计算机辅助设计颈胸段半椎体切除矫形术

Computer aided design orthopaedic resection of cervicothoracic hemivertebras

摘要:

[目的] 介绍计算机辅助设计颈胸段半椎体切除矫形术的手术技术和初步临床效果。[方法] 2016年1月-2020年12月对14例先天性颈胸段半椎体畸形患者行计算机辅助设计颈胸段半椎体切除矫形术。术前使用Mimics软件行矫形设计并模拟矫形过程，术中采用神经电生理监测系统确保手术矫形的安全性，按照术前设计精准置入椎弓根螺钉、切除半椎体、矫正侧凸畸形。术后佩戴支具，维持矫形效果。[结果] 14例患者均顺利完成手术，围术期未见严重血管、神经及脏器损伤等并发症。平均随访(35.5±13.2)个月。共置入140枚椎弓根螺钉，置钉准确率97.1%。术后1周及末次随访颈胸段侧凸Cobb角、局部后凸角、斜颈角、T1倾斜角及锁骨角较术前显著减少(P＜0.05)，术后1周与末次随访比较差异均无统计学意义(P＞0.05)。随访过程无矫形丢失、假关节形成、内固定松动、断裂等发生。[结论] 计算机辅助设计颈胸段半椎体切除矫形术安全有效，可精准植入椎弓根螺钉并完整切除半椎体，提高畸形矫正率。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of computer aided design orthopaedic resection of cervicothoracic hemivertebras. [Methods] From January 2016 to December 2020, 14 patients with congenital cervicothoracic hemivertebra deformity underwent computer aided design orthopaedic resection of cervicothoracic hemivertebras. Mimics software was used for preoperative orthopedic design and simulation, Intraoperative neural monitoring system was used to ensure the safety of surgical correction process，implantation of pedicle screws, hemivertebra resection, and scoliosis deformity correction according to preoperative design. Braces were worn postoperative to maintain the correction effect. [Results] All the 14 patients successfully completed the operation, and no complications such as serious vascular, nerve and organ injury were observed. Follow-up was (35.5±13.2) months. A total of 140 pedicle screws were inserted, with an accuracy of 97.1%. The Cobb Angle of cervicothoracic scoliosis, local kyphosis Angle, torticollis Angle, T1 inclination Angle and clavicular Angle were significantly decreased at 1 week and the last follow-up after surgery (P＜0.05). There was no significant difference between 1 week postoperative and latest follow-up (P＞0.05). No orthopaedic loss, pseudoarthrosis formation, internal fixation loosening or fracture occurred during follow-up. [Conclusion] computer aided design orthopaedic resection of cervicothoracic hemivertebras is safe and effective, accurate pedicle screw implantation and completely hemivertebra resection，improve deformity correction rate.