【摘要】：目的利用Mimics軟件設(shè)計(jì)樞椎前路椎弓根螺釘?shù)睦硐胫冕斖?并測(cè)試樞椎前路椎弓根螺釘?shù)纳锪W(xué)性能,旨在為樞椎前路椎弓根螺釘技術(shù)提供解剖學(xué)及生物力學(xué)依據(jù)。方法征集具有正常頸椎結(jié)構(gòu)的成年人,共40名,行頸椎CT掃描。使用Mimics軟件導(dǎo)入頸椎CT數(shù)據(jù),重建樞椎,根據(jù)中心線確定樞椎前路椎弓根螺釘?shù)睦硐胫冕斖ǖ馈y(cè)量理想置釘通道的相關(guān)指標(biāo):釘?shù)繭O’長(zhǎng)度、樞椎兩側(cè)上關(guān)節(jié)面內(nèi)側(cè)緣頂點(diǎn)的連線至進(jìn)釘點(diǎn)O的距離、樞椎正中矢狀面至進(jìn)釘點(diǎn)O的距離、釘?shù)劳鈨A角、釘?shù)老聝A角、椎弓根內(nèi)中心線上可擬合的最小直徑,以及樞椎椎體前方“人”字嵴頂點(diǎn)(由樞椎上關(guān)節(jié)突下方凹面與椎體外側(cè)緣凹面相交而成的頂點(diǎn))至進(jìn)釘點(diǎn)O的距離。獲得15個(gè)樞椎標(biāo)本,并通過(guò)螺旋CT進(jìn)行掃描。使用Mimics17轉(zhuǎn)換CT圖像,生成三維模型,測(cè)量椎弓根長(zhǎng)度及進(jìn)釘角度。根據(jù)測(cè)量結(jié)果,選取合適直徑及長(zhǎng)度的螺釘。將標(biāo)本隨機(jī)分成兩組,一組從前路在樞椎左右兩側(cè)椎弓根分別置入螺釘;一組分別從樞椎前路及后路椎弓根置入單皮質(zhì)螺釘。將頸椎置于具有環(huán)氧樹(shù)脂的嵌入盒中,測(cè)算其最大軸向拔出力。結(jié)果測(cè)得樞椎前路椎弓根螺釘理想釘?shù)篱L(zhǎng)度(34.15±2.93)mm;進(jìn)釘點(diǎn)至樞椎兩側(cè)上關(guān)節(jié)突上緣的連線距離(4.39±0.67)mm;進(jìn)釘點(diǎn)至樞椎正中矢狀面的距離為(3.95±0.44)mm;釘?shù)劳鈨A角α為(30.8±2.79)°;釘?shù)老聝A角β為(36.35±3.26)°;樞椎椎弓根內(nèi)中心線上可擬合的最小直徑(7.04±0.87)mm;進(jìn)釘點(diǎn)至樞椎椎體前方“人”字嵴頂點(diǎn)的距離(1.45±0.19)mm。在生物力學(xué)實(shí)驗(yàn),即第二部分實(shí)驗(yàn)中,1標(biāo)本由于椎弓根較為狹窄,無(wú)法置入螺釘。最后共納入14個(gè)椎體,其中6個(gè)椎體置入螺釘于樞椎前路左右側(cè)椎弓根。其左側(cè)螺釘?shù)淖畲蟀纬隽?693.53±85.64)N,右側(cè)最大拔出力(732.89±64.78)N。采用配對(duì)樣本t檢驗(yàn)比較左右側(cè)的測(cè)定值,兩側(cè)差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組合并得出最大軸向拔出力為(721.56±83.76)N。共8個(gè)椎體從后路及前路樞椎的椎弓根置入單皮質(zhì)螺釘。前路最大軸向拔出力(718.39±73.68)N,后路(976.95±93.55)N。采取配對(duì)樣本t檢驗(yàn)比較前后路兩組的測(cè)定值,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論對(duì)于大部分患者來(lái)說(shuō),理論上可以在樞椎前路椎弓根置入螺釘,可使用樞椎椎體前方“人”字嵴頂點(diǎn)作為進(jìn)釘點(diǎn),能夠避免損傷脊髓、神經(jīng)根等重要組織。且其生物力學(xué)能力較為可靠,可使螺釘松動(dòng)、拔出等風(fēng)險(xiǎn)下降。但由于樞椎解剖結(jié)構(gòu)個(gè)體差異較大,臨床上仍需針對(duì)每個(gè)個(gè)體的情況,進(jìn)行前路椎弓根螺釘?shù)闹萌搿?br/>[Abstract]:Objective to design the ideal screw placement pathway of anterior pedicle screw with Mimics software and to test the biomechanical properties of anterior pedicle screw in order to provide anatomical and biomechanical basis for the technique of anterior pedicle screw. Methods 40 adults with normal cervical vertebra structure were recruited for cervical CT scan. The Mimics software was used to import CT data of cervical vertebrae to reconstruct the axis and to determine the ideal screw placement channel of the anterior pedicle screw according to the center line. The OO' length of the nail path, the distance from the medial edge of the superior articular surface of the axis to the point O, the distance from the median sagittal plane of the axis to the point O, the angle of inclination outside the nail path, the angle of inclination of the nail path, the distance between the median sagittal plane of the axis and the point O of the screw insertion were measured. The minimum diameter that can be fitted on the inner center of the pedicle, and the distance from the vertex of the "human" cristae in front of the axial vertebral body (which is formed by the intersection between the concave surface of the superior articular