中国修复重建外科杂志

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逐级扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用

吴超 1,2 , 邓佳燕 2 , 谭伦 1 , , 林旭 1 , 袁德超 1

1. 自贡市第四人民医院骨科中心（四川自贡 643000） ;
2. 自贡市第四人民医院数字医学中心（四川自贡 643000）

收稿日期: 2018-07-29;  修回日期:2018-12-24; 

基金项目: 四川省重点科技计划项目（2016JY0108）；四川省卫计委科研课题（17PJ144）；四川省医学会科研课题（2015GK016）

通讯作者: 谭伦, Email: 1098726536@qq.com

Accuracy analysis and clinical application of the progressive navigation template system to assist atlas-axial pedicle screw placement

WU Chao 1,2 , DENG Jiayan 2 , TAN Lun 1 , , LIN Xu 1 , YUAN Dechao 1

1. Department of Orthopedics, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China ;
2. Digital Medical Center, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China

Corresponding Author: TAN Lun, Email: 1098726536@qq.com

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目的 探讨逐级扩大型 3D 打印导板系统（简称逐级导板）辅助寰枢椎椎弓根植钉的准确性。 方法 回顾分析 2015 年 5 月—2017 年 5 月收治的 33 例寰枢椎后路内固定手术患者临床资料，按术中辅助植钉方式不同分为试验组（19 例，采用逐级导板辅助植钉）和对照组［14 例，采用初期单一导航模板（简称初期导板）］。两组患者性别、年龄、致伤原因、损伤节段及类型、术前 Frankel 分级等一般资料比较差异均无统计学意义（P>0.05），具有可比性。比较两组手术时间、术中出血量；于术后即刻 CT 片上采用 Kawaguchi 等方法评价螺钉植钉安全性，计算术后螺钉进钉点偏移量，按 Peng 等方法分别计算钉道在坐标系 XOZ、XOY、YOZ 平面的角度偏移量。 结果 患者均顺利完成手术；试验组手术时间及术中出血量均显著少于对照组（t=–2.360，P=0.022；t=–3.006，P=0.004）。两组患者均获随访，随访时间 12～40 个月，平均 25.3 个月。无重要血管损伤及神经损伤加重发生。术后即刻 X 线片及 CT 示脱位均得到纠正。螺钉植钉安全性评价显示，试验组 76 枚螺钉均为 0 级，植钉安全性 100%；对照组 0 级 51 枚、Ⅰ级 3 枚、Ⅱ级 2 枚，植钉安全性 91.1%；两组比较差异有统计学意义（χ2=7.050，P=0.030）。试验组螺钉进钉点偏移量和 XOY、YOZ 平面角度偏移量均显著小于对照组（P<0.05）；两组 XOZ 平面角度偏移量比较差异无统计学意义（t=1.060，P=0.290）。 结论 逐级导板辅助寰枢椎椎弓根螺钉内固定治疗寰枢椎骨折脱位，相比初期导板能减少手术时间和术中出血量，提高植钉安全性，更能精确匹配术前设计。

Objective To investigate the accuracy of progressive three-dimensional navigation template system (abbreviated as progressive template) to assist atlas-axial pedicle screw placement. Methods The clinical data of 33 patients with atlas-axial posterior internal fixation surgery between May 2015 and May 2017 were retrospectively analyzed. According to the different methods of auxiliary screw placement, the patients were divided into trial group (19 cases, screw placement assisted by progressive template) and control group (14 cases, screw placement assisted by single navigation template system, abbreviated as initial navigation template). There was no significant difference in gender, age, cause of injury, damage segments, damage types, and preoperative Frankel classification between the two groups (P>0.05). The operation time and intraoperative blood loss of the two groups were compared. The safety of screw placement was evaluated on postoperative CT by using the method from Kawaguchiet al, the deviation of screw insertion point were calculated, the angular deviation of the nailing on coordinate systems XOZ, XOY, YOZ were calculated according to Peng’s method. Results All patients completed the operation successfully; the operation time and intraoperative blood loss in the trial group were significantly less than those in the control group (t=–2.360, P=0.022; t=–3.006, P=0.004). All patients were followed up 12–40 months (mean, 25.3 months). There was no significant vascular injury or nerve injury aggravation. Postoperative immediate X-ray film and CT showed the dislocation was corrected. Postoperative immediate CT showed that all 76 screws were of grade 0 in the trial group, and the safety of screw placement was 100%; 51 screws were of grade 0, 3 of gradeⅠ, and 2 of gradeⅡ in the control group, and the safety of screw placement was 91.1%; there was significant difference in safety of screw placement between the two groups (χ2=7.050, P=0.030). The screw insertion point deviation and angular deviation of the nailing on XOY and YOZ planes in the trial group were significantly less than those in the control group (P<0.05). There was no significant difference in angular deviation of the nailing on XOZ between the two groups (t=1.060, P=0.290). Conclusion Compared with the initial navigation template, the progressive navigation template assisting atlas-axial pedicle screw placement to treat atlas-axial fracture with dislocation, can reduce operation time and intraoperative blood loss, improve the safety of screw placement, and match the preoperative design more accurately.

