本文關(guān)鍵詞：計算機(jī)輔助設(shè)計應(yīng)用于復(fù)雜脊柱矯形手術(shù)的初步研究　出處：《南方醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 重度脊柱畸形 后路截骨 脊柱短縮 體感誘發(fā)電位 三維重建 交互式醫(yī)學(xué)影像控制系統(tǒng)

【摘要】：研究背景 伴隨計算機(jī)技術(shù)的興起與發(fā)展,計算機(jī)輔助技術(shù)在醫(yī)學(xué)領(lǐng)域的發(fā)展非常迅猛,并且得到醫(yī)學(xué)界的廣泛認(rèn)可與應(yīng)用,從各個方面豐富了當(dāng)前的醫(yī)學(xué)診療手段,改變了醫(yī)學(xué)診療模式。特別是在骨科領(lǐng)域,基于骨骼系統(tǒng)及骨科手術(shù)的特殊性,計算機(jī)輔助手術(shù)技術(shù)尤與骨科臨床結(jié)合緊密,顯示出良好的實用性,能夠直接用于科學(xué)研究和指導(dǎo)臨床應(yīng)用。而在骨科領(lǐng)域內(nèi),脊柱畸形的手術(shù)治療相對難度較大,涉及三維方向上的精細(xì)解剖和復(fù)雜變異,需要手術(shù)醫(yī)師高超的手術(shù)技巧與豐富的臨床診療經(jīng)驗。隨著三維矯形理論與技術(shù)的發(fā)展、內(nèi)固定系統(tǒng)的改良以及脊柱矯形技術(shù)和麻醉技術(shù)的卓著進(jìn)步,脊柱矯形的手術(shù)效果已經(jīng)獲得了大幅度的提升,但同時亦存在術(shù)式多樣,適應(yīng)癥不夠明確,診療過程不夠標(biāo)準(zhǔn)和規(guī)范,并發(fā)癥的發(fā)生率仍較高等不足之處。目前,計算機(jī)輔助技術(shù)已經(jīng)在脊柱外科獲得一定應(yīng)用,但檢索國內(nèi)外文獻(xiàn),未見將計算機(jī)輔助設(shè)計應(yīng)用于脊柱矯形的相關(guān)報道,其應(yīng)用效果亦不得而知。 研究目的 對計算機(jī)輔助技術(shù)在骨科領(lǐng)域的發(fā)展和應(yīng)用現(xiàn)狀進(jìn)行綜述。對脊柱畸形的手術(shù)治療,特別是重度脊柱畸形的截骨矯形手術(shù)的臨床應(yīng)用進(jìn)展進(jìn)行綜述�；谟嬎銠C(jī)輔助技術(shù)在脊柱外科的前期應(yīng)用,本研究通過運用計算機(jī)輔助設(shè)計輔助探索山羊胸椎椎弓根螺釘?shù)闹冕攨?shù)并試圖模擬截骨矯形手術(shù),以彌補對于實驗動物缺乏手術(shù)操作經(jīng)驗的不足。進(jìn)行山羊后路胸椎單節(jié)段全椎骨切除手術(shù)的實驗研究,利用椎弓根釘棒內(nèi)固定系統(tǒng)的軸向加壓,在脊髓監(jiān)護(hù)下探索脊柱和脊髓短縮的安全范圍,以期為臨床脊柱短縮手術(shù)提供數(shù)據(jù)參考及實驗依據(jù)。同時基于交互式醫(yī)學(xué)影像控制系統(tǒng)這一平臺進(jìn)行重度脊柱畸形矯形手術(shù)相關(guān)的計算機(jī)輔助設(shè)計,進(jìn)而通過臨床分組研究比較組別之間的手術(shù)安全性與手術(shù)效果,探索該技術(shù)對于重度脊柱畸形矯形手術(shù)的重要指導(dǎo)意義。 方法 (1)查閱近年來國內(nèi)外關(guān)于計算機(jī)輔助技術(shù)的文獻(xiàn),了解其發(fā)展史及其在醫(yī)學(xué),尤其是骨科領(lǐng)域內(nèi)的應(yīng)用,檢索相關(guān)新興技術(shù)及其相關(guān)原理、關(guān)鍵技術(shù)、應(yīng)用范圍及進(jìn)展,學(xué)習(xí)并掌握基于交互式醫(yī)學(xué)影像控制系統(tǒng)的計算機(jī)輔助設(shè)計,并應(yīng)用于指導(dǎo)骨科手術(shù)。(2)查閱文獻(xiàn)了解脊柱畸形手術(shù)治療發(fā)展史及當(dāng)期診療手段,重點檢索重度脊柱畸形后路截骨矯形手術(shù)的相關(guān)文獻(xiàn),熟悉各種手術(shù)方式的發(fā)展,包括不同術(shù)式的手術(shù)原理、手術(shù)系統(tǒng)以及適應(yīng)癥、手術(shù)效果以及并發(fā)癥,掌握各種截骨手術(shù)的操作過程,綜述后路截骨矯形手術(shù)的最新進(jìn)展。(3)選擇6只健康山羊進(jìn)行動物實驗,所有動物術(shù)前行X線及MR檢查,排除脊柱及神經(jīng)系統(tǒng)疾病,多層薄層掃描獲取脊柱斷層CT數(shù)據(jù),利用交互式醫(yī)學(xué)影像控制系統(tǒng)重建山羊脊柱模型,分離手術(shù)節(jié)段的椎體,模擬椎弓根螺釘置釘,選擇最佳進(jìn)釘點、置釘方向與深度,模擬脊柱截骨短縮手術(shù)。然后依據(jù)模擬手術(shù)獲取的相關(guān)參數(shù)實施動物實驗,在全程體感誘發(fā)電位監(jiān)護(hù)下完成脊柱后路T6-10的后路椎弓根螺釘固定,從兩側(cè)進(jìn)行T8節(jié)段的全椎骨切除,設(shè)定全椎骨切除后的皮層體感誘發(fā)電位(CSEP)為基準(zhǔn)線,設(shè)定CSEP P1波幅下降50%和／或潛伏期延長10%為提示脊髓損傷的陽性結(jié)果。測量此時截骨間隙的高度,再利用后路胸椎椎弓根釘棒系統(tǒng)的椎間加壓,以1mm/5min的速度模擬脊柱軸向短縮,直至脊髓監(jiān)護(hù)剛好不出現(xiàn)陽性結(jié)果,此時再次記錄截骨間隙高度,如截骨間隙存在,即于截骨間隙植入合適高度的椎間支撐體,完全固定椎弓根釘棒系統(tǒng)并逐層縫合術(shù)口,記錄截骨前后及內(nèi)固定后的CSEP,術(shù)后嚴(yán)密觀測山羊肢體活動情況,繼續(xù)飼養(yǎng)1周,復(fù)查X線及MR檢查,并記錄行為學(xué)檢測指標(biāo)恢復(fù)正常的時間,最終獲得脊柱短縮的安全范圍。(4)臨床研究中選取2010年6月～2012年6月中國人民解放軍廣州軍區(qū)廣州總醫(yī)院骨科醫(yī)院收治的脊柱畸形病例共62例,分為模擬手術(shù)組31例及非模擬手術(shù)組31例。所有病例簽署知情同意書,排除手術(shù)禁忌及其他入組禁忌后,術(shù)前進(jìn)行T1-S1脊柱的多層薄層螺旋CT掃描,模擬手術(shù)組病例獲取CT光盤數(shù)據(jù)導(dǎo)入Mimics10.01軟件平臺進(jìn)行手術(shù)區(qū)域的脊柱以及周圍重要臟器,如心肺、肝臟、腎臟等,以及截骨矯形區(qū)血管的數(shù)字化三維重建,仔細(xì)觀察三維模型了解脊柱及其周圍重要臟器、血管的空間關(guān)系,明確有無結(jié)構(gòu)變異,并確定手術(shù)節(jié)段,是否需要截骨以及截骨區(qū)域,模擬置釘、截骨和內(nèi)固定等手術(shù)操作,優(yōu)化手術(shù)方案,必要時利用快速原型技術(shù)制作三維實物模型輔助術(shù)中參考。非模擬手術(shù)組術(shù)前不進(jìn)行上述操作,單純按照傳統(tǒng)常規(guī)方式結(jié)合術(shù)者經(jīng)驗制定手術(shù)方案。術(shù)后通過X線檢查及CT釘?shù)罀呙璞容^兩組椎弓根螺釘?shù)闹冕敵晒β?定義椎弓根螺釘完全不穿破皮質(zhì)為置釘成功)評估手術(shù)安全性,比較Cobb角糾正率以評估手術(shù)效果。術(shù)后兩組患者進(jìn)行了10～28月的隨訪。 結(jié)果 (1)數(shù)字骨科技術(shù)全面覆蓋了骨科術(shù)前圖像重建及處理、手術(shù)模擬、術(shù)中導(dǎo)航與術(shù)后評估等各個方面,技術(shù)成熟。(2)伴隨脊柱矯形手術(shù)技術(shù)的進(jìn)步,脊柱畸形的手術(shù)效果大幅提升。臨床中,截骨手術(shù)在重度脊柱畸形的矯形中正在逐步得到推廣應(yīng)用,矯形效果良好,但其方式較多,缺乏標(biāo)準(zhǔn),手術(shù)并發(fā)癥多。(3)在缺乏山羊胸椎椎弓根螺釘置釘經(jīng)驗的情況下,基于山羊脊柱CT掃描數(shù)據(jù)的三維重建,通過計算機(jī)輔助設(shè)計獲得了山羊胸椎后路椎弓根螺釘可靠的進(jìn)釘點、置釘方向與深度、螺釘直徑等置釘參數(shù),并成功完成置釘,同時可以模擬截骨短縮手術(shù),最大限度地優(yōu)化實驗方案,保證了動物實驗的實施。