3D打印导板辅助骶2髂骨螺钉置入  

3D printed guider assisted S_2 sacral alar-iliac screw placement

作　　者：郑礼鹏 雷飞 孙先润[2] 叶飞 周庆忠 杨函 杨楠 刘志强 冯大雄 ZHENG Li-peng;LEI Fei;SUN Xian-run;YE Fei;ZHOU Qing-zhong;YANG Han;YANG Nan;LIU Zhi-qiang;FENG Da-xiong(The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;The First People's Hospital of Yunnan Province,Kunming 650032,China)

机构地区：[1]西南医科大学附属第一医院,四川泸州646000 [2]云南省第一人民医院,昆明650032

出　　处：《中国矫形外科杂志》2019年第2期176-180,共5页Orthopedic Journal of China

基　　金：四川省卫计委项目(编号:17PJ209);泸州市科技局项目(编号:[2015]146);云南省应用基础项目(云南省科技厅和昆明医科大学联合专项编号:2015FB095)

摘　　要：[目的]介绍3D打印导板辅助骶2髂骨(S2AI)螺钉置入技术。[方法] 2016年6月～2018年1月,本院收治需使用骶2髂骨螺钉内固定患者17例,男8例,女9例;年龄40～65岁。术前行骨盆CT扫描及三维重建,扫描CT数据导入Mimics软件模拟骶2髂骨螺钉钉道的长度及方向,方向确定后生成导向导管模型;根据S1-S2椎板及棘突形态设计导航模块底座;将导管及底座最终合成导板并打印成形。术中使用导航模块辅助置入骶2髂骨螺钉,记录术中每枚骶2髂骨螺钉置入时间、术中透视次数。术后复查骨盆CT扫描,复查CT数据导入Mimics软件重建骨盆。观察钉道是否穿过骶髂关节,是否穿破骨皮质,测量骶2髂骨螺钉头倾角、外倾角,测量进钉点,统计每枚螺钉数据并分析术前模拟和术后实际相关性。[结果]导板辅助下置入骶2髂骨螺钉34枚,单个螺钉置入时间(11.82±2.09) min,每名患者术中透视次数(4.47±0.94)次。所有螺钉均穿过骶髂关节、在骨皮质内。每侧螺钉术前规划进钉点、实际进钉点差异均无统计学意义(P>0.05),每侧螺钉术前规划头倾角、外倾角差异均无统计学意义(P>0.05)。[结论] 3D打印导板辅助置入骶2髂骨螺钉技术有助于个性化精准置钉,降低血管神经损伤风险,减少透视次数,缩短置钉时间。[Objective] To introduce the technique of 3 D printed guider assisted S2 screw sacral alar-iliac placement.[Methods] From June 2016 to January 2018, 17 patients who needed sacral alar-iliac fixation for treatment of different diseases were hospitalized, including 8 males and 9 females aged from 40 to 65 years. After CT scan and 3 D reconstruction were conducted on the pelvis of the patients before operation, the imaging data were processed by the Mimics software to simulate the S2 sacral alar-iliac screw insertion. Based on the direction and length of the screw and S1~S2 topography, a guider was made by 3 D printing technique. During surgical operation, the real S2 sacral alar-iliac screw was inserted under navigation of the 3 D printed guider. The time consumed for screw placement and X-ray frequency were recorded. The pelvic CT scan was reexamined postoperatively, and the imaging data were processed with the Mimics software once more to create a virtually reconstructed pelvis,which was used for evaluation of whether or not the screw passed through sacroiliac joint, or broke through the cortical bone,and measurement of the inserting point, cephalic tilt angle and lateral tilt angle of the screw placed. The correlation between the simulation and reality of screw placement was analyzed. [Results] A total of 34 S2 AI screws were placed under navigation of the3 D printed guiders. The time elapsed for a screw placement was(11.82±2.09) min, while X-ray exposure frequency was(4.47±0.94) times on average. All screws placed were verified passing through the sacroiliac joint and staying intraosseously. There were no significant difference between the simulation and reality of screw placement regarding to inserting point, cephalic tilt angle and lateral tilt angle of the screw(P>0.05).[Conclusion] The 3 D printed guider assisted S2 screw sacral alar-iliac placement does improve the accuracy, reduce Xray exposure frequency and shorten the operative time.

关 键 词：3D打印导板 S2侧块髂骨螺钉(S2AI螺钉) 骶骨骨盆固定 骶髂关节 

分 类 号：R687[医药卫生—骨科学]