本文選題：頸椎前路椎弓根螺釘 + 導航模板　； 參考：《寧波大學》2017年碩士論文

【摘要】：目的:通過對改良版雙側(cè)頸椎前路椎弓根螺釘影像學的研究,分析其進針角度的最佳值,同時指導改良版螺釘3D打印導向模板的設計。方法:采集22名健康志愿者(15男7女)的頸椎CT數(shù)據(jù),并以DICOM格式導出至Mimics 17.0軟件,依次重建頸椎模型,將模型調(diào)至半透明模式,并以椎體后緣線正中為中心設立坐標軸,依次以5度為一旋轉(zhuǎn)變量以坐標軸為軸心旋轉(zhuǎn)椎體,使椎體椎弓根骨性通道上在頭尾傾和內(nèi)外傾上呈現(xiàn)出不同的投影(椎弓根投影法),通過Auto CAD軟件測量每一實驗組椎弓根骨性通道的投影面積大小及最大橫縱徑,并得出最佳進針角度(對應最大椎弓根投影面積),并以此結(jié)果作為參考以指導尸體改良版頸椎椎弓根螺釘導向模板的設計制作及應用。結(jié)果:實驗得到了全部22名志愿者的頸椎CT數(shù)據(jù),同時通過對影像學軟件的分析得到了不同角度時椎弓根投影面積,收集每位志愿者每個節(jié)段(C3-7)左右側(cè)椎弓根最大投影面積時的角度比進行統(tǒng)計學分析,C3最大椎弓根骨性通道面積為32.87±3.57mm2,最大橫徑5.47±0.97mm,最大縱徑6.99±1.02mm,最佳進針角度為外傾44.71±2.34°,頭傾角為4.16±0.67°(上)、11.67±0.41°(下);C4最大椎弓根骨性通道面積為36.65±3.21mm2,最大橫徑5.73±0.94mm,最大縱徑7.34±1.22mm,最佳進針角度為外傾46.13±3.11°,頭傾4.43±0.58°(上)、12.38±0.63°(下);C5最大椎弓根骨性通道面積為37.32±2.84mm2,最大橫徑5.88±0.86mm,最大縱徑7.62±1.31mm,最佳進針角度為外傾44.66±4.02°,頭傾4.02±0.61°(上)、11.88±0.77°(下);C6最大椎弓根骨性通道面積為40.12±2.84mm2,最大橫徑6.37±0.86mm,最大縱徑7.69±1.19mm,最佳進針角度為外傾43.14±3.71°,頭傾3.52±0.39°(上)、10.85±0.82°(下);C7最大椎弓根骨性通道面積為46.12±2.84mm2,,最大橫徑6.89±1.26mm,最大縱徑8.31±1.39mm,最佳進針角度為外傾42.64±2.94°,頭傾3.07±0.47°(上)、9.95±0.90°(下)。根據(jù)此組數(shù)據(jù),我們設計并制作了改良版頸椎前路椎弓根螺釘導向模板120枚,并在尸體標本進行了置釘試驗,術(shù)后CT顯示得到了95.8%的準確率。結(jié)論:通過椎弓根骨性通道投影法的測量我們獲得了改良版頸椎前路椎弓根螺釘在矢狀位和水平位上的在最佳進針角度,C3、C4在外傾角與尾傾角上具有增大的趨勢,而C5、C6、C7的進針角度則逐漸的下降。而椎弓根骨性通道投影面積及橫縱徑則隨著頸椎節(jié)段的下降越來越大,提示椎弓根的逐漸增粗。同時據(jù)此數(shù)據(jù)設計的頸椎前路椎弓根螺釘導向模板的準確性證明了其最佳進針角度的有效性。
[Abstract]:Objective: to study the imaging of the modified bilateral anterior cervical pedicle screw, and to analyze the optimal angle of the needle, and to guide the design of the modified screw 3D printing guide template. Methods: the CT data of cervical vertebrae were collected from 22 healthy volunteers (15 males and 7 females). The cervical vertebrae model was reconstructed by Mimics 17.0 software with DICOM format. The model was adjusted to translucent model, and the coordinate axis was set up with the center of the posterior margin line of the vertebral body as the center. In turn, 5 degrees as a rotating variable and axis as the axis of rotation of the vertebral body, The projection area and maximum transverse diameter of the bony passage of pedicle in each experimental group were measured by Auto CAD software. The optimal angle of needle entry (corresponding to the maximum pedicle projection area) was obtained, and the results were used as a reference to guide the design and application of the modified cervical pedicle screw guide template. Results: the CT data of all 22 volunteers were obtained, and the projection area of pedicle at different angles was obtained by analyzing the imaging software. The angle ratio of maximum projection area of pedicle of left and right pedicles of each volunteer was analyzed statistically. The maximum pedicle bony passage