该研究由北京市自然科学基金-海淀原始创新联合基金 （L232054） 和首都健康发展研究专项基金 （NO.2024-2024） 资助。

本研究经首都医科大学附属北京友谊医院伦理委员会批准。该方法将通过回顾性案例研究引入，仅使用患者的术前俯卧位计算机断层扫描 （CT） 成像数据。与传统方法相比，辅助经皮椎体成形术 （PVP） 中的“九格面积划分法”提供了一种更简单、更有效的方法，从而减少了手术和辐射暴露时间。这种技术可能有助于更容易识别穿刺点并可能缩短 PVP 程序的学习曲线，从而使年轻居民受益，值得进一步研究。这里描述的个体是一名 68 岁的女性。
1. 使用 X 射线透视、磁共振图像 （MRI）、骨闪烁显像和症状诊断骨质疏松性椎体压缩骨折 （OVCF）
<ol><li>在有背痛、棘突压痛和背部椎旁肌肉等症状的老年患者中确定患有 OVCF 的患者。利用后前 X 射线透视评估 L1 水平是否存在椎体压缩性骨折（图2A）。采用 MRI 成像确认新发腰椎压缩性骨折的诊断，并确定受影响的特定椎骨，确定为 L1（图2B）。</li>
</ol>2. 术前获取患者俯卧位 CT 成像
<ol><li>将患者置于俯卧位，对患者进行俯卧位 CT。通过 X 射线透视和身体检查患者背部确认目标区域，同时按压最痛苦的部位。</li>
	<li>让患者俯卧在手术台上，俯卧位 CT 扫描前将梯度器放在患者的背部，记录患者的体位，然后取下梯度器（图 3）。</li>
	<li>将 CT 图像（1 毫米扫描层厚度、1 毫米层间距以及 90 个切片 （常规扫描）或 400 个切片 （薄切片扫描）保存为 DICOM 格式。</li>
</ol>3. 建立 3D 模型并在医学成像处理软件中模拟操作
<ol><li>通过单击 “新建项目”，将 DICOM 格式的 CT 图像导出到医学成像处理软件中。选择所需的切片以重建压缩的椎骨。</li>
	<li>利用 阈值分割 工具调整目标椎骨的阈值范围，特别是在 125-3071 H 的范围内以创建蒙版。使用 Duplicate Mask 函数生成两个单独的蒙版， 即 Mask A 和 Mask B。</li>
	<li>利用 Mask Edit 功能从 Mask A 中删除目标椎骨。随后，利用布尔运算工具从蒙版 B 中减去蒙版 A，从而形成新的蒙版 C。最后，激活 Calculate 3-D 功能以使用 Mask C 重建目标椎骨;将此 3-D 模型命名为 L1（图 4A）。</li>
	<li>右键单击 Objects 界面中的 New，选择 Draw，然后选择 Cylinder。确保圆柱体的尺寸与穿刺针相同，长度为 12.5 毫米，半径为 1.25 毫米。</li>
	<li>使用 Move 和 Rotate 功能调整圆柱体的位置以达到理想位置（图 4B）。在整个模拟过程中，注意保持针轨迹与既定原则一致：穿刺针必须能够穿过椎弓根，最好在其上半部分，并且尖端的最佳定位是在侧视图上椎体的前三分之一内。</li>
	<li>右键单击 Objects 界面中的 L1，选择 Export STL （导出 STL），然后以 STL 格式导出文件。</li>
</ol>4. 在 3D 逆向工程生产软件中打磨 3D 模型
<ol><li>通过单击 Import（导入），将导出的椎体实体文件导入到 3-D 逆向工程生产软件中。因此，使用 Mesh Doctor 功能来消除模型中的扭曲和尖峰。</li>
	<li>由于 Grid Doctor 功能可能会错误地将正常的解剖结构识别为扭曲或尖峰，因此请注意彻底检查粗略模型以识别任何内部空隙，并按照步骤 4.1 适当填充它们（图 5A）。</li>