在體感誘發(fā)電位監(jiān)護(hù)下截除T8全椎骨,加壓椎弓根釘棒系統(tǒng)進(jìn)行脊柱短縮,測量山羊T8節(jié)段水平脊柱短縮的安全范圍,發(fā)現(xiàn)隨著脊柱短縮負(fù)荷增大,CSEP波幅下降、潛伏期延長,波幅降低多先于潛伏期延長出現(xiàn),但均又逐步恢復(fù)正常,均尚未達(dá)到脊髓監(jiān)護(hù)陽性標(biāo)準(zhǔn),直至截骨間隙完全閉合仍不能導(dǎo)致脊髓監(jiān)護(hù)指標(biāo)陽性改變的出現(xiàn),此時固定內(nèi)固定系統(tǒng),并持續(xù)維持內(nèi)固定1周,發(fā)現(xiàn)所有山羊術(shù)后當(dāng)日肢體活動即完全正常,行為學(xué)檢測指標(biāo)亦均正常,均未出現(xiàn)不可逆性脊髓損傷表現(xiàn)。(4)臨床研究中應(yīng)用Mimics軟件平臺可以清晰地重建脊柱及周圍重要臟器、血管等,術(shù)前可以直觀、客觀地觀察并測量手術(shù)區(qū)域的精細(xì)解剖與變異,能夠反復(fù)多次進(jìn)行模擬置釘、截骨以及內(nèi)固定等手術(shù)操作,甚至能夠預(yù)測手術(shù)效果,從而優(yōu)化手術(shù)方案。兩組臨床病例術(shù)后所有患者均未發(fā)現(xiàn)神經(jīng)、血管損傷及感染等并發(fā)癥,模擬手術(shù)組置釘共418枚,成功率為97.1%,非模擬手術(shù)組置釘共451枚,成功率90.5%,兩組有顯著性差異(p0.001):Cobb角糾正率(模擬手術(shù)組63.3%±14.3%,非模擬手術(shù)組58.3%±13.0%),兩組無顯著性差異(P0.05)。 結(jié)論 (1)數(shù)字技術(shù)大大提高了骨科手術(shù)的精準(zhǔn)度和安全性,有效提升了手術(shù)技術(shù)及手術(shù)效果,凸顯了其臨床實用性。(2)隨著三維矯形理論和內(nèi)固定器械的發(fā)展,截骨術(shù)成為治療重度脊柱畸形的革命性技術(shù),從早期的經(jīng)椎弓根截骨發(fā)展到全椎體切除術(shù),大大提高了重度脊柱畸形的矯形率。但目前重度脊柱畸形的診療策略尚難以達(dá)到標(biāo)準(zhǔn)化和規(guī)范化,相關(guān)的實驗研究及循證醫(yī)學(xué)證據(jù)仍然不足,個體化的截骨矯形手術(shù)方式的選擇及如何規(guī)避手術(shù)并發(fā)癥仍然有待探索研究。(3)在動物實驗中,計算機(jī)輔助設(shè)計可用于缺乏手術(shù)經(jīng)驗時的術(shù)前探索及操作模擬,體感誘發(fā)電位監(jiān)護(hù)下模擬T8水平的脊柱短縮,發(fā)現(xiàn)單位椎體高度的脊柱短縮并不導(dǎo)致脊髓監(jiān)護(hù)的陽性改變及脊髓功能損害,這一結(jié)果穩(wěn)定可靠,可以用于臨床脊柱截骨短縮矯形手術(shù)的參考依據(jù)。(4)在臨床中,重度脊柱畸形往往合并脊柱及周圍軟組織三維方向不同程度的畸形,個體之間矯形參數(shù)相差懸殊,手術(shù)難度極大,我們成功將計算機(jī)輔助設(shè)計技術(shù)運用于重度脊柱畸形的矯形手術(shù),該系統(tǒng)使用方便,操作簡單,不僅可以簡便地重建患者CT數(shù)據(jù)獲得清晰的骨性及軟組織三維結(jié)構(gòu),而且可以直接根據(jù)自己的臨床經(jīng)驗進(jìn)行手術(shù)相關(guān)參數(shù)的測量、制定個體化的矯形方案并反復(fù)多次模擬手術(shù),同時還可以連接快速成型設(shè)備制作實體模型術(shù)中實時參考,為脊柱矯形特別是對復(fù)雜畸形的矯形帶來諸多益處,可以明確地提高手術(shù)準(zhǔn)確性和安全性,甚至通過術(shù)后的重建分析患者的手術(shù)效果及預(yù)后。應(yīng)用計算機(jī)輔助設(shè)計指導(dǎo)脊柱矯形手術(shù),尤其是重度脊柱畸形的矯形手術(shù),均獲得滿意的臨床療效,故推薦在臨床脊柱矯形中進(jìn)一步推廣應(yīng)用。
[Abstract]:Research background
With the rise and development of computer technology, the development of computer aided technology in the field of medicine is very rapid, and has been widely recognized and applied in medical field, from the aspects of enriching the current medical diagnosis method, change the medical treatment model. Especially in the field of Department of orthopedics, particularity of the skeletal system and Department of orthopedics surgery based on surgery computer aided technology especially closely combined with clinical department of orthopedics, shows good practicability, can be directly used in scientific research and clinical applications. While in the Department of orthopedics in the field of surgical treatment of spinal deformity is relatively difficult, involving the direction of three-dimensional fine and complex anatomical variation, surgical techniques are necessary for physicians skilled operation and rich clinical the experience of diagnosis and treatment. With the development of three-dimensional correction theory and technology, internal fixation system improvement and orthopedic surgery and anaesthesia technology Zhuo progress, ridge The operation effect has already obtained the orthopedic column greatly improved, but at the same time also has the operation diversity, indications are not clear enough, the treatment process is not standard and the complication rate is still higher shortcomings. At present, the computer aided technology has got certain application in spinal surgery, but the retrieval of literatures at home and abroad, no the relevant reports of computer aided design application in orthopedic surgery and its application effect also can make nothing of it.
research objective
