| 刘刚,刘斌,方宇,等.3D打印个性化导板辅助在上颈椎后路椎弓根钉置入中的初步临床应用.骨科,2019,10(5): 390-394. |
| 3D打印个性化导板辅助在上颈椎后路椎弓根钉置入中的初步临床应用 |
| Clinical application of 3D printed personalized guide plate in pedicle screw implantation via upper cervical vertebra and posterior approach |
| 投稿时间：2019-07-21 |
| DOI：10.3969/j.issn.1674-8573.2019.05.005 |
| 中文关键词: 3D打印导板 上颈椎 椎弓根钉置入 |
| 英文关键词: 3D printed guide plate Upper cervical spine Pedicle screw placement |
| 基金项目:内蒙古自治区应用技术研究与开发计划（KJT14GX20） |
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| 中文摘要: |
| 目的 探讨3D打印制作个体化颈椎椎弓根螺钉导板辅助上颈椎后路椎弓根钉置入的效果。方法 回顾性分析2013年10月至2018年10月于我院行3D打印导板辅助上颈椎后路椎弓根钉置入内固定治疗的32例颈椎疾病病人的临床资料，寰枢椎骨折15例（Jefferson分型前弓骨折6例、后弓骨折5例、前后弓同时骨折1例、单纯侧块骨折3例），寰枢椎脱位17例。所有病人术前行颈椎三维CT检查，采用Mimics V17.0对目标椎体进行三维重建，3D打印机打印个体化颈椎椎弓根螺钉导板，在导板辅助下置钉。应用疼痛视觉模拟量表（visual analogue scale, VAS）评分、日本骨科协会（Japanese Orthopaedic Association, JOA）颈椎神经功能评分评估手术前后病人颈椎疼痛程度、颈椎神经功能，并于术后进行CT复查，判断螺钉置入准确度，术后钉道内倾角和头倾角与术前设计的差异。结果 32例病人均顺利完成手术，术中导板与椎体后方骨性结构均紧密贴合，共置入椎弓根螺钉127枚，其中C1：64枚，C2：63枚。寰枢椎骨折组手术时间短于寰枢椎脱位组［（183.21±43.02） min vs. （236.62±54.51） min，P＜0.05］，两组术中出血量［（135.52±50.73） ml vs. （185.85±26.95） ml］的差异无统计学意义（P＞0.05）。颈椎术后钉道内倾角和头倾角与术前设计的差异均无统计学意义（P＞0.05）。与术前比较，寰枢椎骨折病人和寰枢椎脱位病人术后VAS评分均显著下降（P＜0.05），JOA评分均显著上升（P＜0.05）。术中未出现并发症，术后并发症发生率为12.50%（4/32），均经对症治疗后好转。结论 3D打印导板辅助可降低上颈椎后路椎弓根钉置入内固定手术的风险，置钉准确度高，术中损伤小，术后并发症少。 |
| 英文摘要: |
| Objective To investigate the effect of 3D printing of individualized cervical pedicle screw guide plate to assist the placement of upper cervical posterior pedicle screw. Methods Thirty-two patients with cervical spine diseases who were scheduled to receive internal fixation treatment with 3D printed guide plate assisted upper cervical posterior pedicle screw in our hospital from October 2013 to October 2018 were analysed retrospectively. There were 15 cases of atlantoaxial fracture (6 cases of anterior arch fracture, 5 cases of posterior arch fracture, 1 case of simultaneous anterior and posterior arch fracture, and 3 cases of simple lateral block fracture. ) and 17 cases of atlantoaxial dislocation. Preoperative three-dimensional CT examination of cervical spine was performed on all patients. Mimics 17.0 software was used for 3D reconstruction of the target vertebra. The 3D printer printed personalized cervical pedicle screw guide plate and screw placement with guide plate assistance. Visual analogue scale (VAS) score and Japanese orthopaedic association (JOA) score were used to evaluate the degree of pain and nerve function of cervical vertebra before and after surgery. Postoperative CT reexamination was conducted to determine the accuracy of screw placement, the difference of internal inclination angle and head inclination angle of screw canal from preoperative design. Results All the 32 patients successfully completed the operation, and the intraoperative guide plate was tightly attached to the posterior bony structure of the vertebral body. A total of 127 pedicle screws were inserted, including C1 64 and C2 63. The operation time of atlantoaxial fracture group was shorter than that of atlantoaxial dislocation group ［(183.21±43.02) min vs. (236.62±54.51) min, P＜0.05］. There was no significant difference in intraoperative blood loss between the two groups ［(135.52±50.73) ml vs. (185.85±26.95) ml (P＞0.05)］. Compared with pre-operative design, there was no significant difference in the internal inclination angle and head inclination angle of screw canal after cervical spine surgery (P＞0.05). VAS score of atlantoaxial fracture patients and atlantoaxial dislocation patients both were decreased significantly after surgery (P＜0.05), and JOA score increased significantly (P＜0.05). No complications occurred during the operation, and complication rate after operation was 12.50% (4/32) and alleviated after symptomatic treatment. Conclusion The 3D printed guide plate assist can reduce the risk of upper cervical vertebra posterior pedicle screw implantation internal fixation surgery, with higher accuracy, less intraoperative injury and fewer postoperative complications. |
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