3D打印导航模板辅助特发性脊柱侧弯椎弓根螺钉置入的准确性  

Accuracy of 3D printing navigation template in pedicle screw placement for idiopathic scoliosis

作　　者：李洪珂 郝申申 王鹏程 杨红杰 董胜利 刘帅 王飞[2] 刘志斌[2] Li Hongke;Hao Shenshen;Wang Pengcheng;Yang Hongjie;Dong Shengli;Liu Shuai;Wang Fei;Liu Zhibin(Department of Spinal Surgery,General Hospital of Pingmei Shenma Medical Group,Pingdingshan 467000,Henan Province,China;Department of Spinal Surgery,Affiliated Hospital of Yan'an University,Yan'an 716000,Shaanxi Province,China)

机构地区：[1]平煤神马医疗集团总医院脊柱外科,河南省平顶山市467000 [2]延安大学附属医院脊柱外科,陕西省延安市716000

出　　处：《中国组织工程研究》2020年第30期4757-4762,共6页Chinese Journal of Tissue Engineering Research

基　　金：陕西省社会发展科技攻关项目(2015SF115),项目负责人:王飞;延安市科技惠民计划项目(2016HM-10-03),项目负责人:王飞。

摘　　要：背景:特发性脊柱侧弯手术置钉操作难度大,手术时间长,采用3D打印导航模板辅助置钉可降低手术难度,优化置钉操作,提升置钉效果,具有显著优势。目的:探讨3D打印导航模板辅助置钉在特发性脊柱侧弯椎弓根螺钉内固定矫形术中的应用价值。方法:回顾性分析2018年1月至2019年8月采用椎弓根螺钉内固定矫形治疗的17例特发性脊柱侧弯患者的临床资料,8例术中应用3D打印导航模板辅助置钉(3D组),9例术中常规徒手置钉(常规组)?术后采用CT扫描螺钉位置评估置钉等级与可接受率;比较2组置钉时间、术中X射线透视次数、置钉出血量、置钉等级、置钉可接受率、二次置钉率、主弯矫形率和置钉相关并发症。结果与结论:①17例患者均顺利完成置钉操作,术中无置钉相关的血管、神经损伤并发症出现。常规组术后出现1例背部疼痛,1例下肢疼痛,经对症治疗后症状消失。②3D组置钉时间短于常规组,术中X射线透视次数、置钉出血量小于常规组,差异均有显著性意义(P<0.05)。③3D组置钉等级、置钉可接受率优于常规组,二次置钉率小于常规组,差异均有显著性意义(P<0.05)。④2组主弯矫形率比较,差异无显著性意义(P>0.05)。⑤提示特发性脊柱侧弯椎弓根螺钉置入内固定矫形过程中采用3D打印导航模板辅助置钉可降低置钉难度,提升置钉准确率。BACKGROUND:Idiopathic scoliosis surgery is difficult and requires a long operation time.Using 3D printing navigation templates to assist in nail placement can reduce the difficulty of surgery,optimize the operation of nail placement,and improve the effect of nail placement,which has significant advantages.OBJECTIVE:To evaluate the application of 3D printing navigation template assisted screw placement in the pedicle screw internal fixation of idiopathic scoliosis.METHODS:Clinical data of 17 cases of idiopathic scoliosis treated by pedicle screw fixation from January 2018 to August 2019 were retrospectively analyzed.Among them,eight patients were treated with 3D printing navigation template assisted screw placement(3D group),while nine patients were treated with conventional screw placement(conventional group).CT scan was used to evaluate the level and acceptability of screw placement after surgery.The time of nail placement,the times of intraoperative X-ray fluoroscopy,the amount of nailing bleeding,the level of nail placement,the acceptable rate of nail placement,the rate of secondary nail placement,the rate of main bending correction and the complications related to nail placement were compared between the two groups.RESULTS AND CONCLUSION:(1)All the 17 patients successfully completed the operation of nail placement,and there were no complications related to nail placement in blood vessel and nerve injury.One case of back pain and one case of lower extremity pain were found in the conventional group,and the symptoms disappeared after symptomatic treatment.(2)The time of nail placement,the times of intraoperative X-ray fluoroscopy and the amount of nailing bleeding in the 3D group were less than those in the conventional group,and the difference was statistically significant(P<0.05).(3)The level and acceptability of nail placement in the 3D group were higher than those in the conventional group,and the rate of secondary nail placement in the 3D group was lower than that in the conventional group,with statistical

关 键 词：骨 内固定 3D 影像 脊柱侧弯 螺钉 导航模板 优化置钉 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]