To summarize the development and application of computer aided technology in the field of Department of orthopedics. Surgical treatment for spinal deformity, especially the progress of clinical application of osteotomy for severe spinal deformity surgery were reviewed. The application of computer aided technology in spinal surgery on the basis of this study through the use of computer aided design exploration goat thoracic pedicle screws screw parameters and try to simulate osteotomy, to make up for lack of experimental animal lack of operation experience. Experimental study of goat posterior total vertebral resection single segmental thoracic surgery, using axial pedicle screw rod fixation system pressure, explore the safety range of spine and spinal cord shortening in spinal cord monitoring, to for a period of clinical spinal shortening surgery to provide reference data and experimental basis. At the same time, based on the platform of interactive medical image control system Computer aided design for corrective surgery of severe spinal deformity is carried out, and then the clinical safety and operative effect between different groups are compared through clinical grouping to explore the important guiding significance of the technology for severe spinal deformity correction surgery.
Method
(1) the published literatures about computer aided technology, understand its development history and its application in medicine, especially in the Department of orthopedics in the field of information retrieval related emerging technology and its related principle, application scope and progress, to learn and master the computer aided design of interactive medical image control system based on the application and to guide the Department of orthopedics surgery. (2) the literature about the history of the development of spinal deformity surgery treatment and the treatment means, the related literature focus on the retrieval of severe spinal deformity posterior osteotomy surgery, familiar with the development of various operation modes, including the operation principle of different operation, operation system and indications, operative effect and complications of operation. The process of mastering all kinds of osteotomy, the latest progress of posterior osteotomy surgery. (3) 6 healthy goats were used in animal experiments, all animal underwent X-ray and M Check out R, spine and nervous system disease, multi fault CT data acquisition spine TLC scanning control system, reconstruction of goat spine model using the interactive medical image, the separation operation segment of vertebral pedicle screw placement, simulation, select the best point of screw insertion angle and depth, simulation of spine shortening operation. Then the parameters according to the simulation surgery to obtain the implementation of animal experiment, the whole body in the sense of posterior pedicle screw complete posterior spinal T6-10 evoked potential monitoring under the fixed T8 segment total vertebral resection from both sides, set the total vertebral resection of somatosensory evoked potential (CSEP) as the base line, set the CSEP P1 amplitude decreased 50% and / or latency of 10% positive results suggest that spinal cord injury. When measuring the osteotomy gap height using posterior thoracic pedicle screw rod system with 1mm/5min intervertebral compression, speed Simulation of axial spine shortening, until spinal cord monitoring just positive results, then again to record the osteotomy gap height, such as the existence of the osteotomy gap, namely in the osteotomy gap implanted suitable height of intervertebral supporting body, completely fixed with pedicle screw system and sutured incision, recorded after fixation of osteotomy before and after CSEP and, close