个体化3D打印模型对于上颈椎骨折中颈椎椎弓根螺钉置钉准确性的影响及临床应用  

Clinical application and effect of individual 3D printing model on pedicle screw placement for upper cervical spine fracture

作　　者：陈云琳[1] 胡旭栋[1] 王扬[1] 许楠健[1] 阮超越 蒋伟宇[1] 马维虎[1] Chen Yunlin;Hu Xudong;Wang Yang;Xu Nanjian;Ruan Chaoyue;Jiang Weiyu;Ma Weihu(Department of Spine Surgery,Ningbo No.6 Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院脊柱外科,315040

出　　处：《中华创伤杂志》2019年第11期970-976,共7页Chinese Journal of Trauma

基　　金：浙江省自然科学基金(LY19H060002);浙江省市波市鄞州区科技计划项目(LY18H060007)。

摘　　要：目的探讨个体化3D打印颈椎模型指导上颈椎骨折中行椎弓根螺钉的准确性和可行性.方法采用回顾性病例对照研究分析2013年8月-2018年12月宁波市第六医院收治的30例上颈椎骨折患者临床资料,其中男19例,女11例;年龄45~67岁,平均53.5岁.利用个体化3D打印颈椎模型行弓根螺钉置钉(研究组)或传统徒手置钉(对照组)进行上颈椎骨折手术,各组15例.共置入椎弓根螺钉120枚,其中研究组和对照组寰椎及枢椎各60枚.记录手术时间及术中出血量,术前及术后视觉模拟评分(VAS)、日本骨科学会(JOA)评分.根据Kawaguchi评价螺钉等级方法,评估术后螺钉位置、分级及有无脊髓及椎动脉损伤等情况.出院后前3个月每月来院复查,前2个月行X线片检查,观察有无内固定松动、断裂等情况.术后第3个月复查颈椎CT,观察颈椎术后骨愈合及融合情况.结果30例患者均随访13~21个月,平均17.8个月.手术时间研究组为95~105 min[(99.1±3.0)min],对照组为100~120 min[(107.0±6.9)min](P<0.01).两组间术中出血量、术前VAS、术前及术后1年JOA评分差异均无统计学意义(P>0.05),术后1年研究组VAS更低(P<0.05).术后1年,研究组VAS[(2.3±0.5)分]较术前[(7.7±0.7)分]降低(P<0.01);JOA评分[(16.8±0.4)分]较术前[(15.9±0.7)分]显著提高(P<0.05).术后1年,对照组VAS为[(2.5±0.5)分]较术前[(7.5±0.5)分]显著降低(P<0.01);JOA评分[(16.5士0.5)分]较术前[(15.9士0.8)分]显著提高(P<0.05).术后行颈椎CT扫描后,研究组寰椎椎弓根螺钉显示0级28枚(93%),1级2枚(7%),2级0枚,3级0枚;枢椎椎弓根螺钉显示0级27枚(90%),1级3枚(10%),2级0枚,3级0枚.对照组寰椎椎弓根螺钉显示0级25枚(83%),Ⅰ级4枚(13%),2级1枚(3%),3级0枚;枢椎椎弓根螺钉显示0级27枚(90%),1级3枚(10%),2级0枚,3级0枚.研究组寰、枢椎椎弓根螺钉置钉准确率高于对照组,但差异无统计学意义(P>0.05).未出现脊髓、椎动脉损伤等严重并发症.术后2个月X�Objective To investigate the accuracy and feasibility of individual 3D printing model for pedicle screw placement in treating patients with upper cervical spine fracture.Methods A retrospective case control study was conducted to analyze the clinical data of 30 patients with upper cervical spine fracture admitted to Ningbo No.6 Hospital from August 2013 to December 2018.There were 19 males and 11 females,aged 45-67 years with an average age of 53.5 years.The 15 patients in the study group were treated with pedicle screw fixation and another 15 patients in the control group were treated with traditional freehand screw fixation.A total of 120 pedicle screws were implanted,with 60 screws in each group.The operation time,intraoperative blood loss,preoperative and postoperative visual analogue score(VAS),Japan Orthopedic Association(JOA)score were recorded.The position and grade of screws were evaluated according to Kawaguchi's evaluation method of screw grade after operation.The patients took monthly reexamination for the first three months after discharge.In the first two months after discharge,the patients took X-ray examination for observation of screw loosening or rupture of internal fixation.At the third month after operation,the patients took CT of cervical spine for observation of bone healing and fusion.Results The mean follow-up duration was 17.8 months(range,13-21 months).The study group had shorter operation time(99.13±3.04)minutes compared with the control group(107.00±6.92)minutes(P<0.01).There were no significant differences in intraoperative blood loss,preoperative VAS,JOA scores before operation and 1 year after operation between the two groups(P>0.05),but the VAS in study group was significantly lower than that in control group(P<0.05).In the study group,the VAS score 1 year after operation[(2.3±0.5)points]was lower than that before the operation[(7.7±0.7)points],and the JOA score[(16.8±0.4)points]was significantly higher than that before the operation[(15.9±0.7)points](P<0.01).In the control g

关 键 词：颈椎 骨折固定术 内 3D打印模型 

分 类 号：R68[医药卫生—骨科学]