三维数字个性化手术设计在青少年特发性脊柱侧凸矫形手术中的应用（英文）
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摘要
背景:青少年特发性脊柱侧凸为青少年脊柱侧凸的最常见类型,畸形所导致的脊柱解剖学变化使得临床螺钉固定风险较高。目的:针对青少年特发性脊柱侧凸患者建立数字化虚拟仿真手术设计方案。方法:内蒙古医科大学第二附属医院脊柱外科收治的17岁青少年特发性脊柱侧凸患者1例行术前16排螺旋CT扫描,将CT资料利用Mimics16.0软件进行三维重建,测量经椎弓根固定螺钉直径,长及固定角度后进行导航模板设计和3D打印,利用导航模板进行手术螺钉固定,术后CT扫描后评估置钉疗效。结果与结论:对该位患者脊柱进行三维重建,利用软件逆向工程设计功能设计导航模板,使得固定螺钉避免穿透椎体前缘皮质和椎弓根内外侧皮质骨,对设计导航模板畸形3D打印,并利用其进行脊柱矫形手术矫形,术后评估,未见螺钉穿出皮质,置钉准确率达100%。结果证实,对于特发性脊柱侧凸患者利用三维数字化重建设计导航模板进行手术置钉具有较高置钉成功率。试验方案经已患者本人及家属知情同意并于2014年4月通过内蒙古医科大学伦理委员会审核,批准号:20140408。
BACKGROUND: Adolescent idiopathic scoliosis is the most common form of scoliosis. Spinal anatomical changes caused by malformation make the risk of clinical screw fixation high. OBJECTIVE: To investigate the method to establish a digital virtual surgery planning system for adolescent idiopathic scoliosis. METHODS: One 17-year-old patient with adolescent idiopathic scoliosis was selected and underwent 16-slice spiral CT scan in Department of Spine, the Second Affiliated Hospital of Inner Mongolia Medical University. Three-dimensional reconstruction of CT data was conducted using Mimics 16.0 software. Navigation template design and three-dimensional printing were performed after measuring the diameter, length of transpedicular screw and angle after fixation. Surgical screw fixation was performed with navigation template, and the effect of screw placement was evaluated after CT scan. RESULTS AND CONCLUSION: Three-dimensional reconstruction was conducted in the patient's spine. Navigation templates were designed using software reverse engineering design function to prevent the screw from penetrating the anterior cortex of the vertebral body and the inner and outer cortical bone of the pedicle. Three-dimensional printing of deformity of navigation template was conducted and it was used in spinal orthopedic surgery. Postoperative evaluation showed that no screw penetrated the cortex and the accuracy of screw placement was 100%. The results showed that the successful rate of screw placement was high for patients with idiopathic scoliosis by using three-dimensional digital reconstruction design navigation template. The patient and her family member signed the informed consent. This study was approved by the Ethics Committee of Inner Mongolia Medical University in April 2014(approval No. 20140408).
BACKGROUND: Adolescent idiopathic scoliosis is the most common form of scoliosis. Spinal anatomical changes caused by malformation make the risk of clinical screw fixation high. OBJECTIVE: To investigate the method to establish a digital virtual surgery planning system for adolescent idiopathic scoliosis. METHODS: One 17-year-old patient with adolescent idiopathic scoliosis was selected and underwent 16-slice spiral CT scan in Department of Spine, the Second Affiliated Hospital of Inner Mongolia Medical University. Three-dimensional reconstruction of CT data was conducted using Mimics 16.0 software. Navigation template design and three-dimensional printing were performed after measuring the diameter, length of transpedicular screw and angle after fixation. Surgical screw fixation was performed with navigation template, and the effect of screw placement was evaluated after CT scan. RESULTS AND CONCLUSION: Three-dimensional reconstruction was conducted in the patient's spine. Navigation templates were designed using software reverse engineering design function to prevent the screw from penetrating the anterior cortex of the vertebral body and the inner and outer cortical bone of the pedicle. Three-dimensional printing of deformity of navigation template was conducted and it was used in spinal orthopedic surgery. Postoperative evaluation showed that no screw penetrated the cortex and the accuracy of screw placement was 100%. The results showed that the successful rate of screw placement was high for patients with idiopathic scoliosis by using three-dimensional digital reconstruction design navigation template. The patient and her family member signed the informed consent. This study was approved by the Ethics Committee of Inner Mongolia Medical University in April 2014(approval No. 20140408).
