3D打印导航模板辅助下植入上胸椎椎弓根螺钉精准性的实验研究  

Experimental study on the accuracy of 3D printed guide plate-assisted implantation of upper thoracic pedicle screws

作　　者：崔利宾[1] 袁鑫[1] 许崧杰[1] 张衍军[1] 张志鹏[2] 陈学明[1] CUI Libin;YUAN Xin;XU Songjie(Department of Spine Surgery,Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京潞河医院脊柱外科,北京市101149 [2]首都医科大学附属北京潞河医院影像科,北京市101149

出　　处：《河北医药》2020年第14期2149-2152,共4页Hebei Medical Journal

基　　金：北京市通州区科学技术委员会立项项目潞河医院解剖实验平台应用研究(编号:KJ2017CX059)。

摘　　要：目的研究3D打印技术制备上胸椎椎弓根螺钉置入导板并辅助置钉,评价螺钉置入的准确性及可行性。方法选取6具正常成人上胸椎(T1~T4)尸体标本,行CT扫描获取相关数据后以DICOM格式存储,将相关数据导入Mimics软件后构建三维模型并通过逆向工程原理设计理想的椎弓根螺钉进针点及钉道方向,根据胸椎附件的解剖形态设计与之契合的反向模块,然后结合进针点与最佳钉道设计导板,最终3D打印成型,利用该导板辅助完成上胸椎椎弓根螺钉的置入。对实际进针点和理想进针点的位置进行统计学分析,应用Kawaguchi等级评价螺钉置入的准确性。结果每具上胸椎标本左右侧各置入4枚椎弓根螺钉,6具标本共置入48枚椎弓根螺钉。48枚螺钉中有1枚螺钉穿破椎弓根壁,优良率为95%。椎弓根螺钉实际进针点与理想进针点位置的差异无统计学意义(P>0.05)。结论应用3D打印导板辅助上胸椎椎弓根螺钉置入能获得满意的置钉精准度,操作简便可行,能够实现置钉的个体化。Objective To investigate the accuracy and feasibility of 3D printed guide plate-assisted implantation of upper thoracic pedicle screws.Methods Six normal adult upper thoracic vertebrae corpse specimens were enrolled in the study,and the relevant data were obtained by CT scan and stored in DICOM format.The data obtained were imported into Mimics software to construct 3D model and design ideal pedicle screw insertion point and nail path according to the principle of reverse engineering.A reverse module was designed according to the anatomical morphology of the thoracic spine accessory and a guide plate was designed.And then the plate was 3D printed which helped in the implantation of upper thoracic pedicle screws.Moreover,the position of the actual needle insertion point and the ideal needle insertion point were analyzed.In addition,Kawaguchi grade was used to evaluate the accuracy of the implantation of upper thoracic pedicle screws.Results Four pedicle screws were placed on both sides of each upper thoracic spine specimen.One out of 48 screws penetrated the pedicle wall,with excellent rate of 95%.There was no significant difference in the location of the actual needle insertion point and the ideal needle insertion point(P>0.05).Conclusion With high precision,3D printed guide plate-assisted implantation of upper thoracic pedicle screws is easy to perform and can be used in individualized screw implantation.

关 键 词：3D打印 导航模板 上胸椎 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]