个体化三维打印导航模板辅助下颈椎椎弓根置钉的实验研究  

A cadaveric study on establishing individualized navigation templates for subaxial cervical pedicle screw insertion,using a three-dimensional printing forming technique

作　　者：黄轩[1] 李凤宁[1] 张帆[1] 王琨[1] 陈智[1] 阳青松[2] 党瑞山[3] 苏佳灿[1] 沈洪兴[1] 李明[1] 

机构地区：[1]第二军医大学长海医院骨科,上海200433 [2]第二军医大学长海医院影像科,上海200433 [3]第二军医大学解剖学教研室,上海200433

出　　处：《中国矫形外科杂志》2014年第20期1880-1884,共5页Orthopedic Journal of China

基　　金：国家自然科学基金面上项目(编号:81372012;31271031);长海医院"1255"学科建设计划项目(编号:CH125540200;CH125520900)

摘　　要：[目的]探讨一种基于三维打印成型技术制备个体化下颈椎椎弓根螺钉导航模板的可行性,并对该方法辅助置钉的准确性进行评估。[方法]选取10具成人尸体的颈椎标本,行CT扫描后将原始数据导入Mimics软件,对C3-7节段行选择性重建,设计与其椎板和棘突相贴合的阴模,利用三维打印技术成型。基于目标椎体三维模型,直视下徒手将阴模制成具有双侧椎弓根螺钉钉道的导航模板,并在其辅助下于各椎体标本置入双侧椎弓根螺钉。术后再次行CT扫描评估螺钉位置。[结果]剔除骨性结构不完整的标本后,共制作62个下颈椎导航模板,辅助置入椎弓根螺钉124枚。CT扫描轴位图像显示121枚螺钉完全位于椎弓根内,3枚部分穿破椎弓根壁;矢状位图像提示除1枚螺钉误入椎间孔外,余钉位准确。[结论]本研究结果表明,基于CT图像,使用Mimics软件能够精确重建下颈椎各节段椎体及其附属结构,并建立其对应阴模。利用三维打印模型所设计的个体化导航模板,辅助置钉准确性高、操作简单,为下颈椎椎弓根螺钉的精确置入提供了一种可供选择的新方法。[Objective]The aim of this cadaveric study was to investigate the feasibility of establishing individualized navigation templates for subaxial cervical pedicle screw insertion,using a 3- dimensional printing forming technique and to evaluate the accuracy of template- assisted pedicle screw insertion.[Method]Ten adult cervical specimens were selected for undergoing CT. After importing the original Dicom data into the Mimics software,the C3- 7level spinal column models were created; these models were used to design and generate the cavity models using a 3- dimensional printing forming technique. After using a free- hand procedure to create a navigation template with a well- established pedicle screw path,the navigation templates were used to insert the bilateral pedicle screws. CT was performed postoperatively to determine the position of the screws. [Result]One- hundred and fourteen pedicle screws were implanted with the assistance of 62 navigation templates. CT axial images showed that 121 pedicle screws were completely contained within the pedicles,while 3 screws perforated the pedicle walls. Sagittal images showed accurate screw placement in all cases,except in 1 case where the screw perforated into the foramen.[Conclusion]Using the Mimics software for establishing the subaxial cervical column and related cavity model based on CT scans proved to be a feasible and precise method. Subaxial pedicle screw insertion assisted by a 3- dimensional printing model is a highly accurate and simple method,which could be an alternative to the conventional technique.

关 键 词：三维打印 椎弓根螺钉 个体化导航模板 熔融沉积快速成型 聚乳酸 

分 类 号：R687.32[医药卫生—骨科学]