3D打印辅助寰枢椎置钉的临床分析  

Clinical Analysis of 3D Printing Assisted Atlantoaxial Screw Placement

作　　者：陈磊[1,2] 朱斌 次仁伦珠[2] 钟华璋 王涛 田大胜 荆珏华[1] Chen Lei;Zhu Bin;Ciren Lunzhu;Zhong Huazhang;Wang Tao;Tian Dasheng;Jing Juehua(Department of Orthopaedics,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of Orthopedics,Shannan People’s Hospital,Shannan 856000,China)

机构地区：[1]安徽医科大学第二附属医院骨科,安徽合肥230601 [2]西藏自治区山南市人民医院骨科,西藏山南856000

出　　处：《实用骨科杂志》2024年第2期138-142,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨3D打印辅助寰枢椎置钉的临床效果。方法回顾性分析2014年3月到2022年9月安徽医科大学第二附属医院收治的33例寰枢椎后路钉棒固定融合术患者的临床资料,其中3D打印组15例,男11例,女4例;年龄20~80岁,平均年龄(52.87±16.97)岁;对照组18例,男13例,女5例;年龄19~68岁,平均年龄(43.39±13.59)岁。3D打印组进行3D打印模型的制作、模型研读、模型模拟制作钉道、预制好理想钉道的模型术中参考置钉;对照组根据术者经验常规徒手置钉。比较两组手术时间、术中出血量、透视次数、术后住院天数、置钉准确性Kawaguchi分级、不同时间点疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)。结果两组患者均获随访,随访时间12~36个月,平均(32.88±7.15)个月。3D打印组手术时间(131.07±28.65)min,短于对照组的(168.11±61.75)min,差异有统计学意义(P<0.05)。3D打印组透视次数(9.80±2.21)次,少于对照组的(14.00±3.36)次,差异有统计学意义(P<0.05)。3D打印组术后3 d VAS评分(2.84±1.04)分,较对照组的(3.37±1.26)分更低,差异有统计学意义(P<0.05)。3D打印组置钉60枚,Kawaguchi分级0级56枚,优良率93.33%;对照组置钉72枚,Kawaguchi分级0级57枚,优良率79.17%;3D打印组置钉准确性优于对照组,差异有统计学意义(P<0.05)。其他相关指标组间比较,差异无统计学意义(P>0.05)。结论3D打印辅助寰枢椎置钉技术可缩短手术时间,提高螺钉的置入精度,减少潜在的神经血管损伤风险,疗效满意。Objective To investigate the clinical effect of 3D printing assisted atlantoaxial screw placement.Methods The clinical data of 33 patients who had posterior atlantoaxial screw fixation and fusion in The Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed.Among them,15 patients were included in the 3D printing group(11 males and 4 females).The age ranged from 20 to 80 years,with an average age of(52.87±16.97)years.The control group consisted of 18 patients(13 males and 5 females).The age ranged from 19 to 68 years,with an average age of(43.39±13.59)years.In the 3D printing group,we made models using 3D printing,studied the mdoels,made ideal screw path on the models,and used the models with the ideal screw path as an intraoperative reference.In the control group,freehand screw placement based on surgeon's experience.Operative time,intraoperative blood loss,fluoroscopy times,postoperative hospitalization days,Kawaguchi grade of screw placement accuracy,visual analogue scale(VAS),and neck disability index(NDI)at various time points were among the indicators that were compared.Results Patients in both groups were followed up for 12 to 36 months,with an average of(32.88±7.15)months.The operation time of the 3D printing group was(131.07±28.65)min,which was shorter than that of the control group(168.11±61.75)min(P<0.05).The fluoroscopy times of the 3D printing group(9.80±2.21)were less than that of the control group(14.00±3.36)(P<0.05).The VAS score of 3D printing group(2.84±1.04)was lower than that of control group(3.37±1.26)3 days after surgery(P<0.05).There were 56 screws of Kawaguchi grade 0 in all 60 screws in the 3D printing group,with an excellent rate of 93.33%.There were 57 crews of Kawaguchi grade 0 in in 72 in the control group,with an excellent rate of 79.17%,the difference was statistically significant(P<0.05).There were no significant differences in other relevant indicators among groups(P>0.05).Conclusion The use of 3D printing technology in atlantoaxial screw plac

关 键 词：寰枢椎融合 寰枢椎骨折 寰枢椎不稳 3D打印 螺钉置入 

分 类 号：R687.3[医药卫生—骨科学]