Cervical Pedicle Screws Under The Individualization In The Clinical Application Research

Objective: The patients by preoperative CT data import into Mimics10.01and UG Imageware13.2to measure relevant anatomy of everysubaxial cervical vertebra, analysis and simulation of pedicle screwplacement, combined with the measurement and simulation data to guideand under intraoperative neural electrophysiological monitoring performsubaxial cervical pedicle screw placement, discusses its security, accuracyand its related problems.Methods:1. Preoperative corresponding segment of the cervicalpedicle screw fixation inpatients underwent CT scanning, the data intoMimics10.01and UG Imageware13.2on the subaxial cervical spine wereanatomic observation and measurement: Mimics10.01analyze the pedicleis completely; medial and lateral cortical bone thickness; cervical pediclecortical bone and cancellous bone width. In Imageware13.2measure thefollowing data after simulationscrew in vertebral:simulation screwmaximum length;angles between analog pedicle screw and terminal plateof vertebral, the distance between lateral mass incross-sectional and X point, the distance between lateral mass outer edge in sagittal plane and Xpoint; angles between simulation screw and sagittal line;internal、external、head and tail angle range of simulation screw,as the selectionand determine the individual screw placement reference.2. The individual screw insertion method in the treatment of vertebralbodies of cervical spondylosis in8cases,21cases of cervical fracture,respectively before operation on the reference to measurement andsimulation of fixed segment determine the entry point and direction,application of neurophysiological monitoring guide pedicle screw tractpreparation and operation (expanding), screw placement, after each patientsunderwent X-ray and CT scan examination, evaluation and analysis ofthe position and direction of the pedicle screw insertion.Results:1.(1) C3~C7pedicle width increases gradually, PSW inthe range of2.05~3.91mm, PW in the range of4.33～7.87mm, themaximum C7, minimum C3.(2) C3~C7angles between simulation ofscrew channel and sagittal line35.0126o～49.2996o，internal anglerange of simulation of screw channel in6.1126o～9.2196o,external anglerange of simulation screw in4.4731o～8.7796o；angles between simulationof screw channel and terminal plate of vertebral in12.6873o～-16.9618o,head angle range of simulation screw in2.5572o～5.8342o and tail anglerange of simulation screw channel in7.0632o～10.8942o；.(3) C3~C7simulation of screw channel length increases, in the range of26.8136~ 35.3419mm, where C7maximum, minimum C3.(4) the distance betweenlateral mass in cross-sectional and X point of C3~C7: the left2.5327±0.3146mm，2.1081±0.4947mm，3.0363±0.3118mm，3.6807±0.4129mm，3.5306±0.4962mm; right:2.3391±0.3229mm，2.1415±0.4373mm，3.1818±0.3089mm，3.6913±0.4316mm，3.3109±0.5336mm;the distance between lateral mass outer edge in sagittal plane and X point:left:1.9261±0.2057mm，2.1262±0.3313mm，2.5015±0.3366mm，2.4217±0.4416mm，2.6800±0.3328mm; right:1.9069±0.2161mm，2.2212±0.3393mm，2.5891±0.3369mm，2.5159±0.3136mm，2.6147±0.4863mm.2. Combined with the measurement results of the individual pediclescrew placement28cases, all of the pedicle screw place sucesscefully,1cases with single segment of unilateral vertebral artery injury, evaluation ofCT imaging: the fist class of screw is193pieces (accounting for93.8%),the screw completely in the pedicle structure in136; only slight penetration(<lmm57pieces,)to the outside. The second class of screws were12(accounting for5.7%). The third class screws in1piece (0.5%).Conclusion: Combined with Mimics and UG Imagewaremeasurement and simulation results and individualized under intraoperativeneural electrophysiological monitoring, pedicle screw placement accuracyis high, easy to clinical extensive application.