组配式角度定位仪与3D打印导航模板在椎弓根螺钉置钉中应用效果的对比研究  

Comparative study of combined angle locator and three-dimensional printing navigation template and their application effect on pedicle screw placement

作　　者：张文玺[1] 周金华[1] 乔之军 刘波[1] Zhang Wenxi;Zhou Jinhua;Qiao Zhijun;Liu Bo(Department of Orthopaedics,the People's Hospital of Liyang,Liyang 213300,China)

机构地区：[1]江苏省溧阳市人民医院脊柱外科,213300

出　　处：《中华解剖与临床杂志》2021年第5期535-542,共8页Chinese Journal of Anatomy and Clinics

基　　金：常州市卫生计生重大科技项目(ZD201510,ZD201927)。

摘　　要：目的对比分析角度定位仪与3D打印导航模板在椎弓根螺钉置钉中的临床应用效果。方法前瞻性随机对照研究。纳入2017年1月—2020年7月溧阳市人民医院脊柱外科收治的脊柱骨折或脊柱退行性变患者40例,其中男18例、女22例,平均年龄59.55岁。术前均行CT薄层扫描,将获取的Dicom数据导入Mimics 19.0软件,分割手术节段,设置进钉通道后进行模型3D打印。病变节段包括颈椎、胸椎、腰椎,按照不同节段进行区组随机化分组,分为定位仪组和导航模板组,各20例,均行后路钉棒内固定术。定位仪组:将夹具固定模型在俯卧位状态,定位仪先进行脊柱水平校零,测量进钉通道的水平面螺钉置入角度(TSA)角及矢状面螺钉置入角度(SSA)+A角(椎体倾斜角)。术中通过定位仪进行手术床的水平校零,采用预演的进钉角度,置入椎弓根螺钉。导航模板组:采用个体化设计的椎弓根定位导航模板,3D打印后进行模拟操作,随后用于术中椎弓根定位。对比观察两组患者临床基线资料,以及模拟手术时间、临床手术中显露与置钉时间;术后复查CT,根据Andrew椎弓根螺钉CT位置分级标准评价椎弓根钉位置。结果两组患者年龄、性别、疾病类型、病变节段部位等基线资料比较,差异均无统计学意义(P值均>0.05)。40例患者均顺利完成手术,共置入椎弓根螺钉185枚。定位仪组患者模拟手术时间为(13.55±5.92)min,导航模板组为(13.60±5.06)min,差异无统计学意义(t=0.029,P>0.05);定位仪组术中显露与置钉时间为(53.25±15.59)min,短于导航模板组的(66.90±19.80)min,差异有统计学意义(t=2.423,P<0.05)。40例185枚椎弓根螺钉位置均为Ⅰ~Ⅱ级,定位仪组Ⅰ级86枚、Ⅱ级5枚,导航模板组Ⅰ级91枚、Ⅱ级3枚,两组比较差异无统计学意义(χ2=0.593,P>0.05)。无一例出现脊髓、神经根、血管损伤。结论角度定位仪在椎弓根置钉方面与椎弓根定位导航模板均有Objective To compare and analyze the clinical application effects of angle locator and three-dimensional(3D)printing navigation template on pedicle screw placement.Methods A prospective randomized controlled study was performed.Forty patients with spinal fractures or spinal degeneration were admitted to the Department of Spine Surgery,Liyang People's Hospital,from January 2017 to July 2020.The patients included 18 males and 22 females,with an average age of 59.55 years.CT thin-slice scan was performed on all patients before surgery,and the Dicom data obtained were imported into Mimics 19.0 software.The surgical segment was divided,and the nail channel was set.Then,a 3D model was printed.The cervical,thoracic,and lumbar vertebrae were included,all of which were fixed with posterior nails and rods.The patients were randomized into block groups and divided into locator and navigation template groups according to different segments.Each group had 20 cases.For the locator group,the 3D model was fixed in the prone position by a fixture.The spine model was horizontally zeroed by the positioner,and the transverse screw angle(TSA)and sagittal screw angle(SSA)+A angle(vertebral inclination angle)of the screw channel were measured.During the operation,the level of the operating table was zeroed by the positioning instrument,and the pedicle screw was implanted with the pre-rehearsed screw insertion angle.For the navigation template group,a personalized pedicle screw navigational template(PSNT)that was 3D printed for simulation operation was adopted.Then,it was used for intraoperative pedicle positioning.The clinical baseline data of the two groups of patients,the simulated operation time,and the time of exposure and nail placement during the clinical operation were compared and observed.Follow-up CT was performed after operation,and the position of the pedicle screw was classified according to Andrew&apos;s pedicle screw CT position classification standard.Results The baseline data of the two groups of patients,such as age,g

关 键 词：脊柱疾病 三维打印 椎弓根螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]