3D打印辅助与徒手上颈椎椎弓钉置入比较  

3D printing assisted screw placement versus conventional freehand counterpart for upper cervical deformity

作　　者：李超 牛国旗[2] 刘香平 张敬堂[1] 李海亚[1] 张斌斌[1] LI Chao;NIU Guo-qi;LIU Xiang-ping;ZHANG Jing-tang;LI Hai-ya;ZHANG Bin-bin(People's Hospital of Taihe County,Taihe 236600,China;The Second Affiliated Hospital,Bengbu Medical College,Bengbu233000,China)

机构地区：[1]太和县人民医院,安徽太和236600 [2]蚌埠医学院第二附属医院,安徽蚌埠233000

出　　处：《中国矫形外科杂志》2023年第14期1338-1340,1344,共4页Orthopedic Journal of China

基　　金：安徽省科技攻关项目(编号:1804h08020247);2021年阜阳市卫健委科研青年项目(编号:FY2021-108)。

摘　　要：[目的]比较3D打印技术辅助上颈椎椎弓根螺钉的置入与徒手置钉的早期临床效果。[方法]2010年5月—2019年5月,对18例上颈椎畸形患者行寰枢或颈枕融合固定术,其中,10例采用3D打印导板引导上颈椎椎弓根置入10例,8例采用常规徒手置钉。比较两组早期临床与影像资料。[结果]所有患者均顺利完成手术,手术共置钉72枚,其中3D组40枚,徒手组32枚。3D组手术时间[(189.7±16.1)min vs(242.1±23.2)min,P<0.001]、术中失血量[(216.6±49.8)ml vs(385.0±23.5)ml,P<0.001]、平均每钉置入时间[(3.3±0.8)min vs(7.0±1.1)min,P<0.001]和透视次数[(8.7±1.1)次vs(30.0±3.3)次,P<0.001]均显著优于徒手组。影像方面,3D组术前模拟置钉和实际置钉在螺钉直径、长度以及与后正中线距离的差异均无统计学意义(P>0.05)。3D组置钉准确优良率显著高于徒手组(97.5%vs 81.3%,P<0.05)。[结论]与传统徒手置钉方法相比,3D打印技术辅助置钉准确率更高,并提高手术效率。[Objective]To compare the early clinical outcomes of 3D printing assisted pedicle screw placement versus conventional free⁃hand technique for the upper cervical deformity.[Methods]From May 2010 to May 2019,18 patients received atlantoaxial or occipitocervi⁃cal instrumented fusion for upper cervical deformity in our hospital.Of them,10 patients had screws placed with 3D printed guider individu⁃ally,while the other 8 patients were by conventional hands-free technique.The early clinical and imaging data were compared between the two groups.[Results]All patients were successfully operated on with a total of 72 screws inserted,including 40 screws in the 3D group and 32 screws in the freehand group.The 3D group proved significantly superior to the freehand group in terms of operative time[(189.7±16.1)min vs(242.1±23.2)min,P<0.001],intraoperative blood loss[(216.6±49.8)ml vs(385.0±23.5)ml,P<0.001],placement time per screw[(3.3±0.8)min vs(7.0±1.1)min,P<0.001]and the number of X-ray exposure[(8.7±1.1)times vs(30.0±3.3)time,P<0.001].Radiographically,there were no significant differences between preoperative simulation and real operation in the 3D group regarding screw diameter,length and distance from the posterior median line(P>0.05).The accuracy rate of screw placement in 3D group was significantly higher than that in freehand group(97.5%vs 81.3%,P<0.05).[Conclusion]Compared with traditional handsfree screw placement,the 3D printing assisted pedicle screw placement has higher accuracy and improved surgical efficiency.

关 键 词：上颈椎畸形 3D 打印 导板 椎弓根螺钉 

分 类 号：R687[医药卫生—骨科学]