	<li>使用 精确表面 功能将实体模型转换为三角形网格表面，选择 有机几何材料 （图 5B）。等待自动表面构建过程完成，然后以 STP 格式导出文件。</li>
</ol>5. 在 3-D 建模设计软件中重建椎体工程模型并确认椎弓根投影的安全进入区域
<ol><li>将精确表面文档的 STP 格式导入 3-D 建模设计软件中，以单击 Open 重建椎体工程模型。使用 剖面视图 功能检查椎弓根在水平、矢状和冠状方向的形态，提供对椎弓根形态和结构的初步观察（图 6A）。</li>
	<li>在 Section View 面板中，调整截面的角度以实现最佳可视化效果。通过使用 透明截面体，观察椎弓根的最窄点（图 6B）并记录左侧面板第 1 部分 的角度参数。</li>
	<li>要调整椎体模型的角度，请单击 插入-特征-移动/复制 功能，然后选择位于左侧面板底部的 平移/旋转 按钮。重新访问 Section View 面板，并将 Section 1 中的 view angle 参数调整为 0。</li>
	<li>在 Section 1 面板中微调位移参数以获得令人满意的椎弓根截面视图。重新定向以获得改进的透视，以观察椎弓根截面。在面板中记录确认的位移参数（图 7）。</li>
	<li>利用上述 Move/Copy 功能来操纵椎体模型的位置。在左侧面板中指定位移参数。使用 Corner Rectangle 工具来包含整个椎体。</li>
	<li>首先，导航到 Features-Reference Geometry-Plane 选项，并将剖视图指定为 First Reference。相应地修改 偏移距离 参数，以将新创建的平面重新定位到椎体的前三分之一。</li>
	<li>继续 在上述 平面上生成草图，并在椎体的中点绘制一个 点 ，表示穿刺的终止点。</li>
	<li>使用 Extruded Cut 功能执行模型的切割。将生成的矩形草图指定为 Selected Contours。</li>
	<li>调整方向和深度，将椎体模型分为两半，即 椎体的一半 和 椎板的一半 （图 8A）。以 SLDPRT 格式保存工程文件，特别是作为该过程的一部分。</li>
	<li>打开包含 椎体零件的文件，然后基于剖切面创建草图。使用 Convert Entities 功能将左椎弓根投影转换为曲线草图。</li>
	<li>对右椎弓根投影重复上述步骤，从而获取另一个曲线草图。使用 填充表面 功能将曲线草图转换为表面，以左右椎弓根投影曲线草图作为边界（图 8B）。</li>
	<li>显示隐藏椎骨后的结果表面。在 特征 面板上选择 放样凸台/基体 功能。</li>
	<li>左椎弓根表面的优越定位，将穿刺终点指定为 轮廓，将产生一个圆锥形结构，描绘出椎弓根穿刺的路径。使用左侧作为参考进行说明，在右侧复制相同的过程。</li>
	<li>使用 Scale 函数放大双边圆锥形结构，质心作为缩放中心点， 比例因子 为 2。使用 Move/Copy Body 功能单独重新定位圆锥结构。</li>
	<li>在 “配合设置 ”面板界面中，选择 结构的顶点 和 穿刺终点，并将匹配模式设置为 “重合”。随后使用 Delete/Keep Body 功能消除椎体（图 9A）。</li>
	<li>双锥形结构是双侧椎弓根穿刺路径的汇编，以 SLDPRT 格式保存。使用 Insert Part 功能，使用椎弓根穿刺装置重新组装椎板部分和椎体部分。只需按下 OK 按钮，即可自动将零件的插入位置与原点对齐（图 9B）。</li>
	<li>使用 Combine Body 函数对各种组件执行 布尔 运算。通过从椎板的一半中减去穿刺组同时保留所有椎板成分的过程，随后的分析表明 ，理想的骨穿刺区域 包括左侧的区域 1、4 和 7（图 9C）。</li>
</ol>

