3D打印个性化导航模板在后路下颈椎椎弓根螺钉置入中的应用价值  

Application value of three-dimensional printing personalized navigation template in posterior lower cervical pedicle screw placement

作　　者：郝申申 刘志斌[1] 王飞[1] 刘延雄[1] 刘荣荣[1] 奥乐 杨翠萍 李霞[1] Hao Shen-shen;Liu Zhi-bin;Wang Fei;Liu Yan-xiong;Liu Rong-rong;Ao Le;Yang Cui-ping;Li Xia(Department of Spine Surgery,Affiliated Hospital of Yan’an University,Yan’an 716000,Shaanxi Province,China)

机构地区：[1]延安大学附属医院脊柱外科,陕西省延安市716000

出　　处：《中国组织工程研究》2018年第11期1701-1706,共6页Chinese Journal of Tissue Engineering Research

基　　金：陕西省社会发展科技攻关项目(2015SF115);延安市科技惠民计划项目(2016HM-10-03)~~

摘　　要：背景:后路下颈椎椎弓根螺钉固定具有诸多优点。然而,由于椎弓根的解剖特殊性,对置钉操作的技术要求较高,对手术者来说也是一种挑战。3D打印技术的应用可辅助完成螺钉置钉,具有一定的优势。目的:介绍3D打印个性化导航模板辅助后路下颈椎椎弓根螺钉置钉的方法,并评估其临床应用价值。方法:回顾性分析2015年6月至2016年12月延安大学附属医院收治的20例需行后路下颈椎椎弓根螺钉内固定的患者。术前将患者的下颈椎CT数据导入相关软件,并设计制造带钉道的3D打印个性化导航模板辅助置钉。记录置入螺钉数量,置钉后进行CT扫描计算置钉准确率。置钉前后以颈肩部疼痛目测类比评分和日本骨科协会颈椎神经功能评分评估临床效果。结果与结论:(1)患者置钉后均获得3个月的随防;(2)3D打印个性化导航模板辅助置入椎弓根螺钉132枚,置钉准确率达94.7%;其中0级125枚(94.7%,125/132),1级3枚(2.3%,3/132),2级4枚(3.0%,4/132),无3级螺钉;(3)治疗后1,3个月患者颈肩部目测类比评分及颈椎日本骨科协会评分均较治疗前明显改善(P<0.05),而治疗后1,3个月评分比较差异无显著性意义(P>0.05);(4)综上,3D打印个性化导航模板辅助下颈椎椎弓根置钉准确率较高,修复效果满意。BACKGROUND:Posterior pedicle screw fixation of lower cervical spine has many advantages.However,because of the special anatomy of pedicle,the technical requirements of nailing placement are high and it is also a challenge to surgeons.The application of three-dimensional(3D)printing technology can help to complete screw placement,and has certain advantages.OBJECTIVE:To introduce the method of 3D printing personalized navigation template assisted posterior lower cervical pedicle screw fixation and evaluate its clinical application value.METHODS:Totally 20 patients with lower cervical spine pedicle screw internal fixation who were treated from June 2015 to December 2016 in Affiliated Hospital of Yan’an University were retrospectively analyzed.Before the surgery,the patient's lower cervical spine CT data was introduced into the relevant software and the 3D printing personalized navigation template assisted nailing pedicle screw was designed.The number of screws inserted was recorded.After the operation,CT scan was used to calculate the accuracy rate of screw placement.Preoperative and postoperative cervical spine Visual Analogue Scale score and spinal function score of Japanese Orthopedic Association were used to evaluate the clinical effect of cervical nerve.RESULTS AND CONCLUSION:(1)All patients were followed up for 3 months postoperatively.(2)3D printing personalized navigation template assisted 132 pedicle screws.The precise insertion rate was 94.7%.Among them,125 screws were at grade 0(94.7%,125/132),3 screws grade 1(2.3%,3/132),4 screws grade 2(3.0%,4/132),no screw grade 3.(3)At postoperative 1 and 3 months,the neck shoulder Visual Analogue Scale score and spinal function score of Japanese Orthopedic Association of the patients were significantly improved(P<0.05),but there was no significant difference(P>0.05),compared with those at preoperative.(4)In summary,3D printing personalized navigation template assisted cervical pedicle screw placement had the high insertion rate and satisfactory clinical efficacy.

关 键 词：骨科植入物 脊柱植入物 下颈椎 椎弓根螺钉 3D打印个性化导航模板 置钉准确率 置钉准确度 颈椎 骨钉 组织工程 

分 类 号：R318[医药卫生—生物医学工程]