process of the axis and the concave surface of the lateral edge of the vertebral body) to the point O of entering the screw. Fifteen axial specimens were obtained and scanned by spiral CT. Mimics17 was used to transform CT images to generate three-dimensional models. Pedicle length and screw angle were measured. According to the measurement results, the appropriate diameter and length of screws are selected. The specimens were randomly divided into two groups, one group was treated by anterior approach and the other group was placed with single cortical screw from anterior approach and posterior pedicle respectively. The cervical vertebrae was placed in an embedded box with epoxy resin and its maximum axial pull-out force was calculated. Results the distance between the ideal nail length of anterior pedicle screw (34.15 鹵2.93) mm; and the superior edge of superior articular process on both sides of axis was (4.39 鹵0.67) mm;. The distance from the point of insertion to the median sagittal plane of the axis was (3.95 鹵0.44) mm;, the angle of inclination 偽 was (30.8 鹵2.79) 擄, and the angle 尾 was (36.35 鹵3.26) 擄. The distance between the minimum diameter of (7.04 鹵0.87) mm; entry point and the vertex of the "human" crest in front of the axial vertebra from the fitted minimum diameter on the central line of the pedicle of the axis (1.45 鹵0.19) mm. In the second part of the biomechanical experiment, the pedicle of 1 specimen could not be inserted because of the narrow pedicle. A total of 14 vertebrae were included, 6 of which were placed screws on the anterior pedicle of the axial approach. The maximum pull-out force of the left screw was (693.53 鹵85.64) N, and that of the right side was (732.89 鹵64.78) N. T-test was used to compare the left and right side values, and there was no significant difference between the two sides. The maximum axial pull-out force was (721.56 鹵83.76) N. A total of 8 vertebrae were placed with a single cortical screw from the posterior and anterior pedicle of the axial vertebrae. The maximum axial pull-out force was (718.39 鹵73.68) N in the anterior approach and (976.95 鹵93.55) N in the posterior approach. The t-test of paired samples was used to compare the measured values of the two groups, and the difference was statistically significant. Conclusion for the majority of patients, screws can be inserted into the anterior pedicle of the axial vertebrae in theory, and the apex of the "human" cristae in front of the axial vertebral body can be used as the point of entry, which can avoid the injury of the spinal cord, nerve root and other important tissues. And its biomechanical ability is reliable, can make screw loose, pull out and so on risk reduction. However, due to the large individual differences in the anatomical structure of the axis, the anterior pedicle screw placement is still needed for each individual.
【學(xué)位授予單位】：寧波大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687;R322

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