个体化3D打印模型辅助后路固定治疗寰枢椎不稳的临床效果  

Clinical effect of individualized 3D printing model assisted posterior fixation in the treatment of atlantoaxial instability

作　　者：林军华 赵善明[1] 张健荣[1] 陈锦明 李小雄 LIN Jun-hua;ZHAO Shan-ming;ZHANG Jian-rong;CHEN Jin-ming;LI Xiao-xiong(Department of Orthopaedics,Xinhui District People′s Hospital of Jiangmen City in Guangdong Province,Jiangmen,529100,China)

机构地区：[1]广东省江门市新会区人民医院骨科,广东江门529100

出　　处：《中国当代医药》2020年第5期74-77,共4页China Modern Medicine

基　　金：广东省江门市医疗卫生科技计划项目(2018020200220002039)。

摘　　要：目的分析个体化3D打印模型辅助后路固定治疗寰枢椎不稳的临床效果。方法选取2017年1月~2018年12月我院收治的20例寰枢椎不稳患者作为研究对象,根据随机数字表法将其分为对照组与研究组,每组各10例。对照组患者根据经验徒手进行内固定治疗,研究组患者通过3D打印技术建立个体化颈椎3D打印模型,术前通过模拟置钉、内固定术进行处理,获得个体化置钉数据,为真实手术提供辅助作用,对患者行一期后路减压术、内固定术。比较两组患者的手术时间、术中出血量以及手术前后的疼痛评分、日本骨科协会(JOA)评分、寰椎齿突间隙、延髓颈髓角。结果研究组患者的手术时间短于对照组,差异有统计学意义(P<0.05);研究组患者的术中出血量少于对照组,差异有统计学意义(P<0.05)。研究组患者术后的疼痛评分低于术前,JOA评分高于术前,寰椎齿突间隙小于术前,延髓颈髓角大于术前,差异有统计学意义(P<0.05);对照组患者术后的疼痛评分、JOA评分与术前比较,差异无统计学意义(P>0.05);对照组患者术后的寰椎齿突间隙小于术前,延髓颈髓角大于术前,差异有统计学意义(P<0.05);两组患者术前的疼痛评分、JOA评分、寰椎齿突间隙、延髓颈髓角比较,差异均无统计学意义(P>0.05);研究组患者术后的疼痛评分低于对照组,JOA评分高于对照组,寰椎齿突间隙小于对照组,延髓颈髓角大于对照组,差异有统计学意义(P<0.05)。结论在寰枢椎不稳患者中,应用个体化3D打印模型辅助后路固定治疗,可以提高置钉成功率,使神经根、椎动脉得到保护,安全性良好,尤其是对先天椎体变异患者以及椎动脉“高跨”患者来说,个体化3D打印模型辅助后路固定治疗的效果显著。Objective To analyze the clinical effect of individualized 3D printing model assisted posterior fixation in the treatment of atlantoaxial instability.Methods From January 2017 to December 2018,20 patients with atlantoaxial instability treated in our hospital were selected as the subjects,and divided into control group and study group by random number table method,with 10 cases in each group.The patients in the control group were treated with internal fixation with bare hands according to experience,and patients in the study group were treated with 3D printing technology to establish an individualized 3D printing model of cervical spine.Analog nailing and internal fixation were used before operation.Fixation was processed to obtain individualized data of nail placement,which provided assistance for real operation.One-stage posterior decompression and internal fixation were performed on patients.The operation time,bleeding volume,and pain score,Japanese Orthopaedic Association(JOA)score,atlas odontoid space,medulla oblongata cervical spinal cord angle before and after operation were compared between the two groups.Results The operation time of the study group was shorter than that of the control group,and the difference was statistically significant(P<0.05).The amount of bleeding in the study group was less than that in the control group,and the difference was statistically significant(P<0.05).After operation,the pain score in the study group was lower than that before operation,JOA score was higher than that before operation,atlas odontoid space was smaller than that before operation,and medulla oblongata cervical spinal angle was lager than that before operation,the differences were statistically significant(P<0.05).There was no significant difference in pain score and JOA score of the control group before and after operation(P>0.05).In the control group,the atlanto odontoid space after operation was smaller than that before operation,and the medulla oblongata angle was lager than that before operation,the differ

关 键 词：个体化3D打印模型 后路固定 寰枢椎不稳 

分 类 号：R318[医药卫生—生物医学工程]