DICOM文件輸入MIMICS工作站。在MIMICS工作站中,建立起參考坐標(biāo)系,三維重建出寰枕骨質(zhì)融合體三維圖像,再在模擬系統(tǒng)中創(chuàng)建一個直徑為3.5毫米的圓柱體,用來模擬成需要植入側(cè)塊的螺釘,在三維狀態(tài)下,調(diào)整它的角度(水平軸面的內(nèi)傾角和矢狀面的上傾角),以保證能夠避開同側(cè)的椎動脈、舌下神經(jīng)管等重要結(jié)構(gòu),然后將模擬螺釘放置到C1側(cè)塊上,得出理想的軸向角(內(nèi)傾角)和矢狀角(上傾角),分別測量軸向角和矢狀角大小,測量螺釘跨越雙皮質(zhì)后螺釘?shù)拈L度,進(jìn)一步確定理想的釘?shù)儡壽E、進(jìn)釘點及出釘點。然后在實際手術(shù)中參考術(shù)前模擬重建的解剖標(biāo)記及參數(shù),包括釘?shù)婪较�、進(jìn)釘點和螺釘長度,對鉆孔進(jìn)行指導(dǎo)。鉆孔后,球探探測釘?shù)赖乃谋谕暾约吧疃?逐步增加釘?shù)郎疃戎晾硐肷疃?球探探測釘?shù)酪淹黄艭1側(cè)塊腹側(cè)面骨皮質(zhì),攻絲沿理想釘?shù)罃U(kuò)通釘?shù)?防止進(jìn)釘時骨皮質(zhì)被撐裂),然后沿釘?shù)乐踩胫睆?.5毫米的螺釘。所有病人術(shù)后再行CT復(fù)查,將DICOM圖像導(dǎo)入到MIMICS模擬系統(tǒng),在2維圖像評估C1LMS的安全性。結(jié)果:一共有176枚螺釘進(jìn)行了分析。平均理想的軸向內(nèi)傾角為14.2°±5°,平均理想的矢狀上傾角為20.5°±9.1°。理想的釘?shù)篱L度19.1mm±2.2mm。影像學(xué)評估顯示,170(96.6%)螺釘理想位置(TypeⅠ),6枚螺釘錯位(TypeⅡ)。總體而言,100%個螺絲被評為安全(TypeⅠandⅡ)。結(jié)論:術(shù)前應(yīng)個體化設(shè)計寰樞椎脫位寰枕融合的頸1側(cè)塊螺釘釘?shù)�。在虛擬現(xiàn)實技術(shù)輔助下,頸1側(cè)塊螺釘可以更安全植入。
[Abstract]:Objective: This study is to explore the use of MIMICS software of virtual technology, C1 lateral mass screw screw parameters and try to personalized, auxiliary screws using simulation parameters in the operation, and evaluate the clinical value of virtual reality screw design technology. Methods: This study included 88 cases of patients with atlantoaxial dislocation. All patients with thin layer CT scanning. The original DICOM file input MIMICS workstation. In MIMICS workstation, establishes the reference coordinate system, reconstruction of atlanto occipital bone fusion of 3D images, and then create a cylinder with a diameter of 3.5 mm in the simulation system, to be used to simulate the lateral mass screw implantation, in 3D state. And adjust its angle (horizontal axis plane angle and sagittal angle), in order to avoid the ipsilateral vertebral artery, hypoglossal canal and other important structures, and then simulate screws on the C1 side to block. An axial angle (angle) and sagittal angle (angle), axial and sagittal angles were measured in size, measuring screw across bicortical screw length after, to further determine the ideal screw trajectory, the screw entry point and nail. Based on the preoperative anatomical markers and reconstruction of simulation parameters then in the actual operation, including the direction of screw, screw and screw length, to the direction of the hole. After drilling, nailing walls integrity detection scout road and depth, gradually increase the depth of the nail to the desired depth, scout screw has exceeded C1 detection side block the ventral surface of the bone cortex, tapping along the ideal nail through the expansion screw (to prevent the nail when the bone cortex was breaking, and then along the road) screw implant diameter of 3.5 mm. All patients after CT review, the DICOM image into MIMICS simulation system in safety assessment of C1LMS 2 dimensional images. Results: a total of 176 screws. Are analyzed. The axial average ideal inclination angle is 14.2 degrees plus or minus 5 degrees, the average of the ideal sagittal angle is 20.5 degree. The length of 19.1mm + 9.1 ~ + 2.2mm. radiographic evaluation showed that the ideal nail, 170 screws (96.6%) ideal position (Type 1), 6 screw dislocation (Type II). Overall, 100% screws were rated as safe (Type I and II). Conclusion: preoperative individualized design of atlantoaxial dislocation of atlanto occipital fusion of 1 cervical lateral mass screw. In virtual reality assisted, 1 cervical lateral mass screw implantation can be more secure.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：TP391.9;R687.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張建;劉建;顧光學(xué);何維棟;霍永峰;;側(cè)塊螺釘在頸椎病單開門手術(shù)中的應(yīng)用[J];河北醫(yī)學(xué);2010年12期

2 唐華軍;吳強(qiáng);熊英輝;劉建平;;下頸椎關(guān)節(jié)突關(guān)節(jié)傾角測量在后路側(cè)塊螺釘固定術(shù)中的應(yīng)用[J];中外醫(yī)療;2010年11期

3 孟憲中;曹俊明;申勇;孟憲國;楊大龍;;側(cè)塊螺釘置入治療頸椎骨折對頸椎曲度的影響[J];中國組織工程研究與臨床康復(fù);2008年04期

4 魏亦兵,周建偉,張志玉,黃煌淵,顧玉東;下頸椎后路側(cè)塊螺釘固定的“兩點法”應(yīng)用解剖研究[J];復(fù)旦學(xué)報(醫(yī)學(xué)版);2005年04期

5 羅琳;鄭華斌;伍光輝;;側(cè)塊螺釘固定結(jié)合頸椎板減壓治療揮鞭樣損傷療效觀察[J];齊齊哈爾醫(yī)學(xué)院學(xué)報;2013年01期

6 劉觀q，

本文編號：1539396