observation of goat limbs after operation, continue for 1 weeks, X-ray and MR examination, and record the behavioral detection indicators to restore the normal time, finally get the safety range of spinal shortening. (4) from June 2010 to June 2012 China people's Liberation Army Genenral Hospital of PLA Guangzhou Military Area Department of orthopedics hospital admitted 62 cases of spinal deformity patients in the clinical study, divided into group of 31 cases of surgical simulation and Simulation of non operation group 31 cases. All patients signed informed consent, exclude contraindication and other groups contraindicated after preoperative T1-S Scanning 1 spine multilayer spiral CT, simulate the surgical group to obtain CT disk data into Mimics10.01 software platform for the operation area of spinal and peripheral organs such as heart, lung, liver, kidney, blood vessels and osteotomy area digital three-dimensional reconstruction, carefully observe the 3D models to understand the important organs and around the spinal space. The relationship between blood vessels, clear the structure variation, and to determine the surgical segment, need osteotomy and osteotomy area, simulation of screw, osteotomy and internal fixation operation, optimize the operation plan, if necessary using rapid prototyping technology refer to the production of three dimensional physical model of auxiliary operation. Without the operation simulation before surgery, simply follow the conventional combination of experience and surgical planning. After operation by X-ray examination and CT scan screw compared with two groups of pedicle screw placement success rate (fixed The operative safety was evaluated by pedicle screw completely without perforation. The corrected rate of Cobb angle was used to evaluate the operative effect. Two groups of patients were followed up for 10~28 months after operation.
Result
(1) digital technology comprehensive coverage of the Department of orthopedics department of orthopedics preoperative image reconstruction and processing, operation simulation, intraoperative navigation and postoperative evaluation and other aspects, mature technology. (2) with spinal surgery technology, the surgical effect of spinal deformity increased dramatically. Clinically, osteotomy in the correction of severe deformity the spine is gradually popularized, orthopedic effect is good, but it means more, the lack of standards, more complications. (3) in the absence of goat thoracic pedicle screw placement experience, three-dimensional reconstruction of goat spinal CT scan based on the data obtained through computer aided design of goat thoracic posterior pedicle screw into reliable nail, screw direction and depth, the diameter of screw screw parameters, and the successful completion of the screw, and can simulate the osteotomy surgery, to optimize the experimental scheme, to ensure the real animal experiment In the application of somatosensory evoked potential monitoring cutting T8 total vertebral compression, pedicle screw system for spinal shortening, safety range measurement goat T8 segment level spinal shortening, with spinal shortening load increases, the amplitude of CSEP decreased and latency was prolonged and the amplitude decreased earlier than latency, but also gradually return to normal, has not reached a positive standard of spinal cord monitoring, until the osteotomy gap closed completely still can not lead to spinal cord monitoring index positive change, the internal fixation system, and maintain internal fixation for 1 weeks, found the goat postoperative day physical activity is completely normal, behavioral detection indicators were normal, were no