【摘要】：目的:探討三維(3D)打印導(dǎo)航模板輔助寰樞椎椎弓根螺釘置釘?shù)膬r(jià)值。方法:回顧性分析2013年1月~2015年10月我院收治的43例寰樞椎骨折和/或脫位患者,均行后路寰樞椎切開復(fù)位內(nèi)固定術(shù)。按手術(shù)方式不同分為3D打印導(dǎo)航模板組(19例)和傳統(tǒng)置釘組(24例)。3D打印導(dǎo)航模板組術(shù)前將患者的頸椎CT數(shù)據(jù)導(dǎo)入Mimics 17.0軟件,行3D重建并設(shè)計(jì)帶釘?shù)赖膶?dǎo)航模板后打印、消毒;術(shù)中將導(dǎo)航模板與置釘椎體貼合緊密后,通過定位孔鉆孔、置釘。傳統(tǒng)置釘組在C型臂X線機(jī)透視下徒手置釘。統(tǒng)計(jì)并對(duì)比兩種置釘方法的準(zhǔn)確率,通過測(cè)量并比較術(shù)前預(yù)設(shè)釘?shù)澜嵌扰c術(shù)后實(shí)際釘?shù)澜嵌炔町愒u(píng)估進(jìn)針角度的精確性。比較兩組的置釘時(shí)間、手術(shù)時(shí)間、透視次數(shù)、術(shù)中出血量及患者頸肩部疼痛視覺模擬評(píng)分(visual analogue scale,VAS)和日本骨科協(xié)會(huì)(Japanese Orthopaedic Association,JOA)頸椎神經(jīng)功能評(píng)分的差異情況。結(jié)果:兩組患者在性別、年齡、臨床診斷、病變節(jié)段、合并癥及術(shù)前是否牽引復(fù)位方面均無統(tǒng)計(jì)學(xué)差異(P0.05)。19例3D打印導(dǎo)航模板輔助置入椎弓根螺釘68枚,置釘準(zhǔn)確率94.1%,置釘時(shí)間2.2±0.4min/枚,透視次數(shù)4.6±1.1次,手術(shù)時(shí)間197±41min,術(shù)中出血量395±64ml;傳統(tǒng)徒手置釘組置入椎弓根螺釘76枚,置釘準(zhǔn)確率76.3%,置釘時(shí)間3.4±0.7min/枚,透視次數(shù)9.4±2.7次,手術(shù)時(shí)間245±67min,術(shù)中出血量552±79ml。兩組置釘準(zhǔn)確率、置釘時(shí)間、透視次數(shù)、手術(shù)時(shí)間及術(shù)中出血量均有統(tǒng)計(jì)學(xué)差異(P0.05)。3D打印導(dǎo)航模板組的內(nèi)傾角及頭傾角與預(yù)設(shè)值無統(tǒng)計(jì)學(xué)差異0.05),置釘角度的精確性明顯優(yōu)于徒手置釘組(P0.05)。術(shù)后3d、6個(gè)月及12個(gè)月患者頸肩部VAS及頸椎JOA評(píng)分較術(shù)前明顯好轉(zhuǎn)(P0.05),而術(shù)后6個(gè)月及12個(gè)月兩組間頸肩部VAS及頸椎JOA評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:3D打印導(dǎo)航模板輔助寰樞椎椎弓根置釘可提高置釘準(zhǔn)確率,同時(shí)還可縮短置釘時(shí)間、手術(shù)時(shí)間,減少透視次數(shù)和術(shù)中出血量。
[Abstract]:Objective: to evaluate the value of three-dimensional (3 D) print-guided template for atlantoaxial pedicle screw placement. Methods: 43 patients with atlantoaxial fractures and / or dislocations treated in our hospital from January 2013 to October 2015 were treated with posterior open reduction and internal fixation of atlantoaxial vertebrae. According to the different operation methods, the patients were divided into 3D print navigation template group (19 cases) and traditional nail placement group (24 cases). The cervical spine CT data were imported into Mimics 17.0 software before operation. The navigation template was tightly attached to the vertebral body during the operation, and the nail was inserted through the hole. The traditional nailing group was treated with C-arm X-ray machine. The accuracy of the two methods was analyzed and compared. The accuracy of the angle was evaluated by measuring and comparing the preset angle before and after operation. The time of nail placement, the time of operation, the times of fluoroscopy, the amount of blood lost during operation, the visual analogue score of neck and shoulder pain (visual analogue scaleVAS) and the (Japanese Orthopaedic Association of Japanese Orthopaedics Association (JOA) were compared between the two groups. Results: there was no significant difference between the two groups in sex, age, clinical diagnosis, pathological segment, complication and traction reduction before operation (P0.05). The accuracy of nail placement was 94.1cm, the time of insertion was 2.2 鹵0.4min/, the times of fluoroscopy was 4.6 鹵1.1, the operative time was 197 鹵41min, the amount of intraoperative bleeding was 395 鹵64ml, the accuracy rate of pedicle screw placement was 76.3 鹵0.7min/, and the times of fluoroscopy was 9.4 鹵2.7 times. The operative time was 245 鹵67 min and the intraoperative bleeding was 552 鹵79 ml. The accuracy of nail placement, the time of nail placement, the number of times of fluoroscopy in the two groups, The time of operation and the amount of intraoperative bleeding were significantly different (P0.05). There was no significant difference in inclinations and scalp angles between the three dimensional printing navigation template group and the preset value (0.05). The accuracy of the angle of nail placement was significantly better than that of the unarmed nail group (P0.05). The VAS and JOA scores of cervical shoulder and cervical vertebrae were significantly improved at 3 days, 6 months and 12 months after operation (P0.05), but there was no significant difference in VAS and JOA score between the two groups at 6 and 12 months after operation (P0.05). Conclusion the accuracy of pedicle screw placement can be improved, the time of nail placement, the time of operation, the times of fluoroscopy and the amount of blood lost during operation can be reduced by using the 3 D navigation template to assist atlantoaxial pedicle screw insertion.
【作者單位】： 延安大學(xué)附屬醫(yī)院脊柱外科;
【基金】：延安市科技惠民項(xiàng)目(編號(hào):2016HM-10-03)
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

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1 姜良海;譚明生;董亮;楊峰;移平;唐向盛;韋z延，

本文編號(hào)：2141875