Intraoperative Three-Dimensional Correction During Rod Rotation Technique
Intraoperative Three-Dimensional Correction During Rod Rotation Technique
复制标题
术中棒旋转过程中的三维矫正技术
作者：
Y. Lafon;V. Lafage;J. Dubousset;W. Skalli
研究设计.通过模拟Cotrel-Dubousset（CD）手术进行数值研究。Objective.量化CD手术期间的术中矫正。背景数据总结。文献中很少报道分析术中手术姿态影响的方法，并且没有考虑在主要手术姿态期间对整个脊柱进行三维矫正。术中正位片限制了对二维矫正的分析，运动跟踪装置仅关注器械区域特定椎骨的运动学研究。方法.本研究纳入了20例平均年龄15岁的重度特发性脊柱侧凸患者，均接受了CD手术治疗。根据术前立体X线摄影和柔韧性测试X线片，为每例患者构建患者特定的有限元模型（T1-L5和骨盆）。自动算法模拟CD手术的所有主要步骤。对于每个步骤，导出椎骨运动学以计算各种临床参数的演变。通过比较虚拟术后脊柱配置与术后体内数据，评价模拟的一致性。结果CD手术在三维复杂的运动学中影响融合脊柱区域内部和外部的椎体水平。每一个术中操作都有助于脊柱侧凸的矫正。第二次棒插入，重点是顶椎，导致所有曲线的全局修改。结论. CD手术的自动化患者特定模拟可以提高我们对手术生物力学的理解。因此，它可以增加术前手术计划的相关性。
Study Design. A numerical study was conducted by simulating the Cotrel–Dubousset (CD) surgery. Objective. To quantify intraoperative correction during CD surgery. Summary of Background Data. Very few methods have been reported in literature to analyze the effect of intraoperative surgical gestures, and none considers the three-dimensional correction of the entire spine during the main surgical gestures. Intraoperative frontal radiographs limit analysis to two-dimensional correction, and movement tracking devices focus the kinematics study of specific vertebrae in the instrumented area only. Methods. This study included 20 patients, mean age 15 years, with severe idiopathic scoliosis treated by CD surgery. A patient-specific finite-element model (T1–L5 and pelvis), based on preoperative stereo-radiography and flexibility test radiographs, was constructed for each patient. An automated algorithm simulated all the main steps of the CD surgery. For each step, vertebral kinematics was exported to compute the evolution of various clinical parameters. Coherence of the simulations was evaluated by comparing the virtual postoperative spinal configuration with postoperative in vivo data. Results. The CD surgery affected the vertebral levels inside but also outside the fused spinal area, in a three-dimensional complex kinematics. Every intraoperative maneuver contributes to scoliosis correction. The second rod insertion, focused on the apical vertebra, leading to a global modification of all the curves. Conclusions. The automated patient-specific simulation of CD surgery may improve our understanding of surgical biomechanics. Therefore, it could increase the relevance of preoperative surgery planning.
用于矫正脊柱侧凸手术的 Harrington 牵引仪器的三维模拟。
影响因子：
3
作者：
Stokes,IA;Gardner-Morse,M
通讯作者：
Gardner-Morse,M