【摘要】：目的 :探討改良3D打印導(dǎo)航模板輔助寰樞椎椎弓根螺釘置釘?shù)臏?zhǔn)確性。方法:選擇我院2015年6月~12月期間行寰樞椎手術(shù)的患者17例,男11例,女6例;年齡25~56歲,平均43.3±8.7歲;寰樞椎骨折脫位13例,寰樞椎畸形4例。術(shù)前將患者的寰樞椎CT數(shù)據(jù)導(dǎo)入Mimics17.0軟件,生成目標(biāo)椎體的三維模型,使用逆向工程原理設(shè)計(jì)與其表面相吻合的反向模板及椎弓根螺釘最佳釘?shù)啦⑸上鄳?yīng)導(dǎo)向通道,標(biāo)桿相對(duì)通道向內(nèi)側(cè)平移約10mm,將導(dǎo)向通道及標(biāo)桿與模板擬合一體,設(shè)計(jì)形成帶有導(dǎo)向通道和標(biāo)桿的改良導(dǎo)航模板。將設(shè)計(jì)好的導(dǎo)板通過3D打印機(jī)打印出來。在3D模型上模擬置釘,體外試驗(yàn)確認(rèn)方案可行后再將改良導(dǎo)航模板消毒、滅菌并應(yīng)用于臨床。術(shù)中將改良3D打印導(dǎo)板與寰樞椎緊密貼合。術(shù)者分別以電鉆及手鉆通過導(dǎo)向通道,以標(biāo)桿為參照物及導(dǎo)向桿,通過導(dǎo)向通道鉆探螺釘通道后取下導(dǎo)板,攻絲后順釘?shù)乐萌胱倒葆�。將術(shù)前規(guī)劃釘?shù)琅c術(shù)后螺釘配對(duì)擬合進(jìn)行螺釘精確性分析,并以Kawaguchi等評(píng)價(jià)法判斷螺釘位置的優(yōu)劣等級(jí)。結(jié)果:手術(shù)時(shí)間106±11min,術(shù)中出血量為220±73ml。共置入68枚頸椎椎弓根螺釘,其中寰椎與樞椎各34枚。術(shù)前預(yù)設(shè)進(jìn)釘點(diǎn)、內(nèi)傾角及頭傾角與術(shù)后相比差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后Kawaguchi等評(píng)價(jià)法顯示:0級(jí)占97.06%(66/68),Ⅰ級(jí)占2.94%(2/68),有2枚螺釘穿破骨皮質(zhì),Ⅱ、Ⅲ級(jí)螺釘數(shù)為0。結(jié)論:通過改良3D打印導(dǎo)板輔助寰樞椎椎弓根置釘,可提高與術(shù)前預(yù)設(shè)最佳釘?shù)赖奈呛隙�、精確匹配術(shù)前計(jì)劃,可提高臨床手術(shù)置釘?shù)臏?zhǔn)確性,減少偏差。
[Abstract]:Objective: to investigate the accuracy of modified 3 D printing navigation template for atlantoaxial pedicle screw placement. Methods: from June to December 2015, 17 patients (11 males and 6 females) underwent atlantoaxial surgery in our hospital, aged 2556 years (mean 43.3 鹵8.7 years), atlantoaxial fracture and dislocation (13 cases) and atlantoaxial malformation (4 cases). Before operation, the atlantoaxial CT data were imported into Mimics17.0 software to generate a three-dimensional model of the target vertebral body, and reverse engineering principles were used to design the reverse template and the best nail path for pedicle screw, and to generate the corresponding guiding channel. The guide channel and the benchmarking bar are fitted with the template and the improved navigation template with the guide channel and the benchmark is designed. Print the designed guide plate through a 3 D printer. A 3D model was used to simulate nail placement. The improved navigation template was sterilized, sterilized and applied to clinical practice after in vitro test confirmed that the scheme was feasible. The modified 3 D printing guide was closely associated with the atlantoaxial vertebrae during the operation. Electric drill and hand drill were used to pass through the guide channel, and the standard rod was used as reference and guide rod. The guide plate was removed after drilling the screw passage through the guide channel, and the pedicle screw was placed along the nail path after tapping. The screw accuracy analysis was carried out by matching the preoperative planning nail path with the postoperative screw fitting, and the Kawaguchi evaluation method was used to judge the screw position. Results: the operative time was 106 鹵11 min and the intraoperative bleeding was 220 鹵73 ml. A total of 68 pedicle screws were inserted, including 34 atlas and 34 axial screws. There was no significant difference between preoperative preset point, internal inclination angle and head inclination angle compared with postoperative (P0.05). After operation, Kawaguchi et al showed that 0 grade accounted for 97.06% (66 / 68) and 鈪，

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