Quadrant系统下3D打印导航模块辅助腰椎精准植钉的应用研究  

Clinical application of accurate placement of lumbar pedicle screws using threedimensional printing navigational templates under Quadrant system

作　　者：陈宣煌[1] 余正希 吴长福[1] 李星[1] 陈旭[1] 张国栋[1] 郑祖高[1] 林海滨[1] 

机构地区：[1]福建医科大学莆田学院附属医院教学医院骨科南方医科大学附属莆田医院骨科莆田学院附属医院骨科,福建莆田351100

出　　处：《中国修复重建外科杂志》2017年第2期203-209,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：福建省中青年教师教育科研项目(JA14274);福建省自然科学基金项目(2016J01607);福建省卫生和计划生育委员会青年科研课题(2015-2-32);福建省医学创新课题(2012-CX-34)~~

摘　　要：目的探讨Quadrant系统微创通道下3D打印导航模块辅助腰椎精准植钉的可行性及疗效。方法取12具成人尸体腰椎(L1~5)标本,经CT扫描及三维重建,于Mimics软件中构建通过椎弓根中心长轴的钉道,根据骨面可剥离范围设计并3D打印导航模块。在尸体标本上实施导航模块辅助下腰椎椎弓根螺钉植入后,再次CT扫描并三维重建,对手术前后重建模型进行三维配准,评价植钉符合率。2014年11月—2015年11月,对31例退行性腰椎不稳患者行Quadrant系统微创通道下3D打印导航模块辅助植钉术。男14例,女17例;年龄42~60岁,平均45.2岁。病程6~13个月,平均8.8个月。单节段15例,两节段13例,三节段3例。术前疼痛视觉模拟评分(VAS)为(7.59±1.04)分,Oswestry功能障碍指数(ODI)评分为(76.21±5.82)分,日本骨科协会(JOA)评分(9.21±1.64)分。结果12具标本共植入120枚螺钉,三维配准显示植钉符合率100%。临床31例患者共植入162枚螺钉。手术时间65~147 min,平均102.23 min;术中出血量为50~116 m L,平均78.20 m L;术中辐射暴露时间为8~54 s,平均42 s。术后3~7 d三维配准显示植钉符合率为98.15%(159/162)。术后4周VAS评分为(2.24±0.80)分,ODI评分为(29.17±2.50)分,JOA评分为(23.43±1.14)分,与术前比较差异均有统计学意义(t=14.842,P=0.006;t=36.927,P=0.002;t=–36.031,P=0.001)。31例患者均获随访,随访时间8~24个月,平均18.7个月。术后切口均Ⅰ期愈合,无手术并发症发生。随访期间复查腰椎X线片及CT显示椎弓根螺钉准确在位,无松动、断裂,椎间植骨融合良好。结论Quadrant系统微创通道下采用3D打印导航模块可以实现手术微创、少辐射及精准植钉目的。Objective To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional （3D） printing navigational templates in Quadrant minimally invasive system. Methods The Ll-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months （mean, 8.8 months）. Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale （VAS） was 7.59±1.04; Oswestry disability index （ODI） was 76.21±5.82; and the lapanese Orthopaedic Association （]OA） score was 9.21±1.64. Results A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes （mean, 102.23 minutes）; the intraoperative blood loss was 50-116 mL （mean, 78.20 mL）; and the intraoperative radiation exposure time was 8-54 seconds （mean, 42 seconds）. At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% （159/162）. At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when

关 键 词：QUADRANT系统 腰椎弓根螺钉 3D打印技术 微创 精准植钉 

分 类 号：R687.3[医药卫生—骨科学]