通过 3D 建模和九宫格法提高椎弓根穿刺精度

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作者对本研究中描述的任何药物、材料或设备没有利益冲突。

经皮椎体成形术 （PVP） 在治疗疼痛性骨质疏松性椎体压缩骨折 （OVCF） 方面显示出良好的临床疗效9。外科医生利用精确的经皮椎弓根穿刺技术在确定穿刺针的最佳插入点、方向和深度方面起着至关重要的作用，从而显着减少并发症的发生10。目前，C 臂 X 光机广泛用于传统 PVP 手术的国内外实践，以方便调整穿刺针的手术路径11。关键方面在于确定 理想的骨穿刺点，该穿刺点通常位于腰椎蒂的“左 10 点，右 2 点”的投影处。“九宫区划分法”具有识别最佳骨穿刺区域的能力。
选择 9 宫 格作为首选的除法方法而不是 “四宫格 ” 和 “十六宫宫 ” 等替代方案的基本原理需要明确澄清。这一决定源于初步实验，这些实验表明，将椎弓根投影分割成 九格区域 最符合临床实践，同时也考虑了参考值。“四格分区法”的特点是操作简便;然而，由于区域划分不精确，其有限的参考价值使得辨别骨穿刺入点的安全性具有挑战性。相反，“十六格面积划分法”提供了对穿刺点安全性的准确判断，但其在外科手术过程中的复杂性阻碍了观察和判断，使其与临床实践不一致。因此，选择了 “九宫面积划分法”，因为它结合了临床可行性和提供令人满意的参考值。
在进一步分析我们之前研究对象12 的临床影像学数据后，发现“左 10 点，右 2 点”的理想椎弓根投影所投射的精确腰椎 PVP 骨穿刺点并不一致。然而，据观察，某些替代穿刺点仍然可以在上述理想骨穿刺点附近产生令人满意的穿刺结果。这些与理想的偏差不会影响手术安全性或准确性。基于这些假设，我们引入了 PVP 椎弓根理想骨穿刺区域的新概念，这涉及在 X 射线前后图像上将椎弓根投影分割成九格区域。通过采用腰椎弓根的 X 射线投影作为解剖参考，我们通过将椎弓根划分为九宫区来建立 PVP 的理想骨穿刺区域，从而超越了单一点的限制。
理论创新有可能通过使用“九宫分区法”辅助的 PVP 手术在腰椎中增强 PVP 穿刺手术路径。这一进步可能会减少术中投影的剂量，并最大限度地减少调整穿刺针入骨点所需的手术时间，最终提高手术效率和疗效。值得注意的是，“九格面积划分法”的理想骨穿刺区域可能因椎体的不同节段而异。为了说明目的，L1 椎体在此上下文中仅用作示例。我们未来的研究将结合更多的案例研究、更广泛的样本细分和对机器人学习的调查，以提高 PVP 穿刺适应症和方法的有效性和客观性。
但是，“九格面积划分法”辅助 PVP 在腰椎中存在一些局限性。学习使用医学成像软件有一个学习曲线。不熟悉软件的外科医生在模板设计过程中犯的任何错误都可能导致结果不成功。此外，必须进行更大规模的研究来验证这一发现的可靠性和实用性。

骨质疏松性椎体压缩骨折 （OVCF） 是骨质疏松性骨折中最普遍的骨折类型，在当代医疗保健中构成了重要的临床问题1。根据目前的指南，经皮椎体成形术被认为是 OVCF2 最有效的微创治疗方式之一。进行经皮椎体成形术 （PVP） 的主要方法涉及椎弓根穿刺方法，它包括三个关键参数：骨穿刺入口点的识别、穿刺角度和穿刺深度。在这些参数中，骨穿刺入口点的选择被认为是最关键的。
目前，C 臂 X 光机广泛用于传统 PVP 手术的国内外实践，以方便穿刺针手术路径的调整。关键方面在于确定“理想的骨穿刺点”，该点通常位于腰椎椎弓根的“左 10 点，右 2 点”的投影处（图 1A）3。尽管他们经验丰富，但即使是经验丰富的外科医生在仅根据个人经验确定合适的穿刺点时也可能会犯错误。这可能导致与穿刺相关的并发症，例如骨水泥渗漏到周围组织、神经根损伤和椎管内血肿 4,5,6。此外，近一半的患者因传统 PVP 而出现局部并发症，其中 95% 的并发症归因于骨水泥渗漏到周围组织或椎旁静脉栓塞7。我们的初步研究发现，腰椎中实际的 PVP 骨穿刺点并不总是位于理想的椎弓根投影“左 10 点和右 2 点”8。一些实际穿刺点也可以在“理想骨穿刺点”附近取得满意的穿刺效果，这不会影响手术的安全性和准确性。
基于上述假设，我们首次提出了腰椎PVP的“理想骨穿刺区域”的概念，并将椎弓根的投影划分为“九宫区”。 理想骨穿刺区域 的概念与穿刺入口点可以通过椎弓根成功安全地到达穿刺理想终点的特定解剖区域有关。术语 “九格区域划分法” 是指 X 射线前后图像中的一种技术，其中椎弓根投影的最长和最短直径被分成三个相等的部分，从而将区域划分为九个区域（图1B）。这些区域从 1 到 9 按顺序编号，从最外层到最内层，从上到下。以腰椎弓根的 X 射线投影作为解剖标志，我们通过“九格面积划分法”建立 PVP 的“理想骨穿刺区域”，而不是局限于单个点。我们使用计算机模拟在穿刺过程中探索安全的穿刺路径。
因此，我们建议实施“九格面积划分法”作为提高 PVP 手术中辅助穿刺技术的便利性、效率和安全性的潜在方法，以提高手术准确性并最大限度地减少穿刺相关并发症。值得注意的是，本研究提出了一种理论方法，需要通过广泛的研究进行验证，以确定其有效性和安全性。

