中国修复重建外科杂志

中国修复重建外科杂志

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

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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。

ObjectiveTo investigate the accuracy of progressive three-dimensional navigation template system (abbreviated as progressive template) to assist atlas-axial pedicle screw placement. MethodsThe 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. ResultsAll 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). ConclusionCompared 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

引用本文: 吴超, 邓佳燕, 谭伦, 林旭, 袁德超. 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. 中国修复重建外科杂志, 2019, 33(2): 212-218. doi: 10.7507/1002-1892.201807129 复制

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