本文選題：寰椎 + 側(cè)塊螺釘　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的探討計算機輔助模擬置釘技術(shù)在寰椎側(cè)塊螺釘精準(zhǔn)置釘中應(yīng)用的可行性。方法回顧性分析2014年1月至2016年1月在河南省人民醫(yī)院骨科二病區(qū)行寰椎側(cè)塊螺釘內(nèi)固定技術(shù)治療的寰樞椎不穩(wěn)患者共51例,其中男性28例、女性23例,年齡31-54歲,平均年齡42.7歲。術(shù)前使用BOHOLO外科手術(shù)模擬器設(shè)計置釘參數(shù)模擬置釘?shù)墓?7例,定義為實驗組,其中陳舊性齒狀突骨折7例,先天齒狀突發(fā)育不全12例,新鮮齒狀突骨折(Anderson IIC型)8例;未使用BOHOLO外科手術(shù)模擬器術(shù)前規(guī)劃進(jìn)行手術(shù)的共24例,定義為對照組,其中陳舊性齒狀突骨折6例,先天齒狀突發(fā)育不全10例,新鮮齒狀突骨折(Anderson IIC型)8例。實驗組術(shù)前CT數(shù)據(jù)導(dǎo)入BOHOLO軟件設(shè)計寰椎側(cè)塊最佳釘?shù)?定義參數(shù)(進(jìn)釘點到椎管最外側(cè)緣即椎弓根內(nèi)緣的距離L1、到寰椎正中矢狀面距離L2、釘?shù)篱L度D、釘?shù)浪矫娼荰SA、矢狀面角SSA),并用BOHOLO軟件測量實驗組術(shù)后實際釘?shù)绤?shù),與術(shù)前規(guī)劃參數(shù)進(jìn)行比較,同時比較兩組手術(shù)時間(min),術(shù)中出血量(ml),調(diào)取兩組患者術(shù)后CT,通過BOHOLO多平面重組成像在CT軸位與冠狀位觀察比較兩組螺釘位置,在軸位上劃分側(cè)塊置釘可靠區(qū):上關(guān)節(jié)面在側(cè)塊內(nèi)的投影區(qū),該區(qū)域內(nèi)螺釘固定安全且強度最可靠,可靠區(qū)以外區(qū)域置釘強度不可靠且有損傷脊髓或椎動脈風(fēng)險。依據(jù)術(shù)后有無并發(fā)癥,術(shù)前以及末次隨訪時的JOA評分、VAS評分以及融合率來評價療效。結(jié)果所有患者術(shù)中均未出現(xiàn)椎動脈以及神經(jīng)損傷的情況,且均獲得隨訪,隨訪時間7~13個月,平均9個月,術(shù)后6個月時,均獲得骨性融合,且無螺釘松動、移位、斷裂的情況發(fā)生。兩組患者基線資料以及病歷組成均無統(tǒng)計學(xué)差異。實驗組共置入寰椎側(cè)塊螺釘54枚,均位于可靠區(qū)內(nèi),占100%,測得最佳釘?shù)绤?shù)L1(左側(cè)5.00±0.92mm、右側(cè)5.19±0.83mm),L2(左側(cè)19.22±1.19mm、右側(cè)18.96±1.09mm),D(左側(cè)20.67±1.62mm、右側(cè)20.26±1.53mm),TSA(左側(cè)12.11±1.40°、右側(cè)11.93±1.47°),SSA(左側(cè)19.82±1.33°、右側(cè)19.56±1.31°),實際釘?shù)绤?shù)L1’(左側(cè)4.74±0.71mm、右側(cè)5.11±0.97mm),L2’(左側(cè)18.96±1.16mm、右側(cè)19.04±1.06mm),D’(左側(cè)20.48±1.55mm、右側(cè)20.48±1.81mm),TSA’(左側(cè)12.19±1.57°、右側(cè)12.22±1.48°),SSA’(左側(cè)19.74±1.29°、右側(cè)19.41±1.22°),規(guī)劃與實際參數(shù)之間差異無統(tǒng)計學(xué)意義(P0.05)。對照組共置入螺釘48枚,其中42枚螺釘位于可靠區(qū)內(nèi),占87.5%,與實驗組存在差異(P0.05);兩組手術(shù)時間分別為(107.22±12.96min、116.88±16.73min),術(shù)中出血量分別為(403.70±101.61ml、484.58±138.00ml),差異存在統(tǒng)計學(xué)意義(P0.05);兩組術(shù)前JOA評分分別為(6.89±1.65、7.33±1.58),VAS評分分別為(3.67±0.73、3.46±0.59),末次隨訪時JOA評分分別為(13.15±2.54、12.58±2.62),VAS評分分別為(1.70±0.61、1.54±0.66),差異組內(nèi)比較均具有顯著意義(P0.05),而組間差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論計算機輔助模擬置釘技術(shù)可以輔助術(shù)中實施準(zhǔn)確置釘,并且有助于提高置釘?shù)臏?zhǔn)確率,減少術(shù)中出血,縮短手術(shù)時間。
[Abstract]:Objective to investigate the feasibility of the application of computer aided nailing technique in the accurate placement of atlantoaxial screws. Methods a retrospective analysis of 51 cases of atlantoaxial instability in the two ward of Henan Province People's Hospital from January 2014 to January 2016 was performed in two cases of atlantoaxial instability, including 28 males, 23 females, age, and age. 54 years old, with an average age of 42.7 years. Before operation, 27 cases of nail parameter simulation were designed by BOHOLO surgical simulator, which were defined as experimental group, including old odontoid fracture in 7 cases, congenital odontoid dysplasia in 12 cases, and fresh odontoid fracture (Anderson IIC type) in 8 cases. The preoperative planning of the BOHOLO surgery simulator was not used for operation. A total of 24 cases were defined as the control group, including 6 old odontoid fractures, 10 congenital odontoid dysplasia and 8 fresh odontoid fractures (Anderson IIC type). The CT data of the experimental group were introduced into the BOHOLO software to design the best nail path of the atlas side block and define the parameters (the distance to the nailed point to the lateral