CN101374470B - 确定椎弓根底周、椎弓根峡部和椎弓根峡部中心的方法 - Google Patents

确定椎弓根底周、椎弓根峡部和椎弓根峡部中心的方法 Download PDF

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CN101374470B
CN101374470B CN2007800033446A CN200780003344A CN101374470B CN 101374470 B CN101374470 B CN 101374470B CN 2007800033446 A CN2007800033446 A CN 2007800033446A CN 200780003344 A CN200780003344 A CN 200780003344A CN 101374470 B CN101374470 B CN 101374470B
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赫克托·O·帕切科
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Abstract

在脊柱外科手术期间，为便于在椎体的椎弓根中置入螺钉而确定椎弓根底周和椎弓根峡部的方法，包括提供与所述椎体的外部皮质表面相切的、在来自所述椎体三维图像的横断面上的椎弓根之中或靠近所述椎弓根，提供一系列的第一线条；提供一系列的第二线条，其穿过所述椎体、处于所述椎体的椎弓根之中或靠近所述椎弓根，垂直于所述一系列的第一线条；将所述椎弓根底周定义为所述外部皮质表面中相邻第二线条彼此呈最大角度的区域；将所述椎弓根峡部定义为所述外部皮质表面中彼此相对的第二线条相互最靠近并平行的区域。所述椎弓根峡部的中心被定义为两个线条的交叉点，所述两个线条来自从所述外部皮质表面延伸出的正交的第二线条的中心。

