Accuracy of screw placement in child’s thoracic pedicle assisted by digital navigation template

doi:10.3969/j.issn.2095-4344.2014.35.015

Chinese Journal of Tissue Engineering Research ›› 2014, Vol. 18 ›› Issue (35): 5660-5665.doi: 10.3969/j.issn.2095-4344.2014.35.015

Previous Articles Next Articles

Accuracy of screw placement in child’s thoracic pedicle assisted by digital navigation template

Zhang Shao-jie^{1, 2}, Wang Xing^{1, 2}, Shi Jun³, Chen Jie¹, Ma Shi-feng¹, Wang Jian¹, Li Zhi-jun^{1, 2},Zhang Yuan-zhi², Liu Hong-wei¹

¹Teaching and Research Office of Human Anatomy, the School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China; ²Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China;³Teaching and Research Office of Physiology, the School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China

Revised:2014-08-01 Online:2014-08-27 Published:2014-08-27
Contact: Li Zhi-jun, Master, Professor, Doctoral supervisor, Teaching and Research Office of Human Anatomy, the School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China; Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China
About author:Zhang Shao-jie, Master, Lecturer, Teaching and Research Office of Human Anatomy, the School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China; Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China Wang Xing, Master, Teaching assistant, Teaching and Research Office of Human Anatomy, the School of Basic Medicine, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China; Digital Medical Center, Inner Mongolia Medical University, Hohhot 010059, Inner Mongolia Autonomous Region, China Zhang Shao-jie and Wang Xing contributed equally to this paper.
Supported by:
the National Natural Science Foundation of China, No. 30660072, 81260269; the Natural Science Foundation of Inner Mongolia Autonomous Region of China, No. 2009MS1112, 2012MS1149; the Youth Innovation Project of Inner Mongolia Medical University, No. YKD2013QNCX018

Abstract

Abstract:

BACKGROUND: Many scholars at home and abroad have already attempted to apply the technique of the internal fixation pedicle screw placement to cure children’s spinal injuries in recent years, because the children’s thoracic pedicle is more small, anatomical structure variation is big and adjacent relationship is complicated, so the application of adult’s pedicle screw technology simply to children who was in a continuous growth and development can increase operation risk greatly. Above this, improving the accuracy of nailing and reducing error rate become keys for further development of cervical pedicle fixation.
OBJECTIVE: To provide an individualized and accurate positioning method for screw placement in thoracic pedicle of children by computer aided design and rapid prototyping technology.
METHODS: After computed tomography scan of four cases of child specimens, the original data were made for three-dimensional reconstruction by the software, then the specimens were randomly divided into two groups: one group used the traditional pedicle internal fixation method, and the other group, first created the individual navigation template using the principle of reverse engineering and rapid prototyping technology. The lumbar pedicle screws were put into the samples by the individual navigation template. The position of the pedicle screws was evaluated according to the computer tomography scan.
RESULTS AND CONCLUSION: The accurate rate of screw placement of the traditional pedicle internal fixation method was 58%; and the accurate rate of screw placement of the individual digital navigation template method was 81%. The success rate was better than the traditional surgery group. Furthermore, chi square test showed that there was a significant difference between two groups (P < 0.05). These findings suggested that there has a high accuracy of the screw placement in thoracic pedicle of children assisted by the individual navigation template, fully reflects the principle of individualization of screw placement, and provides a new feasible method for accurate screw placement in thoracic pedicle of children.

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

全文链接：

Key words: internal fixators, thoracic vertebrae, computer-aided design

CLC Number:

R318

Zhang Shao-jie, Wang Xing, Shi Jun, Chen Jie, Ma Shi-feng, Wang Jian, Li Zhi-jun,Zhang Yuan-zhi, Liu Hong-wei . Accuracy of screw placement in child’s thoracic pedicle assisted by digital navigation template[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(35): 5660-5665.

