颅颈交界不稳定3D打印导向器辅助枕颈融合术  

3D printed guiders assisted occipitocervical fusion for craniocervical junction instability

作　　者：高坤[1] 余正红[1] 邵佳 毛克政 张新胜 高延征[1] GAO Kun;YU Zheng-hong;SHAO Jia;MAO Ke-zheng;ZHANG Xin-sheng;GAO Yan-zheng(Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院脊柱脊髓外科,河南郑州450003

出　　处：《中国矫形外科杂志》2021年第21期1978-1981,共4页Orthopedic Journal of China

摘　　要：[目的]介绍3D打印导向器辅助枕颈融合术的手术技术和初步临床结果。[方法]2012年1月—2019年6月采用3D打印导向器引导下枕颈融合术治疗枕颈交界不稳或脱位患者21例。将颅颈CT的原始数据以DICOM格式导入宝葫芦软件,重建枕骨三维模型。设计枕骨螺钉位置,枕骨螺钉位于枕骨粗隆下方,垂直于枕骨外表面,通过枕内嵴,直径2.0 mm,3枚螺钉中心间距10 mm。建立反向基板,结合钉道数据,设计导板。3D打印实物导板。术中行后正中纵形切口,显露出枕骨与上颈椎后侧。在枢椎下关节突中心点开口,置入椎弓根螺钉。将3D打印的枕骨导板稳定按压贴敷于枕骨表面,建立枕骨钉道。取下导板,放置枕骨钢板,拧入3枚螺钉。用双侧棒将枢椎弓根钉与枕骨钢板连接,矫正枕颈力线,螺钉锁定,颈枕植骨。[结果]所有患者均顺利手术,手术时间(138.51±25.34)min,术中出血量(198.22±63.17)ml;枕骨螺钉平均长度(10.62±0.95)mm。术后随访时间6~24个月(12.66±5.21个月),均获得骨性融合。[结论]使用3D打印导向器辅助枕骨螺钉置入能获得满意的枕骨固定螺钉的长度,有利于枕颈融合。[Objective]To introduce the surgical technique and preliminary clinical results of 3D printed guiders assisted occipitocervi⁃cal fusion.[Methods]From January 2012 to June 2019,21 patients with craniocervical junction instability or dislocation were treated with 3D printed guiders assisted occipitocervical fusion.The original craniocervical CT data were imported into the Baohulu software in DICOM format to reconstruct the three-dimensional craniocervical models.The positions of the occipital screw were designed on the models,which were located below the tuberosity of the occipital bone,perpendicular to the outer surface of the occipital bone,passing through the inner oc⁃cipital crest,with a diameter of 2.0 mm,and an interval of 10mm between screws.The real guiders were made by 3D printer based on estab⁃lishing the reverse base plate and screw tract data.In the clinical setting,a midline longitudinal incision was made to reveal the occipital bone and the posterior side of the upper cervical spine.As openings were made at the center point of the inferior facet process of the axis,a pare of pedicle screws were inserted.The 3D printed guiders were placed on the surface of the occipital bone stably to establish the occipi⁃tal screw tracts.After removing the guiders,the occipital plate was placed and fixed with 3 occipital screws.Bilateral rods were placed to connect the axial pedicle screws with the occipital plate,and then to correct the occipitocervical alignment,finally the rod-screw system was fastened.Bone autografts were implanted on the occipitocervical range.[Results]All the patients had operation performed smoothly with operation time of(138.51±25.34)min,intraoperative blood loss of(198.22±63.17)ml,and occipital screws placed(10.62±0.95)mm in length on average.The postoperative follow-up period lasted for 6-24 months,with(12.66±5.21)months on average.All the patients got oc⁃cipitocervical bony fusion.[Conclusion]This 3D printed guiders assisted occipitocervical fusion does achieve satisfactory le

关 键 词：3D 打印导向器 枕骨 螺钉 枕颈融合 

分 类 号：R687[医药卫生—骨科学]