Description

确定椎弓根底周、椎弓根峡部和椎弓根峡部中心的方法 
本申请要求在2006年1月24日递交的美国临时专利申请第60/761,365号的利益。 
发明领域
本发明主要涉及脊柱外科领域，涉及在脊柱外科中精确放置椎弓根螺钉或器械的计算机化或自动化的方法，特别涉及确定椎弓根底周(pediclebase circumference)、椎弓根峡部和椎弓根峡部中心的方法。 
发明背景 
将螺钉放入人脊柱中是一种普通的外科程序，它使得众多脊柱外科手术得以进行。螺钉通常被放置在腰骶椎的单个椎骨的椎弓根中。由于它们相比于其他固定方法存在的生物力学优势，外科医生正在扩大脊柱(椎弓根螺钉被放在其中)的面积。但是，与脊柱临近的是许多极其重要的结构和器官，特别是颈椎和胸椎区域，它们对手术引起的创伤有很低的耐受性，这可能最终导致严重的疾病和/或死亡。因此，大部分对椎弓根螺钉放置的研究都致力于提高精确度，以将螺钉维持在多骨(骨内)环境中。 
影像导引系统正不断发展，其在辅助外科医生精确放置螺钉中越来越受到欢迎。将椎弓根螺钉置入人脊柱的重要参素是螺钉的直径、长度和精确放置的路径(trajectory)。迄今，许多影像导引系统使得可以手动确 定这些参数，以改善外科医生在放置螺钉时的手动操作。至今，没有任何系统可以自动确定理想的椎弓根螺钉直径、长度和精确放置椎弓根螺钉的路径。本发明提供这种能力，它类似于飞行员驾驶具有电脑控制的航空性能的飞机，使得利用创伤或经皮技术放置椎弓根螺钉。 
2004年12月2日公开的发明专利公开第US 2004/0240715 A1号涉及在脊柱外科手术中确定椎弓根螺钉放置的方法和电脑系统。其公开了一种方法，其首先确定最小的椎弓根直径，用来确定最佳的螺钉路径，随后利用每个椎弓根螺钉的最佳路径来确定最大的椎弓根直径和长度。堆栈(stack)二维横断切片(transverse slice)数据以形成三维数据点，以通过线性最小二乘解确定最佳路径来拟合数据，并要求所述线性最小二乘解在整个最小横断椎弓根宽度上进行。这个方法的缺点在于，它可确定出异常的路径，特别是对于变形的椎弓根骨骼更是如此，结果是确定的螺钉的最佳直径和长度较小，导致产生生物力学较差的构造。相反，如下文所详细描述的，本发明的新的和改进的方法通过确定最佳路径，从而始终将路径沿椎弓根的中心排布，其中通过利用最小横截面(峡部)的中心位点并使用计算机在相反方向正交于(normal to)所限定的区域伸出线条。本发明的新的和改进的方法可为骨内放置确定最大的螺钉直径和长度。 
2005年9月1日公开的美国申请公开第2005/0192575 A1号涉及一种确定理想椎弓根螺钉直径、长度和路径的方法，其中有关于椎弓根与椎体结合的过渡界面(transitional interface)的描述。此过渡界面描述了椎弓根底周(B)，其在前后X射线成像仪(anteroposterior radiographicimaging)上呈圆形皮质密度(round like cortical density)，位于椎体的靠近头部的侧面。此椎弓根底周的重要特点在于，它不同于椎弓根峡部(X，椎弓根中最狭窄的区域)，但有时可以是相同的。椎弓根峡部是使 最大直径的椎弓根螺钉最大化而不会破裂皮质的限速步骤。为了在任何给定的椎弓根中使椎弓根螺钉的直径最大化，必须确定椎弓根峡部。随后，所述椎弓根峡部的中心可用来确定理想的路径，因而可以让椎弓根螺钉沿所述理想的路径同轴放置。 
本申请涉及确定椎弓根底周、椎弓根峡部和椎弓根峡部中心的新的和改进的方法。 
发明概述 
根据本发明的方法，通过任何适合的方式获得椎体的任何平面中的连续堆栈图像(serial stacked images)。这些图像随后被重建，以获得尺寸真实的椎体的三维透视图。以三维和二维图像绘制所述椎弓根底周和椎弓根峡部。 
一旦获得了椎体的真实三维透视图，其随后截取其一个横断面以显现并获得外部皮质层。随后沿所述外部皮质表面的切线方向绘制一系列的第一线条。然后，垂直于所述位于外部皮质表面的切线绘制一系列的第二线条，所述第二线条位于椎体中。 
在所述椎弓根及其向椎体的过渡部分的区域，所述第二线条将用于分辨所述椎弓根底周和椎弓根峡部。具体地，所述椎弓根底周是指相邻第二线条彼此呈最大角度、非线性或不调和的区域。所述椎弓根峡部是指相对的第二线条彼此最平行的区域。所述外部皮质表面上的无穷小的位点(Infinitesimal points)被用来排布所述第一切向平面线条以及它们各自的第二垂直线条。 
定义所述椎弓根峡部后，就需要定义椎弓根峡部的中心，以用来确定同心路径和建造椎弓根圆柱体。虽然许多椎弓根具有椭圆形或不规则体积， 但大多数椎弓根仍被概念化地认为是圆柱形的。这样，就有必要精确地确定这些椎弓根的中心。本发明的方法利用由所述椎弓根峡部定义的截面，随后将位于两个线条交叉点的位点定义为此截面的中心，所述两个线条来自所述外部皮质表面的正交(infinitesimal orthogonal)的第二垂直线条的中心。此方法可以不考虑椎弓根的形状就能确定椎弓根峡部的中心。 
附图简述 
图1A是椎体径向图像的示意图； 
图1B是椎体横向图像的示意图； 
图2是图1B中所示椎体的示意图； 
图3是图2中所示椎体的椎弓根部分的示意图，显示了如图2中所示的正交平面线条及它们各自的垂直线条； 
图4A是椎体纵向图像的示意图，显示了根据本发明方法确定的椎弓根底周和椎弓根峡部的位置； 
图4B椎体横向图像的示意图，显示了根据本发明方法确定的椎弓根底周和椎弓根峡部。 
图4C是椎体冠状图像的示意图，显示了根据本发明方法确定的椎弓根底周和椎弓根峡部的位置； 
图5A是椎弓根峡部横截面的示意图，显示了根据本发明方法确定的椎弓根峡部的中心； 
图5B是具有不规则形状的椎弓根峡部的横截面的示意图，显示了根据本发明方法确定的椎弓根峡部的中心； 
图5C是具有不同不规则形状的椎弓根峡部横截面的示意图，显示了根据本发明方法确定的椎弓根峡部的中心。 
优选实施方式的描述 
椎弓根底周和椎弓根峡部的确定
根据本发明的方法，通过任何适合的方式获得椎体10的任何平面中的连续堆栈图像(serial stacked images)。这些图像随后被重建，以获得尺寸真实的椎体10的三维透视图。如图1A和1B所示，用三维和二维图像绘制所述椎弓根底周B和椎弓根峡部X。 
一旦获得了椎体10的真三维透视图，其随后在横断面上被分割以显现并获得外部皮质层。随后沿所述外部皮质表面12的切线方向绘制一系列的第一线条T。然后，垂直于所述位于外部皮质表面12的第一线条T绘制一系列的第二线条P，所述第二线条P位于椎体10中。其在图2中图示，作为说明性的例子，图2只描绘了两条第一切线T和两条第二垂直线P。 
在所述椎弓根14及其向椎体10的过渡部分的区域，所述第二垂直线条P将用于分辨所述椎弓根底周B和椎弓根峡部X。具体地，所述椎弓根底周B是指相邻第二垂直线条P彼此呈最大角度A、非线性或不调和的区域。相反地，所述椎弓根峡部X是指相对的第二垂直线条P彼此最平行的区域。所述外部皮质表面上的无穷小的位点被用来排布所述第一切向线条T以及它们各自的第二垂直线条P。其示意性地显示在图3中。 
如图4A、4B和4C所示，来自无限多个的横切面(TS1、TS2、TS3...)用来定义所述椎弓根底周B和椎弓根峡部X的点随后被比较以取定所述椎弓根底周B和椎弓根峡部X的解剖学三维位置。图4B和4C显示了横切面TS2穿过椎弓根14的中心，及其分别在横向和冠状突出部上的相应位点。 
椎弓根峡部中心的确定
定义所述椎弓根峡部X后，就必须进一步定义椎弓根峡部的中心C。需要用它来确定同心路径和建造椎弓根圆柱体。大多数椎弓根仍被概念化 地认为是圆柱形；但是，许多椎弓根具有椭圆形或不规则体积。这样，就有必要精确地确定这些椎弓根的中心。如图5A、5B和5C所示，本发明的方法利用由所述椎弓根峡部X定义的截面，随后将位于两个线条交叉点的位点定义为此截面的中心C，所述两个线条来自所述外部皮质表面的正交的第二垂直线条P的中心。如图5A、5B和5C所示，此方法可以不考虑不同椎弓根的形状就能确定椎弓根峡部的中心。 
很容易看到，本发明的方法提供了确定椎弓根底周、椎弓根峡部和椎弓根峡部中心的简单可靠的方法，其让椎弓根螺钉沿着理想的路径被同心地放置。这些方法可以通过任何合适的方式实现，例如通过使用计算机等的视觉成像实现，或通过二维截面手动实现。 
虽然本发明已结合现在认为是最佳实施方式来描述，但要理解的是，本发明并不局限于所揭露的实施方式，相反，本发明有意涵盖在所附权利要求书范围内的所有修改和等同变化。 

