中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (21): 5582-5588.doi: 10.12307/2026.697

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

Mimics三维CT重建辅助颈椎前路椎弓根螺钉置入的形态学测量

胡  寅1，邢  乐2，韩康恩1，李俊潮1，钱梦然1，顾洪闻2，于海龙2，王洪伟2   

  1. 1大连医科大学研究生院，辽宁省大连市  116044；2北部战区总医院骨科，辽宁省沈阳市  110016
  • 接受日期:2025-05-20 出版日期:2026-07-28 发布日期:2026-03-05
  • 通讯作者: 王洪伟，博士，副主任医师，北部战区总医院骨科，辽宁省沈阳市 110016
  • 作者简介:胡寅，男，2000年生，辽宁省沈阳市人，汉族，大连医科大学在读硕士，主要从事脊柱外科疾病的临床及基础研究。
  • 基金资助:
    沈阳科学技术计划(22-321-33-35)；项目负责人：王洪伟

Morphological measurement of anterior cervical pedicle screw placement assisted by Mimics three-dimensional CT reconstruction

Hu Yin1, Xing Le2, Han Kangen1, Li Junchao1, Qian Mengran1, Gu Hongwen2, Yu Hailong2, Wang Hongwei2   

  1. 1Graduate School of Dalian Medical University, Dalian 116044, Liaoning Province, China; 2Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
  • Accepted:2025-05-20 Online:2026-07-28 Published:2026-03-05
  • Contact: Wang Hongwei, MD, Associate chief physician, Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
  • About author:Hu Yin, MS candidate, Graduate School of Dalian Medical University, Dalian 116044, Liaoning Province, China
  • Supported by:
    Shenyang Science and Technology Program, No. 22-321-33-35 (to WHW)

PDF

15

摘要：


文题释义：
前路经椎弓根螺钉内固定：该技术经椎体前方入路，置入经过椎体前缘、椎体、椎弓根，到达后侧侧块，具备良好的生物力学稳定性，仅通过一次前路手术便可达到充分减压和一期坚强固定的目的。但该技术固定难度较高、风险较大，需要精准的解剖学参数去辅助置钉。

Mimics：一款专门针对医学影像进行分割、测量、仿真和三维模拟的交互式软件，可以快速高效地将收集的扫描切片数据重建成三维模型，使测量的解剖学数据更为精准。

摘要
背景：前路经椎弓根螺钉内固定系统通过一次前路手术便可达到充分减压和一期坚强固定的目的，但因为特殊的解剖学结构，置钉风险相对较高，既往国内外学者通过进行解剖学测量肯定了该入路的可行性，但存在样本量相对较小、椎弓根轴定位困难、测量方法相对局限等缺点。 
目的：在影像学基础上针对成人颈椎进行形态学测量，从而为临床前路椎弓根螺钉置入提供解剖学指导。
方法：将50例成人颈椎的3D CT扫描数据导入Mimics系统进行三维重建，并测量其形态学数据，包括椎弓根中轴线距离、椎弓根宽度、椎弓根高度、椎弓根水平轴位角度、椎弓根矢状位角度、横断面上进钉点距离、矢状面上进钉点距离、轴线上椎体长度及轴线上椎弓根长度。
结果与结论：①进钉点定位：C3、C4位于椎体正中矢状面的对侧，距离正中矢状线约为2.060 mm及2.310 mm；C5既可位于正中矢状线同侧也可位于对侧，平均值约为1.224 mm；C6-C7位于同侧，距离正中1.132 mm及2.538 mm；C3-C7距离椎体上终板的距离逐渐增加，平均值范围为2.362-7.350 mm；②进钉点方向：横断面夹角，C3-4平均值逐渐增大，为46.32°-47.36°；C5-7逐渐减小，由44.03°下降至37.80°；矢状面夹角，C3-C4角度需要向尾端偏移，角度分别为95.75°和100.93°；C5-C7角度需要向头端偏移，分别为104.38°，110.34°和104.86°；③进钉点定位及方向在性别及侧别间差异均无显著性意义(P > 0.05)，对于螺钉的选择，除个别患者颈椎发育异常，绝大部分下颈椎椎弓根螺钉男性选择至少30 mm长、4.0 mm直径的螺钉，女性选择至少28 mm长、3.5 mm直径的螺钉进行颈椎前路经椎弓根螺钉固定是安全可靠的；④通过形态学测量证实，前路经椎弓根螺钉固定下颈椎是可行的，但应遵循个体化原则，制定个性化的固定方案。



中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: ">颈椎前路, 经椎弓根螺钉固定, Mimics, 三维重建, 颈椎, 内固定, 形态学测量

Abstract: BACKGROUND: The anterior transpedicular screw fixation system can achieve adequate decompression and strong fixation in a single anterior surgery. However, due to its unique anatomical structure, the risk of screw placement is relatively high. Previous domestic and international scholars have confirmed the feasibility of this approach through anatomical measurements, but there are some drawbacks such as relatively small sample sizes, difficulties in locating the pedicle axis, and limitations in measurement methods.
OBJECTIVE: To perform morphological measurements of the adult cervical spine based on imaging to provide anatomical guidance for anterior transpedicular pedicle screw fixation.
METHODS: 3D CT scan data of 50 adult cervical vertebrae were imported into the Mimics system for 3D reconstruction. Morphological data were measured, including pedicle axis distance, pedicle width, pedicle height, pedicle horizontal axial angle, pedicle sagittal angle, distance from the entry point in the transverse plane, distance to the entry point in the sagittal plane, axial vertebral length and axial pedicle length. 
RESULTS AND CONCLUSION: (1) Positioning of nail entry points: C3 and C4 were located on the opposite side of the median sagittal plane of the vertebral body, with distances from the median sagittal line of approximately 2.060 mm and 2.310 mm. C5 could be located on the same side of the median sagittal line as or opposite to the median sagittal line, with an average value of approximately 1.224 mm. C6-C7 were located on the same side of the body, with distances from the center of the vertebral body of 1.132 mm and 2.538 mm; the distances of C3-C7 from the vertebral body of the upper endplates increasd gradually, with average values ranging from 2.362-7.350 mm. (2) In the direction of the entry point, the cross-sectional pinch angles: C3-4 gradually increased to 46.32°-47.36°, and C5-7 gradually decreased from 44.03° to 37.80°; the sagittal pinch angles: C3-C4 needed to be shifted caudally, with the angles of 95.75° and 100.93°; C5-C7 angles needed to be shifted toward the cephalad, with angles of 104.38°, 110.34°, and 104.86°, respectively. (3) There was no statistical significance in the positioning and orientation of the entry point between genders and sides 
(P > 0.05). For screw selection, except for individual patients with abnormal cervical vertebral development, the vast majority of the lower cervical pedicle screws were selected to be at least 30-mm-long, 4.0-mm-diameter screws for males, and at least 28-mm-long, 3.5-mm-diameter screws for females for anterior transpedicular pedicle screw fixation, which could ensure their safety and reliability while to achieve bicortical screws. (4) Morphological measurements confirm that anterior transpedicular screw fixation of the lower cervical spine is feasible, but a personalized fixation plan should be developed based on individual needs.

Key words: ">anterior cervical spine, transpedicular screw fixation, Mimics, three-dimensional reconstruction, cervical spine, internal fixation, morphological measurement

中图分类号: