摘要
目的:探讨快速成型技术在重度先天性脊柱畸形矫形手术中的应用价值。方法:2005年1月～2007年7月对34例重度先天性脊柱畸形患者进行术前CT扫描、数字化三维重建,将数据导入MEM-300-E熔融挤压快速成型设备构建脊柱模型,直观评估脊柱畸形情况,设计手术方案。其中半椎体畸形22例,椎体分节不全、腰椎严重后凸6例,半椎体合并分节不全等混合畸形6例;胸椎(T2～T10)7例,胸腰段(T11～L2)18例,腰椎(L3～L5)9例;合并脊髓低位或拴系5例,脊髓空洞和骨性纵裂1例;术前侧凸Cobb角50°～125°(平均75°),后凸50°～110°(平均78°)。均采用单纯后路畸形矫正及全节段椎弓根螺钉固定技术,将消毒后的快速成型脊柱模型于术中指导手术进行。术后复查脊柱X线平片及CT三维扫描,并于术后再次进行快速成型构建矫形后脊柱模型。结果:手术时间3.5￣7h,平均4.5h;术中失血400￣1500ml,平均1100ml;未出现脊髓、神经及血管损伤等并发症。术后三维CT扫描示矫形和内固定效果满意,椎弓根螺钉位置良好。27例42个先天性半椎体切除彻底,术后侧凸Cobb角5°～25°(平均16°),侧凸畸形矫正率为80%～98%,后凸畸形矫正率为100%,生理曲度恢复正常;7例经椎弓根楔形截骨矫正的先天性腰椎后凸畸形患者矫形效果满意,腰椎生理前凸恢复正常。术后随访3￣24个月,平均9个月,随访期间矫正率丢失不明显。结论:脊柱快速成型能够直观地反映脊柱畸形情况,可指导术前评估、手术计划制定,对手术矫形和内固定操作具有较好的指导意义。
Objective：To evaluate the significance of rapid prototype techniques in clinical treatment of severe congenital spine deformities.Method：From January 2005 to July 2007,34 patients with severe congenital spine deformities were conducted with CT scanning,three-dimensional digital reconstruction and rapid prototyping （RP） modeling of the spine with MEM-300-E melted extrusion manufacturing machine. These RP-based spine models were used to evaluate the severity of the spine deformity visually,as well as to design the surgical procedures.Off these patients,22 cases were hemivertebrae deformity,6 cases were severe kyphosis,6 cases were multiple deformity including hemivertebrae or severe kyphosis in both thoracic and lumbar vertebrae.There were 7 cases in thoracic vertebrae （T2-T10）,18 cases in thoracic-lumbar vertebrae （Tll-L2）,9 cases in lumbar vertebrae （L3-L5）.Besides 5 cases had the low-set of spinal cord or tethered cord syndrome,1 case had syringomyelia and myeloschisis.The Cobb＇s angle of scoliosis ranged from 50^o to 125^o（mean 75^o）,and the Cobb＇s angle of kyphosis was 50^o to ll0^o（mean 78^o） before surgery.All the surgical procedures were performed posteriorly with pedicle-screw fLxation refered to the sterilized RP spine model during the operation.Plain films and CT scanning were conducted after operation,and the spine model was reconstructed by RP one week after surgery.Result：The operating time was 3.5-Th,mean 4.5h.The blood loss was 400- 1500ml with mean ll00ml.No complication of spinal cord,nerve or blood vessel injury occurred.Three-dimensional CT scanning demonstrated the deformity correction and the instrumentation were satisfying,with all the pedicle screws in accurate position.42 hemivertebrae of 27 cases were resected completely,after operation the Cobb＇s angles of scoliosis were 5^o to 25^o（mean 16^o） with 80%-98% of the correction rate,kyphosis deformity correction rate reached 100%,and the physiological curvature was restored.7 cases of severe lumbar kyph
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2008年第3期196-200,共5页
Chinese Journal of Spine and Spinal Cord
关键词
脊柱畸形
快速成型
三维重建
侧凸
后凸
Spine deformity
Rapid prototype
Three-dimensional reconstruction
Scoliosis
Kyphosis