Claims (6)

1.一种确定椎弓根底周和椎弓根峡部的方法，其包括：
产生椎体的三维图像；
通过取所述三维图像的一个横断面以产生所述椎体的外部皮质层的图像；
在所述横断面上提供一系列的与所述椎体的外部皮质表面相切、在所述椎弓根中和靠近所述椎弓根的第一线条；
提供一系列垂直于所述一系列的第一线条的第二线条，所述第二线条延伸穿过所述椎体，并处于椎体的椎弓根之中或靠近所述椎弓根；
将所述椎弓根底周定义为所述外部皮质表面中相邻第二线条彼此呈最大角度的区域；
将所述椎弓根峡部定义为所述外部皮质表面中彼此相对的第二线条相互最靠近并平行的区域。
2.权利要求1所述的方法，其特征在于，无穷小的位点被用于所述外部皮质表面，以排布所述第一线条和所述第二线条。
3.权利要求2所述的方法，其特征在于，所述椎弓根底周和椎弓根峡部的解剖学三维图像位置是通过比较无限个、以定义所述椎弓根底周和椎弓根峡部的横断面来确定的。
4.权利要求1所述的方法，其特征在于，该方法进一步包括将两个线条的交叉点定义为取自椎弓根峡部的横断面的中心，所述两个线条来自从所述外部皮质表面延伸出的正交的第二线条的中心。
5.权利要求1所述的方法，其特征在于，所述方法是通过计算机生成的图像来操作的。
6.权利要求1所述的方法，其特征在于，所述方法是通过所述椎体的二维界面手动操作的。
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