A Novel Patient-Specific Navigational Template for Cervical Pedicle Screw Placement
A Novel Patient-Specific Navigational Template for Cervical Pedicle Screw Placement
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DOI：
10.1097/brs.0b013e3181c09985
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发表时间：
2009-12-15
期刊：
影响因子：
3
通讯作者：
Zhang, Yuan Z.
中科院分区：
文献类型：
--
作者：
Lu, Sheng;Xu, Yong Q.;Zhang, Yuan Z.
研究设计.前瞻性试验。开发并验证一种新颖的、针对患者的颈椎椎弓根置入导航模板。由于狭窄的骨性解剖结构和靠近椎动脉和脊髓，颈椎内固定手术需要精确的螺钉放置技术。具有预定轨迹的特定钻模板被认为是颈椎椎弓根螺钉放置的有前途的解决方案。招募了需要内固定的颈椎病理患者（n = 25）。对每个颈椎进行容积CT扫描，并根据扫描数据生成三维重建模型。使用逆向工程技术，确定最佳螺钉尺寸和方向，并设计具有与椎体后表面相反的表面的钻模板。使用快速原型技术制造钻模板及其相应椎骨，并进行违规测试。对导航模板进行灭菌，并在术中用于辅助放置颈椎螺钉。共将88枚螺钉插入C2-C7节段，每例患者2 - 6枚螺钉。术后采用CT扫描评估椎弓根螺钉的位置并进行分级。该方法显示了其能够根据颈椎的独特形态定制每个螺钉的位置和尺寸。在所有病例中，在手术过程中手动将钻模板放置在椎体椎板上相对非常容易。模板固定到椎板和椎弓根螺钉插入之间所需的时间约为80秒。88枚螺钉中，71枚螺钉无偏离，14枚螺钉有偏离
Study Design. Prospective trial.Objective. To develop and validate a novel, patient-specific navigational template for cervical pedicle placement.Summary of Background Data. Owing to the narrow bony anatomy and the proximity to the vertebral artery and the spinal cord, cervical instrumentation procedures demand the need for a precise technique for screw placement.Patient. Specific drill template with preplanned trajectory has been thought as a promising solution for cervical pedicle screw placement.Methods. Patients with cervical spinal pathology (n = 25) requiring instrumentation were recruited. Volumetric CT scan was performed on each desired cervical vertebra and a 3-dimensional reconstruction model was generated from the scan data. Using reverse engineering technique, the optimal screw size and orientation were determined and a drill template was designed with a surface that is the inverse of the posterior vertebral surface. The drill template and its corresponding vertebra were manufactured using rapid prototyping technique and tested for violations. The navigational template was sterilized and used intraoperatively to assist with the placement of cervical screws. In total, 88 screws were inserted into levels C2-C7 with 2 to 6 screw in each patient. After surgery, the positions of the pedicle screws were evaluated using CT scan and graded for validation.Results. This method showed its ability to customize the placement and the size of each screw based on the unique morphology of the cervical vertebra. In all the cases, it was relatively very easy to manually place the drill template on the lamina of the vertebral body during the surgery. The required time between fixation of the template to the lamina and insertion of the pedicle screws was about 80 seconds. Of the 88 screws, 71 screws had no deviation and 14 screws had deviation