Figures/Tables 1

References

[1] Fuster S, Vega A, Barrios G,et al. Accuracy of pedicle screw insertion in the thoracolumbar spine using image-guided navigation. Neurocirugia (Astur). 2010;21(4): 306-311.
[2] 刘磊,孙琳, 孙记航,等.1-6岁正常小儿胸椎椎弓根形态学研究[J].中国脊柱脊髓杂志,2013, 23(8):713-717.
[3] 周松,朱泽章,邱勇,等.青少年特发性胸椎侧凸顶椎区椎弓根及椎管的形态学特征[J].中国脊柱脊髓杂志,2013,23(2):113- 118.
[4] Ruf M,Harms J.Posterior hemivertebra resection with transpedicular instrument- tation:early correction in children aged 1 to 6 years. Spine. 2003;28(18): 2132-2138.
[5] Ruf M,Harm J.Pedicle screws in 1-and 2-year-oldchildren. technique,complication,and effect on further growth. Spine. 2002;27(21):460-466.
[6] 李晶,吕国华,王冰.幼儿胸腰椎置入椎弓根螺钉可行性临床研究[J].中华骨科杂志,2009,29(11):1005-1008.
[7] 陈立言,彭新生,李佛保,等.椎弓根钉固定在10岁以下小儿胸腰椎疾患治疗中的应用[J].中国脊柱脊髓杂志,2006,16(4):263-266.
[8] 林斌,邓雄伟,刘晖,等.儿童寰枢椎后路椎弓根螺钉固定的解剖与影像学研究[J].中国临床解剖学杂志,2008,26(4):359-362.
[9] 李鉴轶,张余,郑小飞.儿童脊柱测量及三维重建对脊柱侧凸治疗的意义[J].解剖学杂志,2007,30(3):344-346.
[10] Murakami S,Mizutani J,Fukuoka M,et al.Relationship between screw trajectory of C1 lateral mass screw and internal carotid artery. Spine. 2008;33(24):2581-2585.
[11] 张永刚,王岩,刘郑生,等.数字化三维重建技术定量评估青少年特发性脊柱侧弯胸椎椎弓根的形态变化[J].中国临床康复,2005, 9(22):13-15.
[12] 陆声,徐永清,李严兵,等.脊柱椎弓根定位数字化导航模板的设计[J].中华创伤骨科杂志,2008,10(2):128-131.
[13] 师继红,陆声,张元智,等．数字化脊柱椎弓根导航模板在胸腰椎骨折中的应用[J].中华创伤骨科杂志,2008,10(2):138-141.
[14] 陈玉兵,陆声,徐永清,等.个体化导航模板辅助腰椎椎弓根螺钉置钉准确性实验研究[J].中国脊柱脊髓杂志,2009,19(8):623-626.
[15] 覃炜,权正学,刘洋,等.寰枢椎椎弓根螺钉个体化导向模板的研制与实验研究[J].中国修复重建外科杂志,2010,24(10):1168-1173.
[16] 陈国平,陆声,徐永清,等. 数字化导航模板在下颈椎椎弓根定位定向中的应用[J].西南国防医药,2010,20(6):596-598.
[17] 王建华,夏虹,吴增晖,等.数字骨科技术在儿童上颈椎手术中的应用[J].中国脊柱脊髓杂志,2012,22(6):516-519.
[18] 陈昆,刘爱刚,蔡惠民,等.腰椎椎弓根螺钉置入内固定前三维测量的临床应用[J].中国组织工程研究,2013,17(39):6941-6919.
[19] 洪伟. 数字化技术在脊柱骨折椎弓根螺钉置入中的基础研究与临床评价[D].第三军医大学,2013.
[20] Karaikovic EE, Yingsakmongkol W, Gaines RW Jr. Accuracy of cervical pedicle screw placement using the funnel technique. Spine. 2001;26(22):2456-2462.
[21] Li SG, Sheng L, Zhao H, et al. Clinical applications of computer-assisted navigation technique in spinal pedicle screw internal fixation. Zhonghua Yi Xue Za Zhi. 2009; 89(11):736-739.