引文
[1]Choo QQ,Chiu CK,Lisitha KA,et al.Quantitative analysis of local bone graft harvested from the posterior elements during posterior spinal fusion in adolescent idiopathic scoliosis patients.J Orthop.2019;16(1):74-79.
[2]Demura S,Yaszay B,Bastrom TP,et al.Is decompensation preoperatively a risk in Lenke 1C curves?Spine.2013;38(11):E649-E655.
[3]Aya KL,Yngve D,Charls RM.Acute appendicitis after spine fusion for adolescent idiopathic scoliosis:a case report.Cureus.2018;10(10):e3522.
[4]Xia C,Xu L,Xue B,et al.Rare variant of HSPG2 is not involved in the development of adolescent idiopathic scoliosis:evidence from a large-scale replication study.2019;20(1):24.
[5]Ghayem-Hasankhani E,Omidi-Kashani F.Generalized ligamentous laxity;a parameter should not to be forgotten in preoperative planning of adolescent idiopathic scoliosis.Iran Red Crescent Med J.2012;14(11):702-704.
[6]Bastrom TP,Yaszay B,Shah SA,et al.Major complications at two years after surgery impact srs scores for adolescent idiopathic scoliosis patients.Spine deform.2019;7(1):93-99.
[7]Blanco JS,Perlman SL,Cha HS et al.Multimodal pain management after spinal surgery for adolescent idiopathic scoliosis.Orthopedics.2013;36:33-35.
[8]Lonner BS,Ren Y,Bess S,et al.Surgery for the adolescent idiopathic scoliosis patients after skeletal maturity:early versus late surgery.Spine deform.2019;7(1):84-92.
[9]Pasha S,Sankar WN,Castelein RM.The Link between the 3D spino-pelvic alignment and vertebral body morphology in adolescent idiopathic scoliosis.Spine deform.2019;7(1):53-59.
[10]Moon ES,Kim HS,Sharma V,et al.Analysis of single nucleotide polymorphism in adolescent idiopathic scoliosis in Korea:for personalized treatment.Yonsei Med J.2013;54(2):500-509.
[11]Etemadifar MR,Andalib A,Rahimian A,et al.Cobalt chromium-Titanium rods versus Titanium-Titanium rods for treatment of adolescent idiopathic scoliosis;which type of rod has better postoperative outcomes?Rev Assoc Med Bras(1992).2018;64(12):1085-1090.
[12]Mao S,Xu L,Zhu Z,et al.Association between genetic determinants of peak height velocity during puberty and predisposition to adolescent idiopathic scoliosis.Spine.2013;38(12):1034-1039.
[13]Acar B,Us AK.Results of a new correction technique in surgical treatment of idiopathic scoliosis:mid-term clinical and radiological outcomes.Cureus.2018;10(10):e3454.
[14]Illés T,Somoske?y S.Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements:advantages in evaluation of prognosis and surgical results.Eur Spine J.2013;22(6):1255-1263.
[15]Benke B,Marada G,Tunyogi CsapóM,et al.Comparing the function of the temporomandibular joint before and after surgical treatment in a young patient with idiopathic scoliosis.Case presentation.Orv Hetil.2018;159(50):2144-2149.
[16]Trobisch PD,Samdani AF,Betz R,et al.Sagittal balance and compensatory mechanism after segmental instrumentation for adolescent idiopathic scoliosis.Z Orthop Unfall.2012;150(6):583-587.
[17]Zhang M,Li F,He Y,et al.Registration of brainstem surfaces in adolescent idiopathic scoliosis using discrete Ricci flow.Medical image computing and computer-assisted intervention:MICCAI International Conference on Medical Image Computing and Computer-Assisted Intervention.2012;15(Pt2):146-154.
[18]Fan Q,Xie H,Ma Z,et al.Perioperative predictors of moderate and severe postoperative pain in idiopathic scoliosis patients following spinal correction and fusion operations.Medicine.2018;97(46):e13215.
[19]Snowden RD,Prusick VW,Oeffinger DJ,et al.Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis.J Pediatr Orthop B.2019;28(4):374-379.
[20]Choi DE,Vives MJ,Shah H,et al.Do postoperative drain volumes correlate with intraoperative blood loss and postoperative transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis?J Pediatr Orthop B.2019;28(4):368-373.