margin of the vertebral canal, the distance L1 of the pedicle edge, to the atlas positive. " The median sagittal distance was L2, the length of the nail path was D, the horizontal angle TSA of the nail path, the sagittal angle SSA), and the parameters of the actual nail path after the operation were measured by BOHOLO software and compared with the preoperative planning parameters. At the same time, the operation time (min) and the amount of bleeding (ML) were compared between the two groups, and the postoperative CT of the two groups of patients was transferred to the CT axis and the crown by the BOHOLO multiplane recombination imaging. The position of two groups of screws was observed, and a reliable area of the side block was divided on the axial position: the projection area of the upper articular surface in the side block, the screw fixation and the most reliable strength in this area, the unreliable nail strength outside the reliable area and the risk of injury to the spinal cord or the vertebral artery. JOA score, VAS score and fusion rate were used to evaluate the curative effect. Results all patients had no vertebral artery and nerve injury during the operation, and all the patients were followed up for a period of 7~13 months, mean 9 months, and 6 months after the operation, all of them were fused without screw loosening, displacement and fracture. The baseline data of the two groups of patients, There were no statistical differences in the composition of the medical records. In the experimental group, 54 screws were placed in the lateral mass of the atlas, which were all located in the reliable area, accounting for 100%. The optimum nail path parameters L1 (left 5 + 0.92mm, right 5.19 + 0.83mM), L2 (left 19.22 + 1.19mm, right 18.96 1.09mm), D (left 20.67 + 1.62mm, right 20.26 + 1.53mm), TSA (left 12.11 + 1.40 degrees, right 11.93 + 1.4) 7 degrees), SSA (left 19.82 + 1.33 degrees, right 19.56 + 1.31 degrees), actual nail channel parameters L1 '(left 4.74 + 0.71mm, right 5.11 + 0.97mm), L2' (left 18.96 + 1.16mm, right 19.04 + 1.06mm), D '(left 20.48 + 1.55mm, right 20.48 + 1.81mm), TSA' (left 12.19 + 1.57 degrees, right left-hand degrees), SSA ' There was no statistically significant difference between the planning and the actual parameters (P0.05). 48 screws were inserted in the control group, of which 42 screws were located in the reliable area, accounting for 87.5%, and the difference between the experimental group (P0.05) and the two groups (107.22 + 12.96min, 116.88 + 16.73min), respectively (403.70 + 101.61ml, 484.58 + 138.00ml), respectively. There were statistical significance (P0.05); the preoperative JOA scores in the two groups were (6.89 + 1.65,7.33 + 1.58), VAS scores were (3.67 + 0.73,3.46 + 0.59), and JOA scores were (13.15 + 2.54,12.58 + 2.62) at the last follow-up, and VAS scores were (1.70 + 0.61,1.54 + 0.66) respectively. The differences in the groups were significant (P0.05), but there was no statistical difference between the groups. Study significance (P0.05). Conclusion computer aided simulation nail placement can assist in the accurate placement of nail, and help to improve the accuracy of nail placement, reduce intraoperative bleeding and shorten the operation time.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
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本文編號：2060008