[22] 王星,张少杰,史君,等.个体化导航模板辅助儿童腰椎椎弓根螺钉置钉准确性实验研究[J].中华临床医师杂志(电子版),2013,7(23): 10784-10787.
[23] Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004; 29(3):333-342.
[24] 李明,顾苏熙,朱晓东,等.全节段椎弓根螺钉系统矫治青少年特发性胸腰椎/腰椎侧凸的疗效[J].中国脊柱脊髓杂志,2007,17(4): 261-265.
[25] Fan CY, Tsai TT, Chen LH,et al. Computed tomography-based navigation-assisted pedicle screw insertion for thoracic and lumbar spine fractures. Chang Gung Med J. 2012,35(4): 332-338.
[26] 陈立言,彭新生,李佛保,等.椎弓根钉固定在10岁以下小儿胸腰椎疾患治疗中的应用[J].中国脊柱脊髓杂志,2006,16(4):263-266.
[27] 郑昌坤,黄其衫,胡月正,等.正常儿童胸椎椎弓根的参数测量[J].中华小儿外科杂志,2008,29(7):430-433.
[28] 李晶,吕国华,王冰.幼儿胸腰椎置入椎弓根螺钉可行性临床研究[J].中华骨科杂志,2009,29(11):1005-1008.
[29] Suk SI, Kim WJ, Lee SM, et al. Thoracic pediele screw in spinal deformities: are they really safe? Spine.2001;26(18): 2049- 2057.
[30] 王迎松,张颖,赵智,等.儿童中上胸椎可容纳椎弓根钉直径临床研究[J].脊柱外科杂志,2010,8(1):26-30.
[31] 王欢喜,邓展生,燕好军.肋横突结合区进钉途径研究[J].中国医学工程, 2007,15(11):909-912.
[32] Labrom RD.Growth and maturation of the spine from birth to adolescence.J Bone Joint Surg Am.2007;89(1):3-7.
[33] 韦兴,侯树勋,赵卫东,等.胸椎椎弓根螺钉抗拔出强度的生物力学测试[J].中国临床解剖学杂志,2002,20(5):386-387.
[34] 陈玉兵,陆声,徐永清,等.数字化导航模板辅助胸椎椎弓根螺钉置钉研究[J].中国骨科临床与基础研究杂志,2010,2(2):125-129.
[35] 陈玉兵,陆声,徐永清,等.快速成型个体化导航模板辅助胸椎椎弓根螺钉置入可行性研究[J].中国矫形外科杂志,2009,17(20): 1557-1561.
[36] 陆声,徐永清,张元智,等. 计算机辅助导航模板在下颈椎椎弓根定位中的临床应用[J].中华骨科杂志,2008,28(12):1002-1007.
[37] Braga BP,de Morais JV,Vilela MD. Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series. Arq Neuropsiquiatr. 2010;68(3):390-395.
[38] 温世锋,刘恩志,郭东明,等. CT三维重建立体导航引导技术在胸椎弓根钉置人手术中的应用[J].脊柱外科杂志,2008,6(6): 339-342.
[39] Wu H,Gao ZL,Wang JC,et al. Pedicle screw placement in the thoracic spine: a randomized comparison study of computer-assisted navigation and conventional techniques. Chin J Traumatol. 2010;13(4):201-205.
[40] 田伟,刘亚军,刘波,等.计算机导航在脊柱外科手术应用实验和临床研究[J].中华骨科杂志,2006,26(10):671-675.
[41] 陆声,徐永清,李严兵,等.脊柱椎弓根定位数字化导航模板的设计[J].中华创伤骨科杂志,2008,10(2):128-131.
[42] 周栋,徐南伟,农鲁明,等. CT三维导航系统辅助胸椎椎弓根钉治疗胸椎骨折[J].中华医学杂志,2010,90(23):1612-1614.

