改良数字化导航模板在寰枢椎个体化置钉中的临床应用  

Clinical application of improved 3D printing navigation guiding template for atlantoaxial pedicle screw placement

作　　者：王玉强[1] 牛慧霞[2] 赵耀[1] 刘屹林[1] 张敏[1] 刘宏建[1] 张书豪[1] 赵亮[1] 宋瑞鹏[1] 王卫东[1] 朱忠培[1] 王利民[1] Wang Yuqiang;Niu Huixia;Zhao Yao;Liu Yilin;Zhang Min;Liu Hongjian;Zhang Shuhao;Zhao Liang;Song Ruipeng;Wang Weidong;Zhu Zhongpei;Wang Limin(Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Deparetment of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052 [2]郑州大学第一附属医院神经内科,450052

出　　处：《中华实验外科杂志》2020年第4期627-631,共5页Chinese Journal of Experimental Surgery

摘　　要：目的通过设计改良数字化导航模板并应用于术中辅助寰枢椎椎弓根置钉,评估其临床效果及安全性。方法分析2015年1月至2018年12月郑州大学第一附属医院收治的行后路切开复位寰枢椎椎弓根钉棒系统内固定术治疗的寰枢椎脱位患者38例,根据术中置钉方式的不同,将患者分为模板导航组(18例)和徒手置钉组(20例)。对比两组的手术时间、C臂透视次数、出血量等术中指标;术后采用Kawaguchi法评估置钉位置的满意程度,测量并比较术前预设钉道与术后实际钉道的内倾角、头倾角、进钉点坐标;采用日本骨科协会(JOA)评分、颈椎活动障碍指数(NDI)评估两组术后症状改善程度。组间患者年龄、随访时间、疗效评估等参数应用独立样本t检验;两组间计数资料的比较采用χ2检验,组内计量资料两两比较采用配对t检验。结果 38例患者均顺利完成手术,模板导航组共置入70枚椎弓根螺钉,徒手置钉组置入75枚椎弓根螺钉。模板导航组在手术时间[(87.6±35.4) min]和透视次数[(3.9±1.9)次]方面均明显少于徒手置钉组[手术时间(124.3±56.6) min(χ2=3.734,P<0.05)、透视次数(12.4±4.7)次(χ2=4.327,P<0.05)],差异有统计学意义;模板导航组在出血量[(84.5±55.2) ml]方面略低于徒手置钉组[(96.1±69.4) ml],但两者差异无统计学意义(χ2=0.875,P>0.05)。两组患者在术后随访期内各时间点的JOA评分和NDI指数均有相似改善;但是术后CT提示,模板导航组置钉Kawaguchi分级0级的总准确率为95.7%(67/70),明显高于徒手置钉组[77.3%(58/75),χ2=2.628,P<0.05],差异有统计学意义;模板导航组术后实际测量的内倾角、头倾角、进钉点坐标位置与术前预设值基本一致,而徒手置钉组术后的各置钉参数与术前预设值均存在偏差。结论改良数字化导航模板应用于寰枢椎的辅助置钉操作简便、安全,可显著缩短手术时间、减少放射线暴露,且临床效果满意�Objective To investigate the operative and clinical performance of an improved 3D printed navigation guiding template to develop patient specific solutions for posterior atlantoaxial pedicle screw fixation surgery.Methods Thirty-eight patients with atlantoaxial dislocation admitted between January 2015 to December 2018 were divided into a template navigation group(n=18)and a traditional group(n=20).The template navigation group was assisted by the improved digital guide board,and the traditional group was guided by the C-arm fluoroscopy.The operative time,C-arm fluoroscopy times,blood loss and other intraoperative indicators were compared between two groups.Kawaguchi method was used to evaluate the satisfaction of screw placement.The accuracy and safety of the screw insertion were evaluated using preoperative and postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw entry point location.Japanese Orthopedic Association scale(JOA)score and Neck Disability Index(NDI)were used to evaluate the improvement of postoperative symptoms in the two groups.Independent sample t test was used for evaluation of intergroup patient age,follow-up time,efficacy.Chi-square test was used for comparison of counting data between the two groups,and paired t test was used for comparison of measurement data within the group.Results All patients underwent surgery successfully.A total of 70 pedicle screws were inserted in the template navigation group,while 75 pedicle screws were inserted in the traditional group.The operative time(87.6±35.4)and frequency of fluoroscopy(3.9±1.9)in the template navigation group were significantly reduced as compared with those in the traditional group[Operative time(124.3±56.6)min(χ2=3.734,P<0.05),fluoroscopy frequency(12.4±4.7)(χ2=4.327,P<0.05)].The amount of bleeding[(84.5±55.2)ml]in the template navigation group was slightly les than that in the traditional group[(96.1±69.4)ml],but the difference between the two groups was n

关 键 词：数字化导航 3D打印 寰枢椎脱位 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]