area of C3 was 32.87 鹵3.57 mm 2, the maximum transverse diameter was 5.47 鹵0.97 mm, the maximum longitudinal diameter was 6.99 鹵1.02 mm, and the best angle of needle entry was 44.71 鹵2.34 擄, and the angle of angle was 44.71 鹵2.34 擄, the maximum transverse diameter was 5.47 鹵0.97 mm, and the maximum longitudinal diameter was 6.99 鹵1.02 mm. The angle of head inclination was 4.16 鹵0.67 擄(upper angulation 11.67 鹵0.41 擄) (the maximum area of bone passage of pedicle C _ 4 was 36.65 鹵3.21 mm, the maximum transverse diameter was 5.73 鹵0.94 mm, the maximum longitudinal diameter was 7.34 鹵1.22 mm), the optimum angle of needle entry was extroverted 46.13 鹵3.11 擄, and the angle of cephalic inclination was 4.43 鹵0.58 擄(upper trochanter 12.38 鹵0.63 擄). The maximum area of bone passage was 32 鹵2.84mm2mm, the maximum transverse diameter was 5.88 鹵0.86mm, and the maximum longitudinal diameter was 37.88 鹵0.86mm. Diameter 7.62 鹵1.31 mm, the optimum angle of needle entry is extroverted 44.66 鹵4.02 擄, cephalic inclination 4.02 鹵0.61 擄(C6) 11.88 鹵0.77 擄(area of bone passage of pedicle C6 is 40.12 鹵2.84 mm 2, maximum transverse diameter 6.37 鹵0.86 mm, maximum longitudinal diameter 7.69 鹵1.19 mm, optimum angle of needle entry 43.14 鹵3.71 擄, head inclination 3.52 鹵0.39 擄(10.85 鹵0.82 擄) of pedicle bone passage area of pedicle of lower vertebrae pedicle, maximum transverse diameter 6.37 鹵0.86 mm, maximum longitudinal diameter 7.69 鹵1.19 mm, optimum angle of needle entry 43.14 鹵3.71 擄, head inclination 3.52 鹵0.39 擄(10.85 鹵0.82 擄). The maximum transverse diameter was 6.89 鹵1.26mm, and the maximum longitudinal diameter was 8.31 鹵1.39mm. The optimum angle was 42.64 鹵2.94 擄outward tilting and 3.07 鹵0.47 擄head tilting (9.95 鹵0.90 擄). According to the data of this group, we designed and made 120 modified anterior cervical pedicle screw guide templates, and carried out nail placement tests on cadaveric specimens. The accuracy of CT display after operation was 95.8%. Conclusion: the modified anterior cervical pedicle screw in sagittal and horizontal position has the tendency to increase the external inclination and tail inclination by measuring the bony channel projection of the pedicle. However, the angle of C _ (5) C _ (6) C _ (6) C _ (7) decreased gradually. However, the projection area and transverse longitudinal diameter of pedicle bony channel were larger and larger with the decrease of cervical vertebra segment, suggesting that the pedicle was gradually thickening. At the same time, the accuracy of the guide template of anterior pedicle screw designed based on the data proved the validity of the optimal angle of needle entry.
【學位授予單位】：寧波大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3;R816.8

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