Accuracy of screw placement in child’s thoracic pedicle assisted by digital navigation template

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 1

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Shen Canghai, Feng Yongjian, Song Yancheng, Liu Gang, Liu Zhiwei, Wang Ling, Dai Haiyang. Value of quantitative MRI T2WI parameters in predicting surgical outcome of thoracic ossification of the ligamentum flavum [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(18): 2893-2899.
[2]	Zhou Yu, Liu Yuehong, Liu Shuping, Chen Xi, Qin Wei, Li Qifeng. Spinal stability of intervertebral grafting reinforced by five or six augmenting screws versus transvertebral grafting reinforced by four augmenting screws for thoracolumbar vertebral fractures [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(4): 505-511.
[3]	Li Qingsong, Liu Shaoyu, Yin Zongsheng. Multiple posterior lumbar interbody fusion and posterolateral fusion instrumentation for thoracolumbar kyphosis and osteoporotic fracture in older adults [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(4): 512-517.
[4]	Liang Maohua, Mao Keya, Xia Bo, Liu Qiang,Tang Peifu, Wang Jifang. Osteogenic property of beta-tricalcium phosphate/alpha-calcium sulphate hemihydrate combined bone graft in multi-segment posterolateral arthrodesis of rabbit thoracic vertebrae [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(22): 3500-3505.
[5]	Liang Maohua, Mao Keya, Xia Bo, Liu Qiang, Tang Peifu, Wang Jifang. Application of beta-tricalcium phosphate/alpha-calcium sulfate hemihydrate combined bone grafts in multi-segment arthrodesis of spine: micro-CT evaluation [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(18): 2800-2805.
[6]	Zhong Ze-li, Hu Hai-gang, Lin Xu, Tan Lun, Wu Chao, Zeng Jun, Deng Jia-yan. Measurement of vertebral “shell” volume after thoracolumbar fracture reduction [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(7): 1038-1043.
[7]	Luo Peng-gang, Jin Da-di, Wu Zeng-zhi, Ling Hua-jun, Lin Wei-wen, Zhong Si-long. Comparison of percutaneous and open pedicle screw system in the treatment of multilevel thoracolumbar fractures: the accuracy of screw placement [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(7): 1050-1055.
[8]	Han Li-qiang, Jiang Han, Wang Shu-sen, Li Xiao-dong, Zheng Jin-xin. Long-arm uniaxial screws through Wistle approach versus AF system through conventional approach in the treatment of thoracic and lumbar compressive fractures [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(31): 4949-4954.
[9]	Huang Ya-xiang, Zhao Zi-ping, Wang Zhi-guo, Liao Qi-ming, Xie Yin-hao, Zhang Ping. Digital design of night-time scoliosis brace [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(27): 4327-4331.
[10]	Chang Bu-qing, Feng Hu, Yu Chao-jiang, Shan Hong-jian, Hu Meng-zi, Li Zi-ang, Bu Xiang-bo, Gao Xiao, Jiang Yun-chang. Unilateral placement combined with short-segment five-screw fixation for unstable thoracolumbar fractures [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(27): 4337-4341.
[11]	Yu Jia-li, Nie Er-min, Jiang Rui, Zhang Chun-yuan, Huang Zhe-xun, Zhang Yu-hang, Lu Dun-lang. Digital technology in prosthodontics: impression, shade selection, material design and processing [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(22): 3602-3608.
[12]	Li Sheng-hua, Deng Chang, Zhou Ming-wang, Fu Zhi-bin. Concepts, characteristics and values of precision medicine in the field of orthopedics [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2407-2413.
[13]	Li Kang, Jiang Yan, Tian Da-wei, Liu Xiang-yang. Three-dimensional simulation and simulated mechanical test of individual femoral prosthesis [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(11): 1731-1736.
[14]	Wang Xue-xin, Zhang Ming-jian, Li Xiao-bing, Han Wei-xin, Li Jin-qiao. Three-dimensional bioprinting of tissue/organ analogues: a review on techniques, materials and processes [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(10): 1611-1617.
[15]	Chen Yan-qu, Tang Min, Huang Xuan-ping, Zhou Feng-cheng, Wang Jia-xi. The computer-aided design and manufacturing of individualized miniscrew surgical guides based on a high-precision three-dimensional integrated digital maxillodental model [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(10): 1529-1533.