<table><tbody><tr><td>Computer tomography&amp;nbsp;</td><td>Company GE</td><td></td><td>machine</td></tr><tr><td>Geomagic Wrap (3-D reverse engineering production software)</td><td>Oqton software</td><td></td><td>software</td></tr><tr><td>Magnetic resonance image machine</td><td>Company GE</td><td></td><td>machine</td></tr><tr><td>Solidworks (3-D modeling design software)</td><td>Dassault Syst&amp;egrave;mes&amp;nbsp;-&amp;nbsp;SolidWorks Corporation</td><td></td><td>software</td></tr><tr><td>Spirit Level Plus</td><td>IOS App store</td><td></td><td>gradientor</td></tr><tr><td>X-ray machine</td><td>Company Philips</td><td></td><td>machine</td></tr></tbody></table>

nine-grid area division method: a new ideal bone puncture region for percutaneous vertebroplasty in lumbar spine

经皮椎体成形术 （PVP） 被广泛认为是缓解骨质疏松性椎体压缩性骨折引起的腰痛的有效干预措施。理想的骨穿刺点通常位于腰椎椎弓根的“左 10 点，右 2 点”的投影处。确定最佳骨穿刺点是一项关键而复杂的挑战。经皮椎体成形术 （PVP） 的准确性主要受手术外科医生的熟练程度和常规手术中多荧光镜的使用影响。全球已有穿刺相关并发症的发生率记录。为了提高手术技术的精准度，减少穿刺相关并发症的发生，我们的团队在腰椎应用了 PVP 的「九格分区法」，以改变传统手术方式。有可能减少穿刺次数、辐射暴露剂量和外科手术的持续时间。
该协议引入了“九网格面积划分法”的定义，并描述了在医学成像处理软件中对目标椎骨 DICOM 成像数据进行建模的过程，在 3-D 模型中模拟操作，使用逆向工程生产软件完善 3-D 模型，在 3-D 建模设计软件中重建椎体工程模型，并利用手术数据确定椎弓根投影的安全进入区域。通过采用这种方法，外科医生可以有效、精确和轻松地识别合适的穿刺点，从而减少与穿刺相关的复杂性并提高外科手术的整体准确性。

