3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入与徒手置钉的准确性对比  

Comparison of the accuracy of lower cervical anterior transpedicular screws between three-dimensional printing assembly navigation template and free hand placement

作　　者：盛晓磊 袁峰 李智多 杨宇明 陆海涛 张峻玮 

机构地区：[1]徐州医科大学研究生学院,江苏省徐州市221002 [2]徐州医科大学附属医院骨科,江苏省徐州市221006

出　　处：《中国组织工程研究》2017年第3期406-411,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省卫生厅课题(H201129)~~

摘　　要：背景:下颈椎前路椎弓根钉内固定技术整合了前路和后路手术的优势,仅通过一次前路手术可解决减压和重建两个问题,但该技术固定难度风险大,而3D打印组合式导板的设计可以提高此技术置钉的安全性和准确性。目的:探讨3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入的可行性及准确性,并与徒手置钉进行对比。方法:选取6具成人防腐尸体的颈椎标本,男性2具,女性4具,年龄53-64岁,平均58.5岁,随机分为2组,每组3具颈椎标本。徒手置钉组行徒手置钉;导板辅助置钉组颈椎标本采用CT扫描后获得DICOM格式数据,将原始数据导入Mimics软件三维重建后进行下颈椎(C3-C7)前路椎弓根钉模拟安全钉道的计算机辅助设计,在Pro-E软件中设计出与模拟安全钉道匹配的克氏针定位圆柱帽和可拆分空心钉导向管,并建立与下颈椎椎体前缘贴合的基座,利用3D打印技术制作出导板,在该导板辅助下置钉。置钉后行颈椎CT扫描评价2种置钉方法的置钉可接受率。结果与结论:(1)徒手置钉组共置入30枚螺钉,术后CT扫描Grade 1级22枚,Grade 2级6枚,Grade 3级2枚,位置可接受的(Grade 1-2级)28枚(93%);导板辅助置钉组共置入30枚螺钉,术后CT扫描Grade 1级25枚,Grade 2级4枚,Grade 3级1枚,位置可接受的(Grade 1-2级)29枚(97%),2组下颈椎置钉的可接受率差异无显著性意义(P>0.05);(2)结果表明,3D打印组合式导板的双重定位导向功能使下颈椎前路椎弓根螺钉的置入安全准确,与传统徒手置钉相比,3D打印组合式导板操作简单、易于掌握,体现了置钉的个体化。BACKGROUND： Lower cervical anterior transpedicular screw technology combines the advantages of the anterior and posterior surgery; therefore, the pressure releasing and reconstruction problems can be solved via one time anterior surgery, whereas, the difficulty and risk of the operation are increased. However, the three-dimensional（3D） printing assembly navigation template improves the safety and accuracy of screw placement.OBJECTIVE： To explore the feasibility and accuracy of 3D printing assembly navigation template in lower cervical anterior transpedicular screws and compare it with free hand pedicle screw placement. METHODS： Lower cervical spine specimens of six adult（2 males, 4 females, average age 58.5 years old ranged from 53 to 64 years） corpses were equally and randomly divided into two groups. Group A underwent free hand pedicle screw placement. Groups B（lower cervical anterior transpedicular screws assisted by personalized 3D printing combined navigation template）： Three cadaveric lower cervical spines were examined using CT and data in DICOM format were recorded. After data were processed using software Mimics for 3D model reconstruction, computer-assisted design of optimum trajactory for lower cervical（C3-C7） anterior transpedicular screws placement was worked out and made into a drill template, where the surface was created as the inverse of anterior surface of cervical vertebra. The drill template was materialized in a 3D printing and used to place the screws. Subsequently, CT scan was performed to evaluate the screw orientation and acceptability. RESULTS AND CONCLUSION：（1） Thirty screws were inserted in Group A. The pedicle perforation was classified by CT, Grade 1： 22 screws, Grade 2： 6 screws, Grade 3： 2 screws; insertion rate was acceptable（Grades 1-2）： 28（93%）. Thirty screws were inserted in Group B. The pedicle perforation was classified by CT, Grade 1： 25 screws, Grade 2： 4 screws, Grade 3： 1 screw; insertion rate was acceptable（Grades 1-2

关 键 词：骨科植入物 数字化骨科 前路 椎弓根 3D打印 组合式导航模板 

分 类 号：R318[医药卫生—生物医学工程]