3D打印导航模板辅助颈椎椎弓根螺钉置入导向管长短与置钉准确性分析  

Relation between the length of navigation pipe and accuracy of screw placement in cervical pedicle screw placement assisted by 3D printed navigation template

作　　者：邓佳燕[1] 吴超[1,2] 申丹伟 曾柏方 谭伦[2] DENG Jiayan;WU Chao;SHEN Danwei;ZENG Bofang;TAN Lun(Digital Medical Center,Zigong Fourth People's Hospital,Zigong,Sichuan 643000,P.R.China;Department of Orthopedics,Zigong Fourth People's Hospital,Zigong,Sichuan 643000,P.R.China)

机构地区：[1]自贡市第四人民医院数字医学中心,四川自贡643000 [2]自贡市第四人民医院骨科中心,四川自贡643000

出　　处：《华西医学》2021年第10期1349-1354,共6页West China Medical Journal

基　　金：四川省科技计划项目(2021YJ0049);四川省卫生健康委员会科研课题(20PJ274);四川省医学会科研课题(S20010)。

摘　　要：目的评估3D打印导航模板辅助颈椎椎弓根螺钉置入术后实际置钉与术前模拟置钉的偏差,分析置钉偏差与导向管长度的关联性。方法前瞻性纳入2018年2月-2020年8月在自贡市第四人民医院拟行3D打印导航模板辅助颈1~7椎弓根螺钉置入术的患者共计40例;将其随机分为3组,其中12例导向管长度设为5 mm(5 mm组),13例导向管长度设为10 mm(10 mm组),15例导向管长度设为15 mm(15 mm组)。对这些患者术前颈椎CT图像进行三维建模并模拟置入椎弓根螺钉,根据模拟椎弓根螺钉的位置和方向,设计个体化椎弓根螺钉导板,并对颈椎的三维模型和导板进行3D打印。术前基于3D打印模型和导板模拟手术过程,确认螺钉的安全性;术中按照术前设计和模拟手术过程进行椎弓根螺钉置入。将术后CT图像三维建模,并与术前的三维模型进行配准,通过术后置钉的Grade分级评估置钉安全性,通过测量术后置钉与术前模拟置钉的进钉点偏差、进钉方向在水平面(内倾角)和矢状面(头倾角)的偏差评估置钉准确性,分析不同导向管长度对置钉安全性和准确性的影响。结果导板辅助共计置入椎弓根螺钉164枚,其中5 mm组48枚,包括0级38枚,1级10枚;10 mm组52枚均为0级;15 mm组64枚,包括0级52枚,1级12枚;组间Grade分级差异有统计学意义(P<0.05)。导向管长度为5、10、15 mm时,螺钉进钉点偏差分别为(1.87±0.63)、(1.44±0.63)、(1.66±0.54)mm,内倾角偏差分别为(2.72±0.25)、(0.90±0.21)、(1.84±0.35)°,头倾角偏差分别为(8.63±1.83)、(7.15±1.38)、(8.24±1.52)°,10 mm组均小于其他两组,差异有统计学意义(P<0.05)。结论导板辅助颈椎椎弓根螺钉置入,所有螺钉均为Grade 0级或1级,安全性高;进钉点偏差平均在2 mm以内,准确性高。导向管长度为10 mm时,置钉的安全性和准确性最高。Objective To evaluate the deviation between actual and simulated screw placement after cervical pedicle screw placement assisted by 3 D printed navigation template,and analyze the correlation between screw placement deviation and navigation pipe length.Methods A total of 40 patients undergoing cervical 1-7 pedicle screw insertion assisted by 3 D printed navigation template in Zigong Fourth People’s Hospital between February 2018 and August2020 were included in this prospective study.These patients were divided into 3 groups randomly,including 12 patients with a 5-mm pipe length(5 mm group),13 patients with a 10-mm pipe length(10 mm group),and 15 patients with a 15-mm pipe length(15 mm group).Three-dimensional modeling was performed on preoperative cervical CT images of these patients and simulated pedicle screw was placed.Individualized pedicle screw navigation templates were designed according to the position and direction of simulated pedicle screws,and 3 D printing was performed on the cervical model and navigation templates.Preoperative 3 D printed model and navigation templates were used to simulate the surgical process to confirm the safety of screws.During the operation,pedicle screw placement was performed according to the preoperative design and simulated surgical process.The postoperative CT images were registered with the preoperative CT images in 3 D model.The safety of screw placement was evaluated by the postoperative screw placement Grade,and the accuracy of screw placement was evaluated by measuring the deviation of screw placement point and the deviation of screw placement direction in horizontal plane(inclination angle)and sagittal plane(head inclination angle).The influence of different navigation pipe lengths on the safety and accuracy of screw placement was analyzed.Results A total of 164 pedicle screws were inserted with navigation template assistance,including 48 screws(38 in Grade 0 and 10 in Grade 1)in the 5 mm group,52 screws in the 10 mm group(all in Grade 0),and 64 screws(52 in Grade

关 键 词：颈椎骨折脱位 椎弓根螺钉 3D打印 个性化设计 准确性分析 

分 类 号：R687.3[医药卫生—骨科学]