徒手技术与导板辅助下置入腰椎皮质骨通道螺钉的比较  

Comparison of free-hand technique and guide plate-assisted placement of lumbar cortical bone channel screws

作　　者：赵永辉 梁金龙 罗浩天 徐永清 陆声 ZHAO Yonghui;LIANG Jinlong;LUO Haotian(Department of Orthopaedics,the 920 Hospital of the Joint Service Support Force of the People's Liberation Army,Yunnan,Kunming 650032,China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院骨科/云南省创伤骨科临床医学中心,昆明650032 [2]云南省第一人民医院骨科/昆明理工大学附属医院/云南省数字骨科重点实验室

出　　处：《临床外科杂志》2021年第1期54-57,共4页Journal of Clinical Surgery

基　　金：云南省重大科技专项计划-重大科技专项(生物医药)(2017ZF025);云南省创伤骨科临床医学中心(XZ20191001)。

摘　　要：目的比较徒手技术与3D打印导板技术在腰椎置入皮质骨通道螺钉的安全性和准确率。方法选择9例病人的腰椎CT数据,利用计算机软件建立腰椎三维模型并基于皮质骨钉道设计置钉导板。采用3D打印机每例分别打印出2套腰椎模型和1套置钉导板。由3位不同经验操作者随机选取3例,分别采用徒手置钉和导板辅助置钉。术后行X线片检查,根据螺钉接触皮质骨区域,螺钉穿出位置及穿出距离来评价置钉效果。结果两种方法分别置入90螺钉。徒手组的成功率为73.3%,可接受率为85.6%;导板组的成功率为92.2%,可接受率为98.9%。导板成功率及可接受率均高于徒手,差异有统计学意义(P<0.05)。徒手间操作者2和操作者3置钉成功率和可接受率均大于操作者1,但操作者2和操作者3之间无明显统计学差异(P>0.05);导板方法中3位操作者间比较,差异无统计学意义(P>0.05)。结论 3D打印导板技术较徒手技术在置入腰椎皮质骨通道螺钉方面更安全精准。Objective To compare the safety and accuracy of the free-hand technique and 3D printing guide plate technique in the placement of cortical bone trajectory screws in the lumbar spine.Methods The lumbar spine CT data of 9 patients in our hospital were selected,and the three-dimensional model of the lumbar spine was established using computer software and the drill guide plate was designed based on the cortical bone screw trajectory.A 3D printer was used to print 2 sets of lumbar spine models and 1 set of drill guide plates for each case.Three cases were randomly selected by three operators with different experience,and the screws were placed by free-hand and guide plate respectively.According to different screw placement methods,it is divided into free-hand group and guide plate group.Postoperative X-ray film examination,according to the screw contact cortical bone area,screw penetration position and penetration distance to evaluate the effect of screw placement.Results 90 screws were placed in each group.In free-hand group,the success rate was 73.3%,and the acceptability rate was 85.6%;in guide plate group,the success rate was 92.2%,and the acceptability rate was 98.9%.Success rate and acceptability rate of the guide group were higher than that of the free-hand group(P<0.05).The success rate and acceptance rate of screw placement between operator 2 and operator 3 were both higher than that of operator 1,but there was no significant statistical difference between operator 2 and operator 3(P>0.05).Conclusion Compared with freehand technique,3D printed guide plate technology is more safe and accurate in the placement of lumbar cortical bone trajectory screw.

关 键 词：腰椎 皮质骨通道螺钉 椎弓根螺钉 3D打印技术 

分 类 号：R687.3[医药卫生—骨科学]