3D打印逐级导板辅助椎弓根钉固定下颈椎骨折脱位  

3D-printed progressive guiders for pedicle screw placement in the treatment of lower cervical fractures and dislocation

作　　者：吴超[1,2] 邓佳燕[2] 罗敏[3] 谭伦[1] 胡海刚[1] 袁德超 WU Chao;DENG Jia-yan;LUO Min;TAN Lun;HU Hai-gang;YUAN De-chao(The Fourth Peopled Hospital of Zigong, Zigong 643000, China)

机构地区：[1]四川省自贡市第四人民医院骨科,自贡市643000 [2]四川省自贡市第四人民医院数字医学中心,自贡市643000 [3]四川省自贡市第四人民医院放射影像科,自贡市643000

出　　处：《中国矫形外科杂志》2019年第12期1132-1136,共5页Orthopedic Journal of China

基　　金：四川省重点科技计划项目(编号:2016JY0108);四川省卫计委科研课题项目(编号:17PJ144);四川省医学会科研课题(编号:2015GK016)

摘　　要：[目的]探讨3D打印逐级导航模板系统辅助椎弓根螺钉置钉治疗下颈椎骨折脱位的准确性及临床疗效.[方法]回顾性分析2016年1月~2017年6月本院收治的21例枢椎后路内固定手术患者资料,男20例,女12例;年龄21~57岁,平均(41.52±12.23)岁;C4/5骨折伴脱位4例,C5/6骨折伴脱位8例,C6/7骨折伴脱位9例;随访3~15个月,平均(11.23±7.24)个月.术前将患者颈椎CT数据导入Mimics软件,建立患者拟固定节段颈椎三维模型,通过3-matic软件设计与颈椎模型相匹配的“螺钉定位导板”、“钻孔引导导板”和“攻丝引导导板”,并使用J750打印机打印实物.术中上述导板按置钉顺序逐一辅助螺钉置入的每一步操作,逐级扩大,完成置钉.[结果]21例患者导板的设计及打印时间共计8~10h,共设计并打印导板126个,本组共置入椎弓根螺钉84枚,所有患者均顺利完成手术.术后7例ASIA为A级的患者瘫痪没有恢复,其余患者末次随访ASIA分级均有不同程度提高.术后X线片及CT示脱位均得到纠正.84枚螺钉完全位于椎弓根皮质内(0级),置钉准确率为100%;螺钉在中位冠状面偏离术前模拟钉道中心的平均值是(0.73±0.52) mm;每个椎螺钉的平均偏差分别为:C4 (0.64±0.63) mm、C5(0.52±0.36) mm、C6 (0.84±0.56) mm、C7 (0.86±0.50) mm.[结论]3D打印逐级导航模板系统辅助颈椎椎弓根螺钉的置钉,能较精确的匹配术前设计钉道,提高此类手术的置钉准确性.[Objective] To investigate the accuracy and clinical outcomes of 3D-printed progressive guiders for pedicle screw placement in the treatment of lower cervical fractures and dislocation. [Methods] A retrospective study was conducted on21 patients who underwent surgical treatment for lower cervical fractures and dislocation in our hospital from January 2016 to June 2017, including 20 males and 12 females aged 21~57 years. The fractures accompanied with dislocation involved C4/5 in 4 patients, C5/6 in 8 patients and C6/7 in 9 patients. Before operation the cervical CT data were processed with Mimics software,and a segmental cervical three-dimensional model was established. After that the progressive guiders were designed by using 3-matic software, including location guider, drill guider and tapping guider. Finally, the real cervical model and the progressive guiders were made using a J750 3D printer. A simulating operation was performed on the 3D-printed real cervical model to verify the accuracy of the guiders. During the operation, the cervical pedicle screws were inserted under navigation by using the guiders step by step. [Results] The time consumed for designing and printing the guiders lasted for 8~10 h, and a total of 126 guiders were made for the 21 patients. In the operation a total of 84 pedicle screws were placed smoothly in the 21 patients. Except 7 patients who suffered from complete paralysis with ASIA grade A, and had no any recovery postoperatively, the remaining patients got different upgrades in ASIA grades at the latest follow up. In term of radiographic assessment, the cervical alignment and dislocation were completely corrected in the 21 patients, and 84 screws were completely located within the pedicle cortex(grade 0) with the accuracy of screw placement of 100%.The deviation of surgical screw placement from the preoperative simulation on the coronal plane was(0.73±0.52) mm on average, which contained C4 of(0.64±0.63) mm, C5 of(0.52±0.36) mm, C6 of(0.84±0.56) mm, and C7 of(0.86±0.50) mm.[C

关 键 词：颈椎 骨折脱位 椎弓根螺钉 3D打印技术 

分 类 号：R683.2[医药卫生—骨科学]