[21]Ck C,Kj L,Wh C,et al.Does the severity of the curve in lenke 1 and 2adolescent idiopathic scoliosis patients affect the distance and position of the aorta from vertebra?Spine.2019;44(11):785-792.
[22]Malik AT,Kim J,Yu E,et al.Predictors of a non-home discharge destination fol owing spinal fusion for adolescent idiopathic scoliosis(AIS).Spine.2019;44(8):558-562.
[23]Ovadia D,Drexler M,Kramer M,et al.Closed wound subfascial suction drainage in posterior fusion surgery for adolescent idiopathic scoliosis:a prospective randomized control study.Spine.2019;44(6):377-383.
[24]Chan CYW,Mohamad SM,Tan SH,et al.Do overweight adolescent idiopathic scoliosis(ais)patients have an increased perioperative risk for posterior spinal fusion(PSF)surgery?A propensity score matching analysis of 374 AIS patients.Spine.2019;44(6):389-396.
[25]Kwan MK,Chiu CK,Hasan MS,et al.Perioperative outcome of single stage posterior spinal fusion for severe adolescent idiopathic scoliosis(AIS)(Cobb Angle≥90°):the role of a dual attending Surgeon strategy.Spine.2019;44(6):E348-E356.
[26]Uehara M,Takahashi J,Ikegami S,et al.Prediction of spontaneous lumbar curve correction after posterior spinal fusion for adolescent idiopathic scoliosis lenke type 1 curves.Clin Spine Surg.2019;32(2):E112-E116.
[27]Abousamra O,Sponseller P D,Lonner BS,et al.Thoracic lordosis,especially in males,increases blood loss in adolescent idiopathic scoliosis.J Pediatr Orthop.2019;39(3):e201-e204.
[28]Kakar RS,Li Y,Brown CN,et al.Spine and lower extremity kinematics exhibited during running by adolescent idiopathic scoliosis patients with spinal fusion.Spine Deform.2019;7(2):254-261.
[29]Holewijn RM,De Kleuver M,Kingma I,et al.A prospective analysis of motion and deformity at the shoulder level in surgically treated adolescent idiopathic scoliosis.Gait Posture.2019;69:150-155.
[30]Rapp Van Roden EA,Richardson RT,Russo SA,et al.Analysis of shoulder complex function after posterior spinal fusion in adolescents with idiopathic scoliosis.J Pediatr Orthop.2019;39(1):e32-e38.
[2]Demura S,Yaszay B,Bastrom TP,et al.Is decompensation preoperatively a risk in Lenke 1C curves?Spine.2013;38(11):E649-E655.
[3]Aya KL,Yngve D,Charls RM.Acute appendicitis after spine fusion for adolescent idiopathic scoliosis:a case report.Cureus.2018;10(10):e3522.
[4]Xia C,Xu L,Xue B,et al.Rare variant of HSPG2 is not involved in the development of adolescent idiopathic scoliosis:evidence from a large-scale replication study.2019;20(1):24.
[5]Ghayem-Hasankhani E,Omidi-Kashani F.Generalized ligamentous laxity;a parameter should not to be forgotten in preoperative planning of adolescent idiopathic scoliosis.Iran Red Crescent Med J.2012;14(11):702-704.
[6]Bastrom TP,Yaszay B,Shah SA,et al.Major complications at two years after surgery impact srs scores for adolescent idiopathic scoliosis patients.Spine deform.2019;7(1):93-99.
[7]Blanco JS,Perlman SL,Cha HS et al.Multimodal pain management after spinal surgery for adolescent idiopathic scoliosis.Orthopedics.2013;36:33-35.
[8]Lonner BS,Ren Y,Bess S,et al.Surgery for the adolescent idiopathic scoliosis patients after skeletal maturity:early versus late surgery.Spine deform.2019;7(1):84-92.
[9]Pasha S,Sankar WN,Castelein RM.The Link between the 3D spino-pelvic alignment and vertebral body morphology in adolescent idiopathic scoliosis.Spine deform.2019;7(1):53-59.
[10]Moon ES,Kim HS,Sharma V,et al.Analysis of single nucleotide polymorphism in adolescent idiopathic scoliosis in Korea:for personalized treatment.Yonsei Med J.2013;54(2):500-509.
[11]Etemadifar MR,Andalib A,Rahimian A,et al.Cobalt chromium-Titanium rods versus Titanium-Titanium rods for treatment of adolescent idiopathic scoliosis;which type of rod has better postoperative outcomes?Rev Assoc Med Bras(1992).2018;64(12):1085-1090.
