Background

With modelling and simulation (or in silico) techniques, patient-specific optimization algorithms represent promising tools to support the surgical decision-making process, particularly in 3D correction of adolescent idiopathic scoliosis, where the best intraoperative instrumentation strategy and the correction goals are debated.

Methods

1080 biomechanical intraoperative simulations of a representative pediatric thoracic curve were run according to a full-factorial design approach. Widely accepted instrumentation configurations (5 screw patterns, 4 upper and 3 lower instrumented vertebrae, 6 rod curvatures and 3 rod stiffnesses) were analyzed, assuming concave rod rotation and en bloc derotation as main correction maneuvers. Results in terms of 3D correction and mobility were rated using an objective function for thoracic scoliosis also including surgeon-dependent correction objectives. An extensive sensitivity analysis on correction objectives was performed.

Findings

Multiple optimal strategies were identified, depending on the selected correction objective. They provided significantly better coronal (67% vs. 55%) correction, using comparable instrumented levels (9.9 ± 1.6 vs. 10.7 ± 2.1), screw patterns and significantly higher implant density (1.6 ± 0.3 vs. 1.4 ± 0.2 screws/vertebra) compared to worst ones. Optimal strategies typically included the neutral and the last touching vertebrae in the construct and high stiffness (CoCr, 6 mm) differentially/highly contoured rods.

Interpretation

The computerized algorithm determined the best instrumentation parameters to achieve optimal correction for the considered thoracic case. Multiple clinically equivalent strategies may be used, as supported by the variety of considered correction objectives. The current approach could be translated to any scoliotic curves, including surgeon preferences in terms of instrumentation parameters, intraoperative correction maneuvers and correction objectives.

中文翻译：

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在计算机上针对患者的胸廓特发性脊柱侧弯矫正策略的患者特定优化

背景

随着建模和模拟（或硅）技术，患者特异性优化算法代表有前途的工具来支持手术的决策过程，特别是在青少年特发性脊柱侧凸，其中最好的手术仪器战略和校正目标存在争议的3D校正。

方法

根据全因子设计方法进行了代表性的小儿胸廓曲线的1080次生物力学术中模拟。分析了广泛接受的仪器配置（5种螺钉样式，4种上部和3种下部仪器化的椎骨，6种杆的曲率和3种杆的刚度），并假设杆的转动是凹进的并且整体旋转是主要的校正方法。使用针对胸椎侧凸的目标函数（还包括依赖于医生的矫正目标）对3D矫正和活动性方面的结果进行了评分。对校正目标进行了广泛的敏感性分析。

发现

根据所选的校正目标，确定了多种最佳策略。通过使用可比较的仪器水平（9.9±1.6 vs 10.7±2.1），螺钉样式和显着更高的植入物密度（1.6±0.3 vs. 1.4±0.2螺钉/椎骨），他们提供了显着更好的冠状矫正（67％比55％）。与最坏的相比。最佳策略通常包括构造中的中性椎骨和最后接触的椎骨，以及高刚度（CoCr，6 mm）的差异/高轮廓杆。

解释

该计算机算法确定了最佳仪器参数，以针对所考虑的胸腔情况实现最佳校正。可以使用多种临床上等效的策略，并得到各种考虑的校正目标的支持。当前的方法可以转换为任何脊柱侧弯曲线，包括外科医生在仪器参数，术中矫正操作和矫正目标方面的偏好。