关键词: 寰枢椎; 椎弓根螺钉; 3D 打印

Key words: Atlas-axis; pedicle screw; three-dimensional printing

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1. Dienst M, Engelke C, Prokop M, et al. Unilateral osseous bridging between the arches of atlas and axis after trauma. Spine (Phila Pa 1976), 1999, 24(20): 2105-2108.
2. Tan M, Wang H, Wang Y, et al. Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976), 2003, 28(9): 888.
3. Barnes AH, Eguizabal JA, Acosta FL Jr, et al. Biomechanical pullout strength and stability of the cervical artificial pedicle screw. Spine (Phila Pa 1976), 2009, 34(1): E16-20.
4. Abumi K, Shono Y, Ito M, et al. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976), 2000, 25(8): 962-969.
5. 谭明生, 移平, 王文军, 等. 经寰椎" 椎弓根”螺钉内固定技术的临床应用. 中国脊柱脊髓杂志, 2006, 16(5): 336-340.
6. 张丙磊, 张强, 余枫, 等. 枢椎椎板螺钉固定的解剖学研究. 中国脊柱脊髓杂志, 2006, 16(1): 45-47.
7. 陈其昕, 沈金明, 李方财, 等. 寰椎侧块置钉安全区域的建立及其应用. 中华创伤杂志, 2006, 22(6): 404-407.
8. 覃炜, 权正学, 刘洋, 等. 寰枢椎椎弓根螺钉个体化导向模板的研制与实验研究. 中国修复重建外科杂志, 2010, 24(10): 1168-1173.
9. Jiang L, Dong L, Tan M, et al. Accuracy assessment of atlantoaxial pedicle screws assisted by a novel drill guide template. Arch Orthop Trauma Surg, 2016, 136(11): 1483-1490.
10. 胡勇, 袁振山, 谢辉, 等. 快速成型导向模板辅助下寰枢椎椎弓根螺钉置钉的偏差因素分析. 中华医学杂志, 2013, 93(33): 2659-2663.
11. Hu Y, Yuan ZS, Kepler CK, et al. Deviation analysis of atlantoaxial pedicle screws assisted by a drill template. Orthopedics, 2014, 37(5): 420-427.
12. 王飞, 刘志斌, 张建华, 等. 3D 打印导航模板在辅助寰枢椎椎弓根螺钉置入中的应用价值. 中国脊柱脊髓杂志, 2017, 27(1): 61-68.
13. Kawaguchi Y, Nakano M, Yasuda T, et al. Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide. Spine (Phila Pa 1976), 2012, 37(23): 1983-1988.
14. 张美超, 周海涛, 王超, 等. 对寰枢椎侧块螺钉钛板固定装置的力学性能评价. 中国脊柱脊髓杂志, 2006, 16(9): 685-687.
15. Sugimoto Y, Tanaka M, Nakanishi K, et al. Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report). Arch Orthop Trauma Surg, 2009, 129(1): 25-27.
16. Li S, Ni B, Xie N, et al. Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C1-C2 pedicle fixation. Spine (Phila Pa 1976), 2010, 35(14): E624-632.
17. 郭乃铭, 周跃. 计算机辅助手术导航系统在脊柱外科手术中的应用进展. 中国矫形外科杂志, 2013, 21(8): 787-789.
18. Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
19. 陈宣煌, 余正希, 吴长福, 等. Quadrant 系统下 3D 打印导航模块辅助腰椎精准植钉的应用研究. 中国修复重建外科杂志, 2017, 31(2): 203-209.
20. Wang YT, Yang XJ, Yan B, et al. Clinical application of three-dimensional printing in the personalized treatment of complex spinal disorders. Chin J Traumatol, 2016, 19(1): 31-34.
21. Guo F, Dai J, Zhang J, et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine. PLoS One, 2017, 12(2): e0171509.
22. Lowry DW, Pollack IF, Clyde B, et al. Upper cervical spine fusion in the pediatric population. J Neurosurg, 1997, 87(5): 671-676.
23. 尤微, 王大平, 张世权, 等. CT 扫描层厚参数对骨组织 3D 打印模型精度影响的研究. 中国数字医学, 2017, 12(9): 85-88.
24. 阳宏奇, 雷青, 蔡立宏, 等. 3D 打印导板辅助空心螺钉内固定治疗不稳定性骨盆骨折. 中国修复重建外科杂志, 2018, 32(2): 145-151.