3D打印导板在寰枢椎后路椎弓根螺钉固定术中的临床应用  

Clinical application of 3D-printed navigation template in posterior atlantoaxial pedicle screw fixation

作　　者：毛炳焱[1] 王文聪[1] 胡志喜[1] 丁原[1] 王强[1] 李蕾 唐伟 王常青 Mao Bingyan;Wang Wencong;Hu Zhixi;Ding Yuan;Wang Qiang;Li Lei;Tang Wei;Wang Changqing(Department of Orthopaedic Surgery,Shimen Hospital of Changsha Medical University,Changde 415300,China;Department of Radiology,Shimen Hospital of Changsha Medical University,Changde 415300,China)

机构地区：[1]长沙医学院附属石门医院骨科,湖南省常德市415300 [2]长沙医学院附属石门医院放射科,湖南省常德市415300

出　　处：《中华解剖与临床杂志》2019年第6期564-569,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨3D打印导板技术辅助寰枢椎后路椎弓根螺钉固定术治疗寰枢椎骨折脱位的可行性及临床疗效。方法回顾性分析2015年1月—2017年6月长沙医学院附属石门医院,采用3D打印导板技术辅助寰枢椎后路椎弓根螺钉内固定术治疗的11例寰枢椎骨折脱位患者的临床资料。其中男9例、女2例,年龄52~69岁。寰椎骨折4例,其中前弓骨折2例、前后弓骨折2例;枢椎骨折5例,其中ⅡC型齿状突骨折4例、Hangman骨折1例;寰枢关节脱位2例。术前将患者颈椎CT扫描断层Dicom数据导入逆向工程软件Mimics 17.0,对目标椎体进行分割重建,选取目标椎体后方结构表面形态蒙版扩张,采用布尔运算获得导板模型,分别使用聚乳酸高分子材料和光敏树脂材料3D打印快速成型制作寰枢椎骨折脱位模型以及导板模型。术前利用聚乳酸高分子材料打印的寰枢椎骨折脱位模型进行模拟手术操作,确认导板设计的准确性。光敏树脂材料导板采用环氧乙烷消毒后封装以备术中使用。手术采用常规颈椎后入路切口,术中充分暴露椎体后方表面结构形态,根据术前模拟操作,利用导板辅助置入寰枢椎椎弓根螺钉。记录患者手术时间、术中出血量以及并发症的发生情况。术后6个月根据CT扫描判断螺钉与椎弓根位置关系,采用Kawaguchi等方法评价螺钉置入质量;术后1年采用VAS评估患者颈肩部疼痛情况,采用JOA评分评价患者颈髓神经功能情况。结果11例患者均顺利完成手术,手术时间(130.55±18.83)min;术中出血量(266.36±72.43)mL。11例患者共置入44枚椎弓根螺钉,术后6个月采用Kawaguchi等级评价标准评价螺钉置入质量:0级41枚(93.18%),1级2枚(4.55%),2级1枚(2.27%)。所有患者获随访,随访时间12~26个月,平均17.18个月。随访期间无切口感染、脑脊液漏等并发症出现。术后1年患者颈肩部疼痛VAS(1.00±0.77)分,明显低于术前的(7.91±1.04)分;颈髓神�Objective To discuss the feasibility and clinical efficacy of 3D-printing navigation template for posterior atlantoaxial pedicle screw fixation for the treatment of atlantoaxial fracture and dislocation.Methods From January 2015 to June 2017,11 patients receiving posterior internal fixation with atlantoaxial pedicle screw placement assisted by the 3D-printed navigation template at Affiliated Shimen Hospital of Changsha Medical University were recruited,and their clinical data were reviewed.There were 9 males and 2 females,who were aged from 52 to 60 years old.Four cases had fracture of atlas,with 2 cases in the anterior arch and 2 cases in both anterior and posterior arches.Five cases had atlantoaxial fracture,with 4 cases of typeⅡC odontoid process fracture and 1 case of Hangman's fracture.Two cases had dislocation of the atlantoaxial joint.Dicom images from preoperative cervical CT scan were imported into the reverse engineering software.Segmentation and reconstruction of the target vertebral body were performed.Mask expansion was conducted for the surface morphology of the posterior structure of the target vertebral body.Boolean operation was implemented to obtain the navigation template.Polylactic acid(PLA)and photosensitive resin were used for 3D-printing and rapid prototyping of atlantoaxial fracture and dislocation model and navigation template model,respectively.The surgery was first simulated using the 3D-printed PLA of atlantoaxial fracture and dislocation model,so as to conform the accuracy of navigation template design.The photosensitive resin was disinfected with ethylene oxide and encapsulated prior to use.A conventional posterior cervical approach was adopted.The surface morphology of the posterior vertebra was fully exposed during operation and the atlantoaxial pedicle screw was placed with the assistance of 3D-printed navigation template according to preoperative simulation.The surgical time,intraoperative blood loss and incidence of complications were recorded.The position relationship of the

关 键 词：颈寰椎 枢椎 脊柱骨折 骨折固定术 3D打印 

分 类 号：R687.3[医药卫生—骨科学]