CT 成像和数字建模在医院进行。从 CT 图像构建 3-D 模型需要 30 分钟，在 3-D 逆向工程生产软件中抛光 3-D 模型需要 ~10 分钟，重建椎体工程模型需要 15 分钟，并在 3-D 建模设计软件中确认椎弓根投影的安全进入区域。在这种情况下， 理想的骨穿刺区域 包括左侧的区域 1、4 和 7。 理想骨穿刺区域 的概念是指不同的解剖区域，其中穿刺的入口点可以通过椎弓根有效且安全地到达所需的终点。换句话说，通过调整穿刺针的方向和深度，只要骨穿刺入口点落在这些指定区域内，就可以达到理想的穿刺终点，而不是局限于“左 10 个点”。这种技术可以显着提高外科医生在穿刺过程中的容错能力。需要最少的透视来确定合适的骨穿刺部位，从而减少调整频率、辐射暴露和手术持续时间。
理想的骨穿刺点通常位于腰椎椎弓根的“左 10 点，右 2 点”的投影处，如图 1A 所示。 图 1B 详细概述了九网格区域划分方法中采用的划分细节和方法。目标椎骨的术前图像如图 2 所示。在俯卧位 CT 扫描之前，将梯度器放在患者的背部，并记录患者的体位（图 3）。CT 椎骨图像从冠状面、横向面和矢状面重建为 3-D 模型（图4）。图 4 还显示了图像处理软件中 PVP 操作程序的模拟。 图 5 显示了修复网格并将实体模型转换为三角形网格表面的过程。图 6 说明了通过使用 Section View 功能观察和记录椎弓根最窄点的方法。图 7 说明了调整模型位移参数和确定最终穿刺目标位置所涉及的步骤。图 8 说明了将模型划分为两个不同的部分：椎体的一半和椎板的一半 （A），然后使用转换实体功能 （B） 生成椎弓根投影。图 9 描绘了椎体内的穿刺路径阵列。使用椎弓根穿刺组重新组装椎板和椎体组件，随后从椎板部分去除穿刺组，同时保留所有椎板组件。Combine Body 函数用于对多个组件执行布尔运算，从而确定由区域 1、4 和 7 组成的理想骨穿刺区域。 
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/66906/66906fig01.jpg"> 图 1：A. 传统的“理想骨穿刺点”。 “理想骨穿刺点”通常位于腰椎椎弓根的“左 10 点，右 2 点”的投影处。 湾。 “九宫格面积划分法”简介。 详细介绍了 “Nine-grid Area Division Method” 中采用的划分细节和方法。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig01large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/66906/66906fig02.jpg"> 图 2：目标椎骨的术前图像。 （A） 骨质疏松性椎体压缩性骨折患者的 X 光片。患者目标椎骨的术前 X 射线图像。（A1：后前视图;A2：侧视图）。（B） 骨质疏松性椎体压缩骨折患者的 MRI。患者目标椎骨的术前 MRI 图像。（B1：T1WI 视图;B2：T2WI 视图）。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig02large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/66906/66906fig03.jpg"> 图 3：俯卧位 CT 扫描。 在患者背部使用梯度器测量患者身体的水平角和矢状角，同时进行俯卧位 CT 扫描。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig03large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/66906/66906fig04.jpg"> 图 4：椎骨重建和手术模拟。 （A） 根据 （A1） 冠状面、（A2） 横平面、（A3） 矢状面和 （A4） 三维模型的 CT 椎骨图像，在医学成像处理软件中重建椎骨。（B） 医学成像处理软件中 PVP 操作程序的模拟。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig04large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/66906/66906fig05.jpg"> 图 5：在 3D 逆向工程生产软件中抛光 3D 模型。 优化 3-D 模型的过程。（A） 修复网格，以及 （B） 将实体模型转换为三角形网格曲面。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig05large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/66906/66906fig06.jpg"> 图 6：利用 Section View 功能观察和记录椎弓根。 利用 剖面视图 功能观察 （A） 椎弓根投影和 （B） 记录角度参数。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig06large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/66906/66906fig07.jpg"> 图 7：修改模型位移的参数。 调整模型位移参数并确定最终的穿刺目标位置。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig07large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/66906/66906fig08.jpg"> 图 8：创建椎弓根投影的表示。 （A） 将模型划分为两个不同的部分，然后 （B） 使用 Convert Entities 功能生成椎弓根投影。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig08large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>
<img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/66906/66906fig09.jpg"> 图 9：穿刺路径和理想穿刺区域的确定。 （A） 穿过椎弓根的一组穿刺路径。椎体内穿过椎弓根的穿刺路径阵列。（B） 重建由不同组件组成的模型。通过椎弓根穿刺装置重建椎板和椎体节段。（C） 获取“理想骨穿刺区域”。只有当一个区域完全为蓝色时，它才被认为是理想的骨穿刺区域。理想的骨穿刺区域包括区域 1、4 和 7 通过布尔运算。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66906/66906fig09large.jpg" target="_blank">请单击此处查看此图的较大版本。</a>

作者聚焦：通过先进的穿刺技术提高经皮椎体成形术手术的准确性和效率

在此，我们提出了一种用于经皮椎体成形术的“九格面积划分法”。选择一名 L1 椎体压缩骨折患者作为案例研究。

九格面积划分法：腰椎经皮椎体成形术新的理想骨穿刺区域 

Percutaneous vertebroplasty (PVP) is widely recognized as an efficacious intervention for alleviating low back pain resulting from osteoporotic vertebral ...

nine-grid-area-division-method-new-ideal-bone-puncture-region-for

Nanyang Technological University

Research

JoVE Journal

Medicine

Nine-Grid Area Division Method: A New Ideal Bone Puncture Region for Percutaneous Vertebroplasty in Lumbar Spine

198 次观看.  Capital Medical University. 我们的研究是关于 PVP 手术中的穿刺技术。我们正在努力回答如何在 PVP 手术中提高手术准确性并最大限度地减少穿刺相关并发症。随着新技术的 MGC，各种穿刺技术正在迅速发展，例如导航系统兑换创建引导模板，因此学习使用医学成像软件有一个学习曲线。此外，必须进行更大规模的研究来验证这一建立的可靠性和实用性。采用这种方法，外?...

