3D打印骨小梁融合器辅助治疗颅底凹陷合并寰枢椎脱位的初步疗效分析  

Application of a 3D printed trabecular block cage in treatment of patients with basilar invagination and atlantoaxial dislocation

作　　者：张敏[1] 赵耀[1] 王玉强[1] 刘屹林[1] 王利民[1] 吴学建[1] 刘宏建[1] 张书豪[1] Zhang Min;Zhao Yao;Wang Yuqiang;Liu Yilin;Wang Limin;Wu Xuejian;Liu Hongjian;Zhang Shuhao(Department of Orthopedics,The First Affiliated Hospital to Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,450052

出　　处：《中华创伤骨科杂志》2021年第4期343-348,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨3D打印骨小梁寰枢侧块关节融合器辅助后路内固定治疗颅底凹陷合并寰枢椎脱位的早期疗效。方法回顾性分析郑州大学第一附属医院骨科2017年6月至2019年2月收治的12例颅底凹陷合并寰枢椎脱位患者资料。其中男5例,女7例;年龄34~62岁,平均45.6岁;患者均接受了后路寰枢椎撑开复位内固定手术治疗,术中侧块关节间植入3D打印融合器。比较术前、术后12个月的日本骨科协会(JOA)评分、寰齿前间距(ADI)、颈髓角(CMA)、齿状突尖距钱氏线距离(DOCL),并观察侧块关节的融合情况。结果12例患者均顺利完成手术,手术时间平均116.5 min(85~190 min),透视次数平均9.4次(6~21次),出血量平均82.3 mL(50~210 mL)。术后未出现脑脊液漏、脑梗死等并发症,未出现内置物断裂、移位、松动等情况。所有患者术后获18~42个月(平均26.3个月)随访。JOA评分、ADI、CMA、DOCL由术前的(8.33±0.98)分、(8.66±1.64)mm、119.63°±4.15°和(9.66±2.15)mm分别改善至术后12个月的(14.17±1.03)分、(2.63±0.59)mm、153.76°±7.88°和(2.07±0.69)mm,差异均有统计学意义(P<0.05);手术节段均骨性融合。结论3D打印骨小梁融合器辅助后路内固定在治疗颅底凹陷合并寰枢椎脱位患者中能够实现满意的复位,维持关节间隙的撑开高度,疗效满意。Objective To explore the short-term outcomes of a 3D printed trabecular block cage to assist posterior internal fixation for the treatment of patients with basilar invagination and atlantoaxial dislocation.Methods Between June 2017 and February 2019,12 patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial distraction and posterior internal fixation at Department of Orthopedics,The First Affiliated Hospital to Zhengzhou University.They were 5 males and 7 females,aged from 34 to 62 years(average,45.6 years).3D printed cages were inserted intraoperatively between the joints of the atlantoaxial lateral mass.The atlanto-dental interval interval(ADI),cervico-medullary angle(CMA)and distance from tip of the odontoid process to Chamberlain's line(DOCL)and the Japanese Orthopedic Association(JOA)scale were compared between preoperation and 12 months postoperation to observe the fusion of the joints of the atlantoaxial lateral mass.Results Operation went on uneventfully in all the 12 patients.Operation time averaged 116.5 min(from 85 to 190 min),fluoroscopy frequency 9.4 times(from 6 to 21 times),and intraoperative bleeding 82.3 mL(from 50 to 210 mL).No such postoperative complications occurred as cerebrospinal leak,cerebral infarction,or breakage,displacement or loosening of implants.All patients were followed up for 18 to 42 months(mean,26.3 months).Their preoperative JOA,ADI,CMA and DOCL[8.33±0.98,(8.66±1.64)mm,119.63°±4.15°and(9.66±2.15)mm]were significantly improved to 14.17±1.03,(2.63±0.59)mm,153.76°±7.88°and(2.07±0.69)mm(P<0.05)at 12 months postoperation.Bony fusion was achieved in all the operative segments.Conclusion In the treatment of patients with basilar invagination and atlantoaxial dislocation,a 3D-printed trabecular block cage can be used to assist posterior internal fixation to achieve satisfactory reduction and maintain the height of joint space,leading to satisfactory short-term outcomes.

关 键 词：扁颅底 寰枢关节 骨排列不齐 内固定器 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]