3D打印模型在寰枢椎陈旧性脱位评估及手术中的应用  

Application of 3D printed models in evaluation and surgical treatment for old atlantoaxial dislocation

作　　者：王栋[1] 董晖 赵波[1] 李锋涛[1] 秦杰[1] 李浩鹏[1] 贺西京[1] WANG Dong;DONG Hui;ZHAO Bo;LI Feng-tao;QIN fie;LI Hao-peng;HE Xi-jing(The Second Department of Orthopaedics,The Second Affiliated Hospital,Xi'an Jiao Tong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院骨二科,西安710004

出　　处：《中国矫形外科杂志》2019年第2期111-115,共5页Orthopedic Journal of China

摘　　要：[目的]探讨3D打印技术在寰枢椎脱位术中临床可行性和有效性。[方法]回顾性分析2012年1月～2016年1月收治的42例寰枢椎脱位患者。其中,22例采用3D打印模型进行术前评估及3D打印导板辅助椎弓根螺钉置入进行后路手术(3D组),男14例,女8例,平均年龄(41.67±8.85)岁。20例患者采取常规术中牵引,后路寰枢椎椎弓根螺钉内固定、复位、植骨融合手术(传统组),男12例,女8例;平均年龄(42.73±5.40)岁。比较两组的手术时间、出血量和颈椎JOA评分,以及影像测量的置钉准确度和延髓颈脊髓角(CMA)。[结果]在手术时间[(128.34±4.53) min vs (164.50±8.46) min,P<0.05],术中出血量[(200.64±12.78) ml vs (320.22±30.63) ml,P<0.05],置钉总准确率[90.91%(80/88) vs 76.25%(61/80),P<0.05]方面,3D组显著优于传统组,两组间差异均有统计学意义。两组患者术后平均随访(32.64±3.58)个月。两组术后CMA均较术前显著增加,差异有统计学意义(P<0.05),但相同时间点,两组间差异均无统计学意义(P>0.05)。术后1年,3D组有1例(4.55%),传统组有2例(10.00%)发生不融合,均进行了翻修手术。末次随访时,行颈枕固定融合的病例活动受限较明显,寰枢椎融合病例无明显活动受限。[结论] 3D打印术辅助治疗寰枢椎脱位,有助于节省手术时间,减少术中失血量,提高椎弓螺钉置入的准确性。[Objective] To explore the feasiblity and clinical outcomes of using 3 D printed models for evaluation and surgical treatment of old atlantoaxial dislocation. [Methods] A retrospective study was done on 42 patients who underwent surgical treatment for old atlantoaxial dislocation treated from January 2012 to January 2016. Of them, 22 patients, including 14 males and 8 females aged(41.67±8.85) years on average, received preoperative evaluation with 3 D printed models, and then open reduction and instrumented fusion with pedicle screw fixation steered by 3 D printed guiders through posterior approach(the 3 D group), while the remaining 20 patients, including 12 males and 8 females aged(42.73±5.40), had operation performed with conventional technique(the conventional group). The operation time, intraoperative bleeding and Janpanese Orthopaedic Association(JOA) cervical score, as well as the accuracy of screw placement and cervicomedullary angle(CMA) measured radiographically were compared between the two groups. [Results] The 3 D group was significantly superior to the conventional group regarding to operation time [(128.34±4.53) min vs(164.50±8.46) min, P<0.05], intraoperative blood loss [(200.64±12.78) ml vs(320.22±30.63) ml, P<0.05] and accuracy of pedicle screw placement [90.91%(80/88) vs 76.25%(61/80), P<0.05]. All the patients in both groups were followed up for(32.64±3.58) months on average. The JOA scores in both groups significantly increased postoperatively compared with those preoperatively(P<0.05), although no a significant difference was proved between them at any corresponding time point(P>0.05). In addition, the CMAs in the two group significantly improved after operation compared with those before operation(P<0.05), despite of the fact that no statistically significant difference between the two groups at any matching time point(P>0.05). At 1 year after operation, one patient in the 3 D group(4.55%) and 2 patients in the conventional group(10.00%) were proved failed fusion, and received revisi

关 键 词：寰椎枢椎脱位 3D打印 延髓颈脊髓角 

分 类 号：R687[医药卫生—骨科学]