视频: 作者聚焦：通过先进的穿刺技术提高经皮椎体成形术手术的准确性和效率

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle screws after spinal surgery, which is a serious concern. To address this problem, diverse types of pedicle screws have been examined to identify those with good fixation strength and osseointegration in spine bone. The porcine spine is a good alternative for the human spine in the evaluation of pedicle screws due to the anatomical size, mechanical characteristics, and cost. Although several studies have reported that pedicle screws are efficient in the porcine model, no study has described detailed protocols for the evaluation of a pedicle screw using the porcine model. Here, we describe a detailed method for evaluating transpedicular screws using an in vivo porcine lumbar spine model. The technical details for anesthesia, spine surgery, and harvest provided here will facilitate with the evaluation of the transpedicular screw fixation model.

An Anesthesia, Surgery, and Harvest Method for the Evaluation of Transpedicular Screws Using an In Vivo Porcine Lumbar Spine Model

Here, we introduce a method to evaluate transpedicular screws by using an in vivo porcine lumbar spine model.

用于评估椎弓根螺钉的麻醉，手术和收获方法<em&gt;体内</em&gt;猪腰椎模型

Pedicle screw fixation is the gold standard for the treatment of spinal diseases. However, many studies have reported the issue of loosening pedicle ...

科研

医学

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons&#39; experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case study.

三维打印指南模板辅助皮椎间盘（PVP）

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique

Lateral interbody fusion provides a significant biomechanical advantage over the traditional transforaminal lumbar interbody fusion due to the large implant size and optimal implant position. However, current methods for lateral interbody cage placement require either a two-staged procedure or a single lateral decubitus position that precludes surgeons from having either full access to the posterior spine for direct decompression or comfortable pedicle screw placement.
Herein is one institution's experience with 10 cases of a prone single-position approach for simultaneous access to the anterior and posterior lumbar spine. This allows both lateral lumbar interbody cage placement, direct posterior decompression, and pedicle screw placement, all in one position. Three-dimensional (3D) navigation is utilized for increased precision in both approaching the lateral spine and interbody cage placement. The traditional blind psoas muscle tubular dilation was also modified. Tubular retractors and lateral vertebral body retractor pins were used to minimize the risks to the lumbar plexus.

The single-position, prone, lateral approach allows for both lateral lumbar interbody placement and direct posterior decompression with pedicle screw placement in one position.

三维导航引导，俯卧，单位，侧腰椎椎体间融合技术

Lateral interbody fusion provides a significant biomechanical advantage over the traditional transforaminal lumbar interbody fusion due to the large ...

神经科学

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient.
In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

C-arm-free oblique lumbar interbody fusion at the L5-S1 level (OLIF51) and simultaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This technique does not expose the surgeon or operating staff to radiation hazards.

无 C 型臂同时 OLIF51 和经皮椎弓根螺钉固定在单个侧位

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

胸腰椎后凸畸形患者改良后椎柱切除术

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Treating Osteoporotic Spinal Fractures in Elderly Patients via a Modified Clinical Bone Cement Injection Technique

The minimally invasive injection of bone cement (MIIBC) is an effective way to treat senile osteoporotic spinal fractures (OSF) in clinical practice. However, the intraspinal dura and nerves may be damaged when the puncture needle passes through the pedicle. Therefore, in this protocol, the puncture site was optimized during the surgery, selecting the same 1-2 cm away from the surface projection of the diseased vertebra. The needle was punctured along the lateral cortex of the pedicle from the junction of the pedicle and the vertebral body into the vertebral body. Meanwhile, bone cement was used as a filling material, and the MIIBC was performed by a percutaneous puncture at the external edge of the pedicle under C-arm fluoroscopy. This modified puncture site is far away from the spinal canal as possible, thereby reducing the risk of the puncture needles penetrating the spinal canal and damaging the nerves and dura mater. In conclusion, a modified MIIBC by percutaneous lateral pedicle puncture can effectively relieve pain in elderly patients with OSF.

<meta charset="utf8"></head><body>通过改良的临床骨水泥注射技术治疗老年患者的骨质疏松性脊柱骨折

Presented here is a modified procedure for minimally invasive injections of bone cement to treat osteoporotic spinal fractures in elderly patients.

