The Three Dimensional Measurement And Analysis In The Evaluation Of Congenital Scoliosis And Design Of Personalized Surgical Plan

ObjectiveThe study put emphasis on applying the computer-assisted technology, and created a set of new methods of disgnosis and treatment of congenital scoliosis:1.By using CAD software, three-dimensional reconstrction of the whole spine of normal human skeletal system was taken, and the relevant parame ters of the spinal model, as a standardized reference object, were measur ed accurately.2. Three-dimensional reconstrction of the whole spine of CS patients was taken, and the relevant parameters of CS patients was measured accurat ely to analyse the morphology of scoliosis, charateristics of deformity, balance and rotation of spine synthetically and precisely. Then a set of3D measurement method of congenital scoliosis was created. The parameters of CS patients was compared with those of the normal human skeletal syst em. Through analyzing the difference between two groups of data, which he lped to guide the design of the treatment.3. According to the first two steps of the measurement and analysis, a report to evaluate and analysis CS were created and the plan of treatme nt was formulated in order to improve the security and accuracy of surger y.Methods1. The segmentation of spinal CT was output into DICOM data. Every ve rtebral was divided by3D reconstruction after exporting the DIMCOM data by mimics software and converted the format into STL.3D measurements of normal human skeletal system quantifying the cervical lordosis, thoracic kyphosis, thoracolumbar junction kyphosis, lumbar lordosis, pelvic incide nce, sacrum slop, pelvic tilt were standardizedly computed by imageware s oftware.2. The parameter of CS patients including hemivertebral deviation, he mivertebral wedging, cobb’s angle, trunk axis line, center sacral vertebr ae line, scoliotic deformities and imbalance, cervical lordosis, thoracic kyphosis, thoracolumbar junction kyphosis, lumbar lordosis, pelvic incid ence, sacrum slop, pelvic tilt, rotation of vetebra, the shape and pose o f the hemivertebra, stable vertebrae, apex, upper and lower end vertebra was quantified, whose data were made a comparison with those of normal hu man skeletal system.3. According to the data above a report of evaluating and analyzing C S was developed to help to formulate the CS treatment plan. In the part o f surgical treatment design, surgical segment, parameters of pedicle scre ws including number, length and diameter. Computer-assisted templates for CS as pedicle-guiding template, fixation rod template and even osteotomy template for severe CS patients were designed innovatively by CAD softwa re.Results1. Among the mean of20normal persons’data, cervical lordosis was24.9725°±2.9068°, thoracic kyphosis was25.5905°±4.4872°, thoraciclu mbar junction kyphosis was1.8953°±4.9457°, lumbar lordosis was44.6841°±6.0539°, pelvic incidence was39.7093°±6.0539°, sacral slope was36.4440°±3.5449°, pelvic tilt was7.9687°±3.8070°2. The data of one CS patient:hemivertebra deviation was25.7984mm, hemivertebral wedging was81.2290°, cobb’s angle of sagittal view was2.4045°, cobb’s angle of coronal view was65.9991°, The trunk imbalance a ngle was4.7139°.distance from centers to TAL(distance from hemivertebra1center to TAL was86.4465mm, distance from L2center to TAL was70.3903mm, distance from L1center to TAL was56.1080mm, distance from L4cente r to TAL was57.7228mm, distance from L5center to TAL was35.5076mm), ce rvical lordosis was-21.2808°, thoracic kyphosis was9.0344°, thoracicl umbar junction kyphosis was11.7951°, lumbar lordosis was45.1930°, pelvi c incidence was38.8717°, sacral slope was33.8001°, pelvic tilt was11. 7604°, the rotations of L5. L4, L2, L1respectively were29.8374°,31.7369°,48.3985°,24.5037°.3. The average preoperative Cobb’s angle of scoliosis was41.5°, and the average Cobb’s angle of kyphosis was28.9°. Preoperative3D digital designs for surgery were performed for all the patients. Intraoperative pedicle screw placement was accurate and rapid, and the mean operative ti me was5.6h. The average blood loss was1363.6ml. Postoperative deformi ty correction was excellent in all the patients. The average postoperativ e Cobb’s angle of scoliosis was4.0°(correction rate92.30%, P<0.05), a nd the average postoperative Cobb’s angle of kyphosis was16.2°(correct ion rate44.03%, P<0.05). Patients were followed from8months to57mont hs, and the average duration of follow-up was27.6months. According to1ast follow-up, the average postoperative Cobb’s angle of scoliosis was3.9°, and the average postoperative Cobb’s angle of kyphosis was15.0°. T here were no statistical differences between postoperative results and la st follow-up results (P>0.05).ConelusionAim at the complicacy and diversity of CS, it was an innovative trial to undergo the3D analysis and evaluation of CS anatomy, and also formul ate a personal treating plan. The trial will provide benefit for the diag nostic and treating development of CS. The type and severity of CS will b e evaluated precisely in order to improve the quality of treatment.