[12]Mao S,Xu L,Zhu Z,et al.Association between genetic determinants of peak height velocity during puberty and predisposition to adolescent idiopathic scoliosis.Spine.2013;38(12):1034-1039.
[13]Acar B,Us AK.Results of a new correction technique in surgical treatment of idiopathic scoliosis:mid-term clinical and radiological outcomes.Cureus.2018;10(10):e3454.
[14]Illés T,Somoske?y S.Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements:advantages in evaluation of prognosis and surgical results.Eur Spine J.2013;22(6):1255-1263.
[15]Benke B,Marada G,Tunyogi CsapóM,et al.Comparing the function of the temporomandibular joint before and after surgical treatment in a young patient with idiopathic scoliosis.Case presentation.Orv Hetil.2018;159(50):2144-2149.
[16]Trobisch PD,Samdani AF,Betz R,et al.Sagittal balance and compensatory mechanism after segmental instrumentation for adolescent idiopathic scoliosis.Z Orthop Unfall.2012;150(6):583-587.
[17]Zhang M,Li F,He Y,et al.Registration of brainstem surfaces in adolescent idiopathic scoliosis using discrete Ricci flow.Medical image computing and computer-assisted intervention:MICCAI International Conference on Medical Image Computing and Computer-Assisted Intervention.2012;15(Pt2):146-154.
[18]Fan Q,Xie H,Ma Z,et al.Perioperative predictors of moderate and severe postoperative pain in idiopathic scoliosis patients following spinal correction and fusion operations.Medicine.2018;97(46):e13215.
[19]Snowden RD,Prusick VW,Oeffinger DJ,et al.Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis.J Pediatr Orthop B.2019;28(4):374-379.
[20]Choi DE,Vives MJ,Shah H,et al.Do postoperative drain volumes correlate with intraoperative blood loss and postoperative transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis?J Pediatr Orthop B.2019;28(4):368-373.
[21]Ck C,Kj L,Wh C,et al.Does the severity of the curve in lenke 1 and 2adolescent idiopathic scoliosis patients affect the distance and position of the aorta from vertebra?Spine.2019;44(11):785-792.
[22]Malik AT,Kim J,Yu E,et al.Predictors of a non-home discharge destination fol owing spinal fusion for adolescent idiopathic scoliosis(AIS).Spine.2019;44(8):558-562.
[23]Ovadia D,Drexler M,Kramer M,et al.Closed wound subfascial suction drainage in posterior fusion surgery for adolescent idiopathic scoliosis:a prospective randomized control study.Spine.2019;44(6):377-383.
[24]Chan CYW,Mohamad SM,Tan SH,et al.Do overweight adolescent idiopathic scoliosis(ais)patients have an increased perioperative risk for posterior spinal fusion(PSF)surgery?A propensity score matching analysis of 374 AIS patients.Spine.2019;44(6):389-396.
[25]Kwan MK,Chiu CK,Hasan MS,et al.Perioperative outcome of single stage posterior spinal fusion for severe adolescent idiopathic scoliosis(AIS)(Cobb Angle≥90°):the role of a dual attending Surgeon strategy.Spine.2019;44(6):E348-E356.
[26]Uehara M,Takahashi J,Ikegami S,et al.Prediction of spontaneous lumbar curve correction after posterior spinal fusion for adolescent idiopathic scoliosis lenke type 1 curves.Clin Spine Surg.2019;32(2):E112-E116.
[27]Abousamra O,Sponseller P D,Lonner BS,et al.Thoracic lordosis,especially in males,increases blood loss in adolescent idiopathic scoliosis.J Pediatr Orthop.2019;39(3):e201-e204.
[28]Kakar RS,Li Y,Brown CN,et al.Spine and lower extremity kinematics exhibited during running by adolescent idiopathic scoliosis patients with spinal fusion.Spine Deform.2019;7(2):254-261.
[29]Holewijn RM,De Kleuver M,Kingma I,et al.A prospective analysis of motion and deformity at the shoulder level in surgically treated adolescent idiopathic scoliosis.Gait Posture.2019;69:150-155.
[30]Rapp Van Roden EA,Richardson RT,Russo SA,et al.Analysis of shoulder complex function after posterior spinal fusion in adolescents with idiopathic scoliosis.J Pediatr Orthop.2019;39(1):e32-e38.