数字骨科技术在儿童上颈椎手术中的应用

Application of digital orthopaedic technique in pediatric upper cervical operation

中文关键词:  上颈椎  儿童  数字骨科

英文关键词:Upper cervical  Children  Digital orthopaedic tech

中文摘要:

  【摘要】 目的：探讨数字骨科技术在儿童上颈椎手术中的应用价值。方法：我院2009年3月～2011年3月共收治7例上颈椎疾患患儿。其中，先天性游离齿状突伴寰枢椎脱位4例，枢椎肿瘤伴寰枢椎脱位1例，顽固性寰枢椎旋转脱位1例，颅底凹陷症合并寰枕脱位1例。术前均行薄层CT扫描，将数据输入Mimic，Simpleware软件后，建立三维仿真模型，用于手术模拟和术中辅助，并根据需要设计寰枢椎椎弓根导航模板。在数字骨科技术支持下共实施后路手术4例，前路手术2例，前后联合手术1例。术后CT钉道扫描观察寰枢椎螺钉的置入情况，并采用日本矫形外科协会JOA评分系统对脊髓功能进行术前、术后评分。结果：7例患者，均顺利实施手术，手术时间3～6h，平均3.5±0.6h；手术出血300～400ml。实施后路寰椎椎弓根钉棒固定5例，实施前路TARP手术2例。共置入后路寰椎椎弓根螺钉10枚，枢椎椎弓根螺钉10枚，寰椎前路侧块螺钉2枚，枕骨髁前路螺钉2枚，枢椎逆行椎弓根螺钉2枚，枢椎椎体钉2枚。术后CT扫描显示，所有螺钉位置良好，未出现螺钉偏入椎管或椎动脉孔的现象。术后患者肢体麻木症状减轻或消失，四肢肌力明显改善，JOA评分由术前的8.6±1.5分，提高到15±1.8分（P<0.05）。结论：采用数字骨科技术辅助手术，可以有效提高儿童上颈椎手术的成功率，降低手术风险。

英文摘要:

  【Abstract】 Objectives： To investigate the application digital orthopaedic technique in pediatric upper cervical operation. Methods: From March 2009 to March 2011, 7 children suffering from upper cervical disorders underwent posterior instrumentation or transoral anterior reduce plate (TARP) fixation. Among them, there were C1-2 dislocation combined with congenital odontoid malformation in 4 cases, C1-2 tumor complicated with C1-2 dislocation in 1 case, solid C1-2 rotational dislocation in 1 case and basilar invagination complicated with C1-2 dislocation in 1 case. All patients underwent thin slice CT scan before operation, then the DICOM data were put into Mimic and Simpleware software, and after that the three dimentional model of upper cervical as well as individual navigation template were produced, which were used for imitating operation and screw implantation. Anterior approach was performed in 4 cases, posterior approach in 2 cases, and combined anterior and posterior approach in 1 case. After operation, CT -scan was used to evaluate the screw path, and the neurofunction was evaluated by JOA score. Results: All 7 patients got a successful operation. The mean operation time was 3-6 hours(average, 3.5±0.6 hours). The blood loss was 300-400ml. Posterior instrumentation was performed in 5 cases and TARP in 2 cases, which included 10 atlas pedicle screws, 10 axis pedicle screws, 2 anterior atlas mass screws, 2 occipital condyle screws, 2 anterior axis retro-pedicle screws, and 2 axis vertebral body screws. Postoperative CT scan showed good position of all screws, without penertration into vertebral cannal or vertebral artery groove. All 7 patients had limb numbness and weakness improved significantly, with the JOA score increasing from 8.6±1.5 to 15±1.8(P<0.05). Conclusions: Digital orthopaedic technique can ensure the safety and lower surgical risk, which is applicable to pediatric upper cervical surgery.