摘要目的 探讨应用Mimcs软件对胸腔镜下胸椎侧凸前路松解术胸壁锁孔的术前个体化设计的可行性及优点.方法 2009年3月至2010年9月收治特发性脊柱侧凸患者9例,男3例,女6例；12 ～18岁,平均14.7岁;脊柱侧凸采用Lenke分型:Ⅰ型3例,Ⅱ型6例.术前主胸弯cobb角85°～110°,平均96°;柔软率15％ ～29％,平均25.3％,术前利用Mimics软件和CT数据完成锁孔个体化设计并应用于临床完成脊柱松解术,二期行后路的矫形、内固定及植骨融合. 结果 9例患者均完成镜下脊柱松解(6例患者松解5个椎间隙,3例患者松解6个椎间隙),其中5例患者选择4个锁孔,4例患者选择3个锁孔.手术时间为85～150 min(平均113 min),术中出血量为200 ～400 mL(平均275mL) ;术后均未出现呼吸衰竭及其他严重并发症；矫形率52％～69％(平均57.6％),外观改善明显.9例患者经个体化设计的各孔(32孔)位置较常规设计开孔位置均后移约1～7 cm(平均3.5cm). 结论 应用Mimics软件对胸腔镜下胸椎侧凸前路松解术胸壁锁孔的术前个体化设计可提供理想的开孔位置,有利于术中操作.

abstractsObjective To investigate the feasibility and advantage of using Mimics software to individually design chest portals preoperatively in thoracoscopic anterior release for patients with thoracic scoliosis.Methods This series consisted of 3 males and 6 females,with an average age of 14.7 years (ranging from 12 to 18 years).By Lenke classification,there were 3 cases of type Ⅰ and 6 rases of type Ⅱ.Their preoperative main thoracic Cobb angles at the coronal plane ranged from 85° to 110°( average,96°)、and their average flexibility was 25.3％ (from 15％ to 29％ ).Before operation,CT data of the patients ( including spine and thorax) were imported into the Mimies software to complete design for chest portals (ineluding the number and site) for each individual patient.The individually designed chest portals were used in clinic anterior spinal release to correct the stiff curve.Posterior correction,internal fixation,bone graft and fusion were carried out in the secondary surgery for the scoliosis. Reslts All the 9 cases completed anterior spinal release under thoracoscopy.Five intervertebral spaces were released in 6 rases,and 6 in 3.Four partals were designed for 5 patients and 3 portals for the rest 4 cases.The operative time ranged from 85 to 150 minutes (average,113 minutes),and blood loss ranged from 200 to 400 mL(average,275 mL) during the operation.No respiratory failure,death or other serions complications occurred after the operation.The last correction rates after 2 operations ranged from 52％ to 69％ (average,57.6％ ).Appearances of the patients were greatly improved.The positions of individually designed 32 portals for the 9 patients were 1 to 7 cm (average,3.5 cm) more backward than those conventionally designed. Conclusions Mimics software can be used to individually design preoperative chest portals in thoracoscopic anterior release for patients with thoracic scoliosis.The individual design can be completed in computer and thus provide ideal positions to facilitate the opetation.