本文選題：Quadrant系統(tǒng) + 腰椎弓根螺釘��； 參考：《中國修復(fù)重建外科雜志》2017年02期

【摘要】：目的探討Quadrant系統(tǒng)微創(chuàng)通道下3D打印導(dǎo)航模塊輔助腰椎精準(zhǔn)植釘?shù)目尚行约隘熜�。方法�?2具成人尸體腰椎(L1~5)標(biāo)本,經(jīng)CT掃描及三維重建,于Mimics軟件中構(gòu)建通過椎弓根中心長軸的釘?shù)?根據(jù)骨面可剝離范圍設(shè)計(jì)并3D打印導(dǎo)航模塊。在尸體標(biāo)本上實(shí)施導(dǎo)航模塊輔助下腰椎椎弓根螺釘植入后,再次CT掃描并三維重建,對(duì)手術(shù)前后重建模型進(jìn)行三維配準(zhǔn),評(píng)價(jià)植釘符合率。2014年11月—2015年11月,對(duì)31例退行性腰椎不穩(wěn)患者行Quadrant系統(tǒng)微創(chuàng)通道下3D打印導(dǎo)航模塊輔助植釘術(shù)。男14例,女17例;年齡42~60歲,平均45.2歲。病程6~13個(gè)月,平均8.8個(gè)月。單節(jié)段15例,兩節(jié)段13例,三節(jié)段3例。術(shù)前疼痛視覺模擬評(píng)分(VAS)為(7.59±1.04)分,Oswestry功能障礙指數(shù)(ODI)評(píng)分為(76.21±5.82)分,日本骨科協(xié)會(huì)(JOA)評(píng)分(9.21±1.64)分。結(jié)果12具標(biāo)本共植入120枚螺釘,三維配準(zhǔn)顯示植釘符合率100%。臨床31例患者共植入162枚螺釘。手術(shù)時(shí)間65~147 min,平均102.23 min;術(shù)中出血量為50~116 m L,平均78.20 m L;術(shù)中輻射暴露時(shí)間為8~54 s,平均42 s。術(shù)后3~7 d三維配準(zhǔn)顯示植釘符合率為98.15%(159/162)。術(shù)后4周VAS評(píng)分為(2.24±0.80)分,ODI評(píng)分為(29.17±2.50)分,JOA評(píng)分為(23.43±1.14)分,與術(shù)前比較差異均有統(tǒng)計(jì)學(xué)意義(t=14.842,P=0.006;t=36.927,P=0.002;t= 36.031,P=0.001)。31例患者均獲隨訪,隨訪時(shí)間8~24個(gè)月,平均18.7個(gè)月。術(shù)后切口均Ⅰ期愈合,無手術(shù)并發(fā)癥發(fā)生。隨訪期間復(fù)查腰椎X線片及CT顯示椎弓根螺釘準(zhǔn)確在位,無松動(dòng)、斷裂,椎間植骨融合良好。結(jié)論Quadrant系統(tǒng)微創(chuàng)通道下采用3D打印導(dǎo)航模塊可以實(shí)現(xiàn)手術(shù)微創(chuàng)、少輻射及精準(zhǔn)植釘目的。
[Abstract]:Objective to investigate the feasibility and efficacy of 3 D print navigation module assisted precise screw implantation in Quadrant system. Methods 12 adult cadavers with L1 ~ (5) lumbar vertebrae were examined by CT scanning and 3D reconstruction. The nail passage through the long axis of the pedicle was constructed in the mimics software. According to the range of bone dissection, the navigation module was designed and 3D printed. After the pedicle screw implantation was performed on the cadavers, CT scanning and 3D reconstruction were performed again, the reconstruction model before and after operation was registered, and the coincidence rate of screw implantation was evaluated. November 2014 to November 2015. Thirty-one patients with degenerative lumbar spine instability were treated with 3 D print navigation module under Quadrant system. There were 14 males and 17 females, aged 42 to 60 years (mean 45.2 years). The course of disease ranged from 6 to 13 months (mean 8.8 months). There were 15 cases with single segment, 13 cases with two segments and 3 cases with three segments. The preoperative pain visual analogue score (VAS) was 7.59 鹵1.04, and the Oswestry dysfunction index (ODI) score was 76.21 鹵5.82, and the Japanese Orthopedic Association (JOAA) score was 9.21 鹵1.64. Results 120 screws were implanted in 12 specimens. A total of 162 screws were implanted in 31 patients. The operative time was 65 ~ 147min (mean 102.23 mins), the blood loss was 50 ~ 116mL (mean 78.20mL), the radiation exposure time was 854 s (mean 42s). Three dimensional registration on 3 ~ 7 days after operation showed that the coincidence rate of implant nail was 98.15 / 162%. At 4 weeks after operation, the VAS score was 2.24 鹵0.80 and the ODI score was 29.17 鹵2.50. The JOA score was 23.43 鹵1.14, and the difference was statistically significant compared with that before operation. The difference was statistically significant (t = 36.927p 0.002t = 36.031P0.001P 0.002t = 36.031P 0.001n = 36.031), and the follow-up time was 824 months (mean 18.7 months). All the incisions healed in one stage, and no complications occurred. During the follow-up period, X-ray and CT findings showed that the pedicle screw was in the correct position, no loosening and fracture, and good fusion of intervertebral bone graft. Conclusion using 3D print navigation module in Quadrant system can achieve minimally invasive, less radiation and precise nail implantation.
【作者單位】： 福建醫(yī)科大學(xué)莆田學(xué)院附屬醫(yī)院教學(xué)醫(yī)院骨科南方醫(yī)科大學(xué)附屬莆田醫(yī)院骨科莆田學(xué)院附屬醫(yī)院骨科;
【基金】：福建省中青年教師教育科研項(xiàng)目(JA14274) 福建省自然科學(xué)基金項(xiàng)目(2016J01607) 福建省衛(wèi)生和計(jì)劃生育委員會(huì)青年科研課題(2015-2-32) 福建省醫(yī)學(xué)創(chuàng)新課題(2012-CX-34)~~
【分類號(hào)】：R687.3

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