3D打印导板辅助与徒手寰枢椎弓根钉置入比较  

Comparison of 3D printed guider assisted versus freehand atlantoaxial pedicle screw placement

作　　者：姜泽威 汤舒婷 周纪平 姚树强 丛波 刘彬 吴瑞 李佳佳 谭明生[2] 谭远超 JIANG Ze-wei;TANG Shu-ting;ZHOU Ji-ping;YAO Shu-qiang;CONG Bo;LIU Bin;WU Rui;LI Jia-jia;TAN Ming-sheng;TAN Yuan-chao(Wendeng Osteopathic Hospital,Weihai 264400,China;China-Japan Friendship Hospital,Beijing 100020,China)

机构地区：[1]山东省文登整骨医院,山东威海264400 [2]中日友好医院,北京100020

出　　处：《中国矫形外科杂志》2021年第10期880-884,共5页Orthopedic Journal of China

摘　　要：[目的]探讨3D打印导板辅助上颈椎椎弓根钉置入的可行性和准确性,提供一种安全的手术方法。[方法]回顾分析2018年01月~2019年12月行寰枢椎手术的患者54例。依据医患沟通结果分为两组,25例3D打印导板辅助置钉(导板组),29例徒手置钉(徒手组)。比较两组围手术期、随访与影像资料。[结果]54例手术均顺利完成,术中未出现严重椎动脉及脊髓损伤。两组手术时间及出血量的差异均无统计学意义(P>0.05),导板组的透视次数[(3.75±1.21)次vs(9.46+2.71)次,P<0.05]和单钉置入时间[(2.23±0.45)min vs(3.46±0.72)min,P<0.05]明显少于徒手组。随时间推移,两组患者的VAS评分均显著减少(P<0.05),而JOA颈椎评分均显著增加(P<0.05),两组ASIA神经功能评级均显著改善(P<0.05)。相应时间点,两组VAS、JOA评分和ASIA评级的差异均无统计学意义(P>0.05)。术后CT影像显示导板组置钉准确率显著优于徒手组(96.00%vs 88.79%,P<0.05)。与术前相比,术后1周和末次随访时两组患者寰椎-齿状突间隙(atlantodental interval,ADI)和脊髓空间(space available for cord,SAC)均显著增加(P<0.05);相同时间点,两组间ADI和SAC的差异均无统计学意义(P>0.05)。至末次随访时,两组患者均达到C1-C2骨性融合,内固定物无断钉、松动等不良改变。[结论]3D打印导板技术辅助下置入寰枢椎椎弓根螺钉,提升了螺钉置入的安全性及精确性,曝光次数少。[Objective] To evaluate the feasibility and accuracy of 3 D printed guider assisted upper cervical pedicle screw placement,and provide a safe surgical technique. [Methods] A retrospective study was conducted on 54 patients who underwent atlantoaxial surgery from January 2018 to December 2019. Based on the consequence of doctor-patient communication, patients were divided into two groups.Of them, 25 patients received 3 D printed guider assisted pedicle screw placement(guider group), while the remaining 29 patients had pedicle screw placed by freehand technique(freehand group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the 54 patients had operations completed successfully, without injuries to vertebral artery and spinal cord during surgical procedures. Although there was no statistically significant difference in operation time and blood loss between the two groups(P>0.05), the guider group proved significantly superior to the freehand group regarding the number of fluoroscopies [(3.75±1.21) times vs(9.46+2.71) times, P<0.05] and time consumed for a single screw inserted [(2.23±0.45) min vs(3.46±0.72) min, P<0.05]. The VAS scores significantly reduced(P<0.05), whereas the JOA scores for cervical spine significantly increased(P<0.05), and the ASIA grade for neurological function significantly improved over time in both groups(P<0.05). However, there were no statistically significant differences in the VAS and JOA scores, as well as ASIA grades between the two groups of at any corresponding time point(P>0.05). In term of postoperative CT evaluation, the guider group was significantly superior to the freehand group in accuracy of pedicle screw placement(96.00% vs88.79%, P<0.05). Compared with those preoperatively, the atlantodental interval(ADI) and the space available for cord(SAC) increased significantly at 1 week after operation and at the latest follow-up in both groups(P<0.05), nevertheless, there was no statistically significant difference in ADI and SAC

关 键 词：3D打印 寰枢椎 椎弓根螺钉 

分 类 号：R687[医药卫生—骨科学]