腰椎一侧椎弓根螺钉联合对侧关节突螺钉3D打印导板的设计和实验研究  

A novel 3D printing template for unilateral lumbar pedicle screw with contralateral translaminar facet screw fixation

作　　者：邵振轩 吕青波 车灿文 唐笠 王鉴顺[1] 池永龙[1] 王向阳[1] 吴爱悯[1] SHAO Zhen-Xuan;LV Qing-Bo;CHE Chan-Wen;TANG Li;WANG Jian-Shun;CHI Yong-Long;WANG Xiang-Yang;WU Ai-Min(Department of Spine Surgery,The Second Affiliated Hospital and Yuying Children s Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Radiology,The Second Affiliated Hospital and Yuying Children s Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院,第二临床医学院脊柱外科,浙江温州325027 [2]温州医科大学附属第二医院,第二临床医学院影像科,浙江温州325027

出　　处：《转化医学电子杂志》2018年第3期33-37,共5页E-Journal of Translational Medicine

基　　金：温州市科技计划基金项目(Y20160369);国家自然科学青年基金项目(81501933);浙江省新苗计划项目(2016R413061);国家级大学生创新创业训练计划项目(201510343001)

摘　　要：目的:设计一种用于指导一侧椎弓根螺钉联合对侧关节突螺钉的新型3D打印导板,并验证其准确性。方法:双节段腰椎CT数据60例,导入Mimics软件中重建三维图像,并模拟一侧椎弓根螺钉联合对侧关节突螺钉。分别测经椎板关节突关节螺钉轨迹和垂直线的夹角,记为α;下位椎体上终板平面和螺钉轨迹的夹角,记为β;中线和螺钉轨迹的夹角,记为γ。同时在CATIA软件中设计3D导板,并打印,最后通过3D导板在3D打印的腰椎模型上指导置钉。并拍摄正侧位X片,测量相应角度,最后对比腰椎打印模型和三维重建数字模型中的角度参数。结果:本研究设计的新型3D导板指导经椎板关节突关节螺钉发现,57枚在皮质骨内,3枚穿破皮质但<2 mm,无螺钉穿破皮质且>2 mm。腰椎打印模型和三维重建数字模型中的角度参数对比,差异无统计学意义,一致性良好。结论:通过Mimics和CATIA软件设计的一侧椎弓根螺钉内固定+对侧关节突关节螺钉内固定3D导航模板可以准确地指导置钉。Objective:To design a novel 3D printing template for unilateral lumbar pedicle screw with contralateral translaminar facet screw fixation and validate its accuracy.METHODS:Sixty functional segmental unit-“two adjacent segments”-CT data was imported into Mimics software to reconstruct the 3D digital images,then,the unilateral lumbar pedicle screw with contralateral translaminar facet screw trajectory was imitated.Three angles of translaminar facet screw trajectory were measured on 3D digital images.α:the angle between the screw trajectory and the vertical line;β:the angle between the screw trajectory and the upper endplate of lower vertebra;γ:the angle between the screw trajectory and midline of the lumbar vertebra.3D navigate template was designed in CATIA software,then,it was exported and imported into 3D printer to print 3D template,and used to guide the screw fixation on 3D printed lumbar models.Finally,the X-ray images of fixed 3D printed lumbar models were obtained and measured.The results from 3D digital images and 3D printed models were compared.RESULTS:Fifty-seven translaminar facet screws didn t penetrate out the cortex,3 the translaminar facet screws partially penetrate out the cortex,but less than 2 mm,no screw penetrate out the cortex and more than 2 mm.No significant difference of the angles between 3D digital images and 3D printing models were observed.CONCLUSION:Our novel unilateral lumbar pedicle screw with contralateral translaminar facet screw 3D printing template can guide the screw trajectory accurately.

关 键 词：3D打印 三维重建 内固定 腰椎 

分 类 号：R683.2[医药卫生—骨科学]