个体化3D打印导航模板辅助寰枢椎骨折置钉中的准确性研究  

Study on the accuracy of individualized 3D printing navigation template in atlantoaxial fracture screw

作　　者：程嘉伟 牛国旗[1] 李超 刘路坦 周乾坤 朱军 刘涛[1] 蒋维利 陈辉[1] CHENG Jiawei;NIU Guoqi;LI Chao;LIU Lutan;ZHOU Qiankun;ZHU Jun;LIU Tao;JIANG Weili;CHEN Hui(Department of Orthopaedics,the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第二附属医院骨科,安徽蚌埠233000

出　　处：《实用医学杂志》2021年第18期2380-2385,共6页The Journal of Practical Medicine

基　　金：安徽省科技攻关项目(编号:1804h08020247)。

摘　　要：目的探讨个体化3D打印导向模板辅助寰枢椎骨折椎弓根螺钉置入的准确性和安全性。方法选取2017年9月至2019年6月在蚌埠医学院第二附属医院收治的寰枢椎骨折患者11例,收集患者的颈椎三维CT数据,利用计算机Mimics软件重建颈椎的三维骨骼模型,获取寰枢椎椎弓根、棘突、椎板和侧块的解剖特征,模拟椎弓根螺钉的最佳轨迹,根据理想的椎弓根通道设计反向模板,并用3D打印机制作出患者颈椎实体模型和相对应的寰枢椎导航模板。由同一名脊柱外科医生利用导板于颈椎模型上置钉,共置入44枚寰枢椎椎弓根螺钉。螺钉置入后,进行CT薄层扫描和Mimics重建,根据螺钉有无穿破椎弓根皮质及螺钉的头倾角和内倾角,评价置钉准确性。结果11例颈椎模型共置入44枚寰枢椎椎弓根螺钉。术后CT扫描显示,没有螺钉穿破椎弓根皮质,理想螺钉轨迹和实际螺钉轨迹的头倾角和内倾角差异无统计学意义(P>0.05)。结论个体化3D打印导航模板在辅助寰枢椎骨折置钉中具有较高的准确性、安全性,值得临床进一步的研究和推广使用。Objective To investigate the accuracy and safety of the individualized 3D print-guided template in the placement of atlantoaxial fracture pedicle screws.The navigation template suitable for the placement of atlantoaxial pedicle screw was designed and made by using 3D printing technology,the accuracy of the template was verified,and the deviation of screw trajectory was quantitatively analyzed.Methods Eleven patients with atlantoaxial fracture were treated in the second affiliated Hospital of Bengbu Medical College from September 2017 to June 2019.The three-dimensional CT data of cervical vertebrae were collected,and the three-dimensional bone model of cervical vertebra was reconstructed by computer Mimics software.The anatomical characteristics of atlantoaxial pedicle,spinous process,lamina and lateral mass were obtained,the best trajectory of pedicle screw was simulated,and the reverse template was designed according to the ideal pedicle channel.The 3D printing mechanism was used to make the patient′s cervical solid model and the corresponding atlantoaxial navigation template.A total of 44 atlantoaxial pedicle screws were implanted by the same spinal surgeon using the cervical model guide plate to assist in the simulated operation.After screw placement,thin slice CT scan and Mimics reconstruction were performed again.The accuracy of screw placement was evaluated according to the measurement of whether the screw had penetrated the pedicle cortex and the screw,and compared the head inclination angle and internal inclination angle of the actual screw track with that of the ideal screw track.Results A total of 44 atlantoaxial pedicle screws were placed in 11 cervical models.Postoperative CT scan showed that no atlantoaxial screw penetrated the pedicle cortex,and there was no significant difference in head inclination and introversion angle between ideal screw track and actual screw track(P>0.05).Conclusion The individualized 3D printing individualized navigation template had high accuracy and safety in auxiliary a

关 键 词：寰枢椎 椎弓根螺钉 导航模板 3D打印 

分 类 号：R683.2[医药卫生—骨科学]