Wang Xing, Shi Jun, Zhang Shojie, Zhang Zhifeng, Li Xiaohe, Li Zhijun
Department of Anatomy, Basic Medical College, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China.
Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia, China.
Indian J Orthop. 2017 Jul-Aug;51(4):468-473. doi: 10.4103/0019-5413.209955.
Pedicle screw technique is commonly used treatment of adult spinal trauma, tumor, degeneration. The application of pedicle screws is very challenging in children because children have a fast growing spine and spinal pedicle morphology of children and adult has large difference. 3 D reconstruction individual navigation templates improve the success rate of pediatric pedicle screw system. This study is aimed to provide a precise method for lumbar spine pedicle screw placement in children using computer-aided design and rapid prototyping technology.
Computed tomography (CT) scans of cadaver specimens of 4 children were obtained, and the raw data were reconstructed using three-dimensional reconstruction software. Pedicle screws were placed using the conventional method or by using individually designed navigation templates based on the principles of reverse engineering and rapid prototyping technology.
We evaluated the accuracy of the pedicle screws placed using the two methods by CT scan. Ten navigation templates were designed for placement of 20 lumbar pedicle screws in the navigation group, and CT scan confirmed that all the screws were placed accurately in the corresponding pedicle. Conversely, of the 20 lumbar pedicle screws placed using the conventional method, 3 screws perforated the pedicle. The findings showed that lumbar pedicle screw placement was successful using navigation templates in children.
This technique is simple, easy to master, and allows personalized screw placement, thus providing a new and feasible method for lumbar pedicle screw placement in children.
椎弓根螺钉技术常用于治疗成人脊柱创伤、肿瘤及退变。由于儿童脊柱生长迅速且儿童与成人的脊柱椎弓根形态有很大差异，因此在儿童中应用椎弓根螺钉极具挑战性。三维重建个体化导航模板提高了儿童椎弓根螺钉系统的成功率。本研究旨在利用计算机辅助设计和快速成型技术为儿童腰椎椎弓根螺钉置入提供一种精确方法。
获取4名儿童尸体标本的计算机断层扫描（CT）图像，使用三维重建软件对原始数据进行重建。采用传统方法或基于逆向工程和快速成型技术原理使用单独设计的导航模板置入椎弓根螺钉。
通过CT扫描评估两种方法置入椎弓根螺钉的准确性。导航组为置入20枚腰椎椎弓根螺钉设计了10个导航模板，CT扫描证实所有螺钉均准确置入相应椎弓根。相反，采用传统方法置入的20枚腰椎椎弓根螺钉中，有3枚穿出椎弓根。结果表明，使用导航模板在儿童中成功置入了腰椎椎弓根螺钉。
该技术简单、易于掌握，可实现个性化螺钉置入，从而为儿童腰椎椎弓根螺钉置入提供了一种新的可行方法。
