个性化3D打印辅助手术治疗A型颅底凹陷症  

Individualized 3D printing-assisted surgical procedures for type A basilar invagination

作　　者：刘杰 孟增东[1] 谢旭华[1] 雷云坤[1] 孙先润[1] LIU Jie;MENG Zeng-dong;XIE Xu-hua;LEI Yun-kun;SUN Xian-run(Department of Orthopaedics,The First People's Hospital of Yunnan Province,Kunming 650032,China)

机构地区：[1]云南省第一人民医院骨科

出　　处：《中国矫形外科杂志》2019年第11期1034-1038,共5页Orthopedic Journal of China

摘　　要：[目的]介绍个体化3D打印技术辅助治疗A型颅底凹陷症的技术。[方法] 2017年1月~2018年6月收治A型颅底凹陷症患者21例。对每例患者均行枕颈部CT扫描重建和CTA检查,利用mimics软件重建患者枕颈部3D模型,并对枢椎椎弓根螺钉进针点、进针角度、螺钉直径、长短进行个体化设计,3D打印机打印制作患者枕颈部1:1大小模型和螺钉导向模板,在3D模型及螺钉导向模板的指导下完成手术操作,术后复查枕颈部CT重建扫描,对置钉位置及临床疗效进行对比分析。[结果] 12例患者行前路口咽松解加后路枕颈减压固定融合,9例患者行单纯后路减压复位固定融合术。其中,18例患者均在术中模型、螺钉导板和C臂透视辅助下置入枢椎椎弓根螺钉,3例患者因枢椎椎弓根细小选择置入C3椎体椎弓根螺钉,术后复查枕颈部CT提示寰枢椎脱位完全复位,螺钉位置良好,无患者出现神经和椎动脉损伤,2例患者术后出现颈后伤口感染,清创联合敏感抗生素治疗后痊愈。术后平均随访(6.02±4.47)月,术后1、3、6个月JOA评分,寰齿前、后间隙,脊髓脑干角得到明显改善。[结论]术前个体化3D打印和枢椎弓根螺钉位置设计可以有效提高手术中置钉准确率,减少术中神经和椎动脉损伤的风险。[Objective] To introduce the technique of individualized 3D printing-assisted surgical procedure for treatment of type A basilar invagination.[Methods] Between Jan 2017 and June 2018, 21 patients with type A basilar invagination were surgically treated in our hospital. The individualized 3D printed real models of the craniovertebral junction and screw guiders were made based on the preoperative computer tomography(CT) and CT angiography(CTA) by using 3D printing technology.The posterior internal fixation was simulated on the 3D printed models to obtain data, including the entry point, orientation,length and diameter of the pedicle screw for each patient. Decompression and internal fixation with screws navigated by 3D printed guiders were performed through anterior combined with posterior approaches, or posterior alone. The results were evaluated using the Japanese Orthopaedic Association(JOA) score, as well as anterior atlanto-dens interval(ADI), posterior atlantodens interval(PAI) and cervicomedullary angle(CMA) measured on radiographs.[Results] Of the 21 patients, 12 patients received anterior transoralpharyngeal release combined with posterior decompression and instrumented fusion, while 9 patients had posterior decompression and instrumented fusion only. Among them, 18 patients had axis pedicle screw inserted, whereas the other 3 patients had C3 pedicle screw placed due to too thin axis pedicles with navigation of the 3D printed guiders. Complete atlantoaxial reduction was achieved in all the patients with proper position of screw inserted that revealed by postoperative CT scanning, and no serious complications, such as nerve or vertebral artery injuries, happened in anyone of them. Two patients had superficial incision infection, which cured with local debridement and intravenous sensitive antibiotics. The patients were followed up for an average of(6.02±4.47) months. The JOA score, ADI, PAI and CMA significantly improved at 1, 3 and 6 months postoperatively compared those before operation.[Conclusion] Indi

关 键 词：颅底凹陷症 寰枢椎脱位 3D打印 椎弓根螺钉 

分 类 号：R687[医药卫生—骨科学]