irreversible spinal cord injury. (4) can clearly reconstruct the spine and important organs surrounding the application of Mimics software in clinical research vessels, can be directly observed and objectively before operation. Fine anatomical measurement of the operation area and variation, which can repeatedly simulate the screw osteotomy and internal fixation operation, and can even predict the operation effect, in order to optimize the surgical plan. Clinical cases in two groups after operation all patients were found no nerve, vascular injury and complications such as infection, a total of 418 screw simulation operation group one, the success rate was 97.1%, the non simulation operation group nailing a total of 451, the success rate was 90.5%, there was significant difference between two groups (p0.001): Cobb angle correction rate (analog operation group 63.3% + 14.3%, 58.3% + 13% non simulated surgery group), no significant differences between the two groups (P0.05).
conclusion
(1) digital technology can greatly improve the accuracy and safety of operation in the Department of orthopedics, improve the surgical technique and operative effect, highlighting its clinical utility. (2) with the development of three-dimensional correction theory and instrumentation, become the osteotomy for the treatment of severe spinal deformity of the revolution of technology, from the early pedicle cut-off the bone to the entire vertebral resection, greatly improving the severe orthopedic spinal deformity rate. But the current strategy for diagnosis and treatment of severe spinal deformity is difficult to achieve standardization and related experimental research and evidence-based medicine is still insufficient, individual osteotomy methods and the choice of how to avoid the complications of surgery remains to be to explore and study. (3) in animal experiments, computer aided design for the lack of surgical experience when preoperative exploration and operation simulation, simulation of shortening T8 somatosensory evoked potential monitoring in spinal level under It is found that the unit of vertebral height, spinal shortening does not lead to positive changes and the function of spinal cord spinal cord monitoring, this result is stable and reliable, can be used for clinical spine shortening surgery reference. (4) in the clinic, severe spinal deformity is often associated with 3D spine and surrounding soft tissue deformities between the individual parameters, correction disparity, operation difficulty is great, our success will be the technology of computer aided design applied to severe spinal deformity correction surgery, the system is easy to use, simple operation, can not only simple reconstruction with CT data obtained clear three-dimensional structure of bone and soft tissue, and can be directly related to the operation of measuring parameters according to the our clinical experience, orthopedic individualized and repeated surgical simulation, but also can be connected with rapid prototyping equipment production model The type of operation in real-time reference, especially for scoliosis bring many benefits to complex deformity correction, can clearly improve the operation accuracy and safety, even through the postoperative reconstruction analysis of patients with the effect of surgery and prognosis. The application of computer aided design guidance for spinal surgery, especially in severe spinal deformity correction surgery clinical curative effect were satisfactory, so it is recommended to be widely used in clinical orthopedic surgery.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 高梁斌,李健,李佛保,周錦桐;強直性脊柱炎脊柱后凸截骨矯正量的臨床研究[J];廣東醫(yī)學(xué);2002年01期

