Van Brussel K, Vander Sloten J, Van Audekercke R, Fabry G
Afdeling Biomechanica en Grafisch Ontwerpen, Katholieke Universiteit Leuven, Heverlee, Belgium.
Technol Health Care. 1996 Dec;4(4):365-84.
Internal fixation techniques are in common used to stabilize vertebral fractures and correct severe scoliosis. Consolidation of injured vertebrae with neighbouring intact vertebra is the goal in the former case whilst fusion of the vertebrae in a corrected position is aimed at in the latter case. Degenerative spine diseases are not considered in this paper. Classical instrumentation consists of rods (e.g., Cotrel-Dubousset, Harrington, Luque-Galveston) attached to the bone by means of hooks or wires. More recently, transpedicular screws are introduced as an alternative bone/implant interface. Comparing the results of several studies, the posterior pedicle screw based devices demonstrate the ability to produce the most rigid constructs. However, the insertion of pedicle screws implicates a relatively high complication risk and its success strongly depends on the experience of the surgeon. Incorrect drilled holes or malplacement of the screws can result in nerve root injuries and fracture of the pedicle. Studies reported complication ratios up to 30% with substantial neurological implications. A certain degree of automation of the critical actions may be necessary to enhance the safety of pedicle screw insertion. Two techniques of computer assisted spine surgery are compared. Both techniques permit a computer assisted surgical planning based on CT images. During operation the first system permanently observes the position of the drill relative to the spine and informs the surgeon on the deviation of the actual drill path to the planned drill path. The second system uses a pre-operative surgical planning to design and construct a mechanical drill guide, fitting perfectly on the patient's spine.
内固定技术常用于稳定椎体骨折和矫正严重脊柱侧弯。在前一种情况下，目标是使受伤椎体与相邻完整椎体融合，而在后一种情况下，目标是使椎体在矫正位置融合。本文不考虑退行性脊柱疾病。传统的器械包括通过钩子或钢丝固定在骨上的杆（如 Cotrel-Dubousset、Harrington、Luque-Galveston）。最近，椎弓根螺钉作为一种替代的骨/植入物界面被引入。比较多项研究的结果，基于椎弓根螺钉的后路器械显示出能够产生最坚固结构的能力。然而，椎弓根螺钉的植入意味着相对较高的并发症风险，其成功与否很大程度上取决于外科医生的经验。钻孔不正确或螺钉放置不当可导致神经根损伤和椎弓根骨折。研究报告的并发症发生率高达30%，具有重大的神经学影响。可能需要一定程度的关键操作自动化来提高椎弓根螺钉植入的安全性。比较了两种计算机辅助脊柱手术技术。两种技术都允许基于CT图像进行计算机辅助手术规划。在手术过程中，第一个系统会持续观察钻头相对于脊柱的位置，并告知外科医生实际钻孔路径与计划钻孔路径的偏差。第二个系统使用术前手术规划来设计和构建一个机械钻孔导向器，使其完美贴合患者的脊柱。
