基于3D打印的腰椎旁肌间隙入路椎弓根螺钉数字化植入研究  

Digital implantation of pedicle screw via lumbar paravertebral clearance muscle approach based on 3D printing

作　　者：吴长福[1] 张国栋[1] 陈宣煌[1] 陈旭[1] 林海滨[1] 郑祖高[1] 余正希 张怀志[1] 高小强[1] Wu Changfu;Zhang Guodong;Chen Xuanhuang;Chen Xu;Lin Haibin;Zheng Zugao;Yu Zhengxi;Zhang Huaizhi;Gao Xiaoqiang(Department of Orthopedics,the Affiliated Hospital of Putian University,Putian 351100,Fujian,China)

机构地区：[1]莆田学院附属医院骨科,福建莆田351100

出　　处：《右江民族医学院学报》2018年第5期447-450,共4页Journal of Youjiang Medical University for Nationalities

基　　金：福建省莆田学院国家基金预研项目(2015089);福建省教育厅中青年教师教育科研项目(JA14274);福建省科技厅自然科学基金项目(2016J01607);福建省卫生和计划生育委员会青年科研课题(2015-2-32)

摘　　要：目的探讨数字化设计及3D打印技术在腰椎旁肌间隙入路下椎弓根螺钉植入中应用的可行性、准确性、客观性、优越性。方法 50例临床腰椎病例行薄层CT扫描,运用Mimics软件行腰椎三维重建,确定最佳进钉点和进钉方向,设计腰椎旁肌间隙入路下椎弓根螺钉植入的个性化导航模块。3D打印腰椎椎体及导航模块,以导航模块导引椎弓根钉道,置入克氏针。测量数字化设计虚拟操作椎弓根螺钉长度与实际3D打印模型操作所置入螺钉长度,分析比较术前设计及术后效果符合程度。结果全部病例术前均数字化设计确定手术方案,腰椎3D打印模型在3D打印导航模块辅助下顺利手术,手术均按术前设计准确实施,克氏针位置与术前设计高度一致,进入钉道长度差异无统计学意义。结论数字化设计及3D打印技术能良好指导腰椎旁肌间隙入路椎弓根螺钉植入,有助于实现手术精准化和微创化。Objective To explore the feasibility,accuracy,objectivity and advantages of the application of digital design and 3D printing technology in pedicle screw implantation via lumbar paravertebral clearance muscle approach. Methods Fifty lumbar diseases cases were scanned by thin layer CT.The 3D lumbar reconstruction was performed by Mimics software for confirming the best nail pin point and direction,and personalized navigation module of pedicle screw implantation via lumbar paravertebral clearance muscle approach was designed.Through 3D printing technology,we printed out lumbar vertebral body and navigation module.A Kirschner wire was placed in the pedicle screw channel guided by navigation module.The virtually designed pedicle screw length and the actual implanted pedicle screw length guided by actual 3D-printed module were measured,and the coincidence degree was compared between preoperative design and postoperative results. Results The preoperative digital design operation plan was conducted for all cases.The 3D printed lumbar spine model assisted by 3D printed navigation module resulted in smoothly surgical operation.The surgery of implementation was performed accurately according to the preoperative design,the Kirschner wire position was highly consistent with preoperative design,the nail length within screw channel had no statistical difference. Conclusion Digital design and 3D printing technology can guide the pedicle screw implantation via lumbar paravertebral clearance muscle approach and it can help to achieve precision and minimally invasive surgery.

关 键 词：腰椎旁肌间隙入路 椎弓根螺钉 数字化设计 3D打印模块 

分 类 号：R744[医药卫生—神经病学与精神病学]