2 倪春鴻,侯炯,許華,侯鐵勝,李明,白玉樹,趙新剛;常壓及控制性降壓下脊髓急性牽拉損傷比較研究[J];脊柱外科雜志;2004年04期

3 劉新宇;鄭燕平;原所茂;侯勇;杜偉;;脊柱側(cè)凸術(shù)中皮層體感誘發(fā)電位(CSEP)監(jiān)護(hù)的應(yīng)用價值[J];脊柱外科雜志;2005年04期

4 周忠杰;宋躍明;劉立岷;;胸腔鏡輔助治療特發(fā)性脊柱側(cè)凸的研究進(jìn)展[J];脊柱外科雜志;2010年03期

5 杜匯良,黃世霖,張金換;醫(yī)學(xué)圖像三維有限元重建中的數(shù)據(jù)管理及T10～T12胸椎模型建立[J];生物醫(yī)學(xué)工程學(xué)雜志;2004年05期

6 趙金城,劉士新;計算機(jī)虛擬現(xiàn)實技術(shù)在現(xiàn)代醫(yī)學(xué)中的應(yīng)用[J];醫(yī)療裝備;2001年04期

7 胡勇,胡從云,陸?zhàn)K;脊柱側(cè)凸矯形術(shù)中脊髓監(jiān)護(hù)基準(zhǔn)的選擇[J];中華骨科雜志;2000年09期

8 熊傳芝,郝敬明,唐天駟;椎弓根釘?shù)绤?shù)的變異性及其相關(guān)因素的研究[J];中華骨科雜志;2002年01期

9 劉雷,裴福興,呂波,沈彬,楊靜,周宗科;皮層體感誘發(fā)電位監(jiān)測脊髓牽張性損害的實驗研究[J];中華物理醫(yī)學(xué)與康復(fù)雜志;2004年09期

10 高梁斌，徐海榮，，寥維宏;椎弓椎體截骨矯正駝背的動物模型復(fù)制[J];中華實驗外科雜志;1994年02期

本文編號：1425366