Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
Techno DESIGN S.r.l., via Rosa Jemma, 2, 84091, Battipaglia, SA, Italy.
Med Biol Eng Comput. 2017 Sep;55(9):1549-1562. doi: 10.1007/s11517-017-1627-9. Epub 2017 Feb 3.
Many diseases of the spine require surgical treatments that are currently performed based on the experience of the surgeon. For pedicle arthrodesis surgery, two critical factors must be addressed: Screws must be applied correctly and exposure to harmful radiation must be avoided. The incorrect positioning of the screws may cause operating failures that lead to subsequent reoperations, an increase in the overall duration of surgery and, therefore, more harmful, real-time X-ray checks. In this paper, the authors solve these problems by developing a method to realize a customized surgical template that acts as a drilling template. The template has two cylindrical guides that follow a correct trajectory previously calculated by means of an automatic algorithm generated on the basis of a vertebra CAD model for a specific patient. The surgeon sets the template (drilling guides) on the patient's vertebra and safely applies the screws. Three surgical interventions for spinal stabilization have been performed using the template. These have had excellent results with regard to the accuracy of the screw positioning, reduction of the overall duration of the intervention, and reduction of the number of times the patient was exposed to X-rays.
许多脊柱疾病需要手术治疗，目前这些手术都是基于外科医生的经验来进行的。对于椎弓根融合术，有两个关键因素必须解决：螺钉必须正确定位，并且必须避免接触有害辐射。螺钉的定位不正确可能会导致手术失败，从而导致后续的再次手术，增加手术的总时长，因此需要进行更多的、实时的 X 射线检查。在本文中，作者通过开发一种方法来解决这些问题，该方法可以实现一种定制的手术模板，作为钻孔模板。该模板有两个圆柱形导向器，它们遵循一个预先计算好的正确轨迹，该轨迹是通过基于特定患者的椎骨 CAD 模型生成的自动算法计算得出的。外科医生将模板（钻孔导向器）放置在患者的椎骨上，然后安全地拧入螺钉。已经使用该模板完成了三例脊柱稳定的手术干预，这些手术在螺钉定位的准确性、手术总时长的减少以及患者接受 X 射线照射次数的减少方面都取得了非常好的效果。