通过改良的临床骨水泥注射技术治疗老年患者的骨质疏松性脊柱骨折

The minimally invasive injection of bone cement (MIIBC) is an effective way to treat senile osteoporotic spinal fractures (OSF) in clinical practice. ...

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

Here, we present a protocol for the &#34;isolation zone&#34; technique in the treatment of lumbar disc herniation (LDH) under full-endoscopic spine surgery (FESS), including intervertebral foramen formation, targeted catheterization, nucleus pulposus resection, and annulus fibrosus formation, which together completely block the pain from the nerve conduction pathway.

全内窥镜隔离区技术治疗腰椎间盘突出症

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its ...

Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for minimally invasive anterior lumbar interbody fusion (Mini-ALIF). This article is a technical description of anterior lumbar spine surgery under a microscope. We retrospectively collected information on patients who underwent microscope-assisted Mini-ALIF surgery at our hospital between July 2020 and August 2022. A repeated-measures ANOVA was used to compare imaging indicators between periods. Forty-two patients were included in the study. The mean volume of intraoperative bleeding was 180 mL, and the mean operative time was 143 min. The mean follow-up time was 18 months. Apart from one case of peritoneal rupture, no other serious complications occurred. The postoperative foramen and disc height were both higher on average than before surgery. The spreader-assisted micro-Mini-ALIF is simple and easy to use. It can provide good intraoperative disc exposure, good discrimination of important structures, adequate spreading of the intervertebral space, and the restoration of the necessary intervertebral height, which is very helpful for less experienced surgeons.

The technique described in this article is well-suited to the Mini-ALIF procedure, allows for excellent exposure and decompression, and facilitates microscope-assisted manipulation.

显微镜辅助微创前腰椎椎间融合术的临床应用

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for ...

Biomechanical Analysis of Adjacent Segments after Spinal Fusion Surgery Using a Geometrically Parametric Patient-Specific Finite Element Model

This study aimed to perform a mechanical analysis of adjacent segments after spinal fusion surgery using a geometrically parametric patient-specific finite element model to elucidate the mechanism of adjacent segment degeneration (ASD), thereby providing theoretical evidence for early disease prevention. Fourteen parameters based on patient-specific spinal geometry were extracted from a patient's preoperative computed tomography (CT) scan, and the relative positions of each spinal segment were determined using the image match method. A preoperative patient-specific model of the spine was established through the above method. The postoperative model after L4-L5 posterior lumbar interbody fusion (PLIF) surgery was constructed using the same method except that the lamina and intervertebral disc were removed, and a cage, 4 pedicle screws, and 2 connecting rods were inserted. Range of motion (ROM) and stress changes were determined by comparing the values of each anatomical structure between the preoperative and postoperative models. The overall ROM of the lumbar spine decreased after fusion, while the ROM, stress in the facet joints, and stress in the intervertebral disc of adjacent segments all increased. An analysis of the stress distribution in the annulus fibrosus, nucleus pulposus, and facet joints also showed that not only was the maximum stress in these tissues elevated, but the areas of moderate-to-high stress were also expanded. During torsion, the stress in the facet joints and annulus fibrosus of the proximal adjacent segment (L3-L4) increased to a larger extent than that in the distal adjacent segment (L5-S1). While fusion surgery causes an overall restriction of motion in the lumbar spine, it also causes more load sharing by the adjacent segments to compensate for the fused segment, thus increasing the risk of ASD. The proximal adjacent segment is more prone to degeneration than the distal adjacent segment after spinal fusion due to the significant increase in stress.

<meta charset="utf8"></head><body>使用几何参数化患者特异性有限元模型对脊柱融合手术后相邻节段进行生物力学分析

Here, we used a patient-specific finite element model to analyze the mechanical changes in adjacent segments after spinal fusion surgery. The results showed that fusion surgery reduced the overall motion of the lumbar spine but increased the load on and stress in adjacent segments, especially the proximal segment.

使用几何参数化患者特异性有限元模型对脊柱融合手术后相邻节段进行生物力学分析

This study aimed to perform a mechanical analysis of adjacent segments after spinal fusion surgery using a geometrically parametric patient-specific ...

九格面积划分法：腰椎经皮椎体成形术新的理想骨穿刺区域

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使用几何参数化患者特异性有限元模型对脊柱融合手术后相邻节段进行生物力学分析