改良金属个性化导航模板辅助颈椎椎弓根置钉的准确性  

Accuracy assessment of cervical pedicle screws placement assisted by a modified customized metal navigational template

作　　者：张东升 王建华 李洪吉 郑勇强 廖穗祥 吕浩然[1] 朱昌荣 夏虹 ZHANG Dong-sheng;WANG Jian-hua;LI Hong-ji;ZHENG Yong-qiang;LIAO Sui-xiang;Lü Hao-ran;ZHU Chang-rong(Department of Spinal Surgery,Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou 510700,Guangdong,China;Department of Spinal Surgery,Orthopaedic Hospital,General Hospital of Southern Theater of PLA,Guangzhou 510010,Guangdong,China)

机构地区：[1]广州医科大学附属第五医院脊柱外科,广州510700 [2]解放军南部战区总医院骨科医院脊柱外科,广州510010

出　　处：《脊柱外科杂志》2019年第5期340-344,共5页Journal of Spinal Surgery

基　　金：广东省科技计划项目(2014A040401060,2017A090905038);广州市科技计划项目(201508020005)

摘　　要：目的探讨利用激光选区熔化成型技术制作金属材质手术导航模板的可行性及准确性。方法选取新鲜成人正常颈椎标本(C1~6)8具,随机分为金属导航模板组(金属组)和树脂导航模板组(树脂组),每组4具。所有标本均通过CT扫描获取dicom格式数据,将数据导入计算机后,根据分组设计并制作金属或树脂颈椎椎弓根螺钉导航模板。2组分别在相应导航模板辅助下置入椎弓根螺钉,行CT钉道扫描,对2种模板的准确性和安全性进行评价。结果8具标本分别于C1~6的每个节段置入2枚螺钉,每组48枚,共计96枚。金属组置钉准确率为87.5%(42/48),树脂组为70.8%(34/48),2组比较差异有统计学意义(P<0.05)。金属组置钉安全率为97.9%(47/48),树脂组为93.8%(45/48),2组比较差异无统计学意义(P>0.05)。结论利用激光选区熔化成型技术制作的改良金属个性化导航模板具有良好的置钉准确性和安全性,为颈椎椎弓根螺钉的精确置入提供了一种新的方法。Objective To explore the feasibility and accuracy of a modified customized metal navigational template made by selective laser melting technology for cervical pedicle screw placement.Methods Eight fresh nomal adult cervical specimens(C1-6) were randomly divided into 2 groups,the metal navigational template group(metal group) and the resin navigational template group (resin group).All the specimens underwent CT examination,and the CT data stored in dicom format were imported into a computer workstation to design and fabricate the navigational templates.The specimens in metal group were operated under the guidance of modified metal navigational templates,and the specimens in resin group were operated by using conventional resin navigational templates.The accuracy and security of the screw positioning was evaluated by postoperative CT.Results A total of 96 screws were inserted with an equal distribution of 48 screws in each group.Forty-two(87.5%) of the screws in metal group vs.34(70.8%) in resin group were fully contained within the pedicle,and there was a significant difference between the 2 groups(P < 0.05). Forty-severn(97.9%) of the screws in metal group vs.45(93.8%) in resin group were within the“safe zone”,and there was no significant difference between the 2 groups(P > 0.05).Conclusion Cervical pedicle screw insertion guided by a modified customized metal navigational template is a highly accurate and safe method,thus could be an alternative to the conventional technique.

关 键 词：颈椎 骨钉 计算机辅助设计 成像 三维 

分 类 号：R681.531[医药卫生—骨科学]