计算机辅助设计颈胸段半椎体切除术△

Computer aided design assisted cervicothoracic hemivertebrae resection and deformity correction

摘要:

[目的]介绍计算机辅助设计颈胸段半椎体切除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、钉-棒系统矫正侧凸畸形。术后佩戴支具，维持矫形效果。[结果]患者均顺利完成手术，未见严重血管、神经及脏器损伤等并发症。共置入 140 枚椎弓根螺钉，置钉准确率 97.1%。平均随访（35.5±13.2）个月。与术前相比，末次随访时，颈胸段侧凸 [(53.9±17.9)°， (11.5±2.5)°, P＜0.001]、局部后凸 Cobb 角 [(27.8±9.8)°，(10.7±1.6)°, P＜0.001] 均显著改善。末次随访时，斜颈角、T₁倾斜角及锁骨角均较术前显著减少（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，可精准置入椎弓根螺钉并完整切除半椎体，提高手术效率。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of computer aided design (CAD) assisted cervicothoracic hemivertebrae resection and deformity correction. [Methods] From January 2016 to December 2020, 14 patients with congenital cervicothoracic hemivertebra malformations were treated with CAD assisted cervicothoracic hemivertebra resection and deformity correction. Mimics software was used to perform orthopedic design and simulate the orthopedic process before surgery. Under neuroelectro-physiological monitoring system used during surgery to ensure the safety of surgical correction, pedicle screws were precisely inserted according to the preoperative design, half vertebra was removed, and the scoliotic deformity was corrected by pedicle screw-rod system. The brace was worn after operation to maintain the correction effect. [Results] All patients were successfully operated, with no serious vascular, nerve and organ injuries and other complications. A total of 140 pedicle screws were inserted, with an accuracy of 97.1%. Compared with those preoperatively, the cervicothoracic scoliotic angle [(53.9±17.9)°, (11.5±2.5)°, P＜0.001], the kyphotic angle [(27.8±9.8)°, (10.7±1.6)°, P＜0.001] significantly improved at the latest follow-up lasted for (35.5±13.2) months. In addition, the torticollis angle, T₁ inclination and clavicular angle were significantly reduced postoperatively (P＜0.05). No loss of correction, pseudoarthrosis and loosening of internal fixation occurred in anyone of them during follow-up. [Conclusion] The CAD assisted cervicothoracic hemivertebra resection and deformity correction are safe and effective to insert pedicle screws and complete hemivertebra resection accurately, and improve surgical efficiency.