3D打印导板辅助椎弓根螺钉置入治疗陈旧性Ⅱ型齿状突骨折  

3D printing navigation template assisted pedicle screw placement for the treatment of typeⅡold odontoid fractures

作　　者：董伟鑫[1] 储振涛 胡勇[1] 赖欧杰[1] 袁振山[1] DONG Wei-xin;CHU Zhen-tao;HU Yong;LAI Ou-jie;YUAN Zhen-shan(Department of Spinal Surgery,Ningbo No.6 Hospital,Ningbo 315040,Zhejiang,China)

机构地区：[1]宁波市第六医院脊柱外科,浙江宁波315040

出　　处：《中国骨伤》2024年第8期779-785,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较徒手置钉和应用3D打印导板辅助置钉在陈旧性Ⅱ型齿状突骨折患者中的安全性和临床疗效,并评价临床疗效。方法:2018年11月至2022年12月收治38例陈旧性Ⅱ型齿状突骨折患者,均表现为慢性颈痛,根据寰枢椎椎弓根螺钉置入方式不同分为导板组和徒手组。导板组17例,男9例,女8例,年龄(51.30±13.20)岁;病程(22.18±7.59)个月。徒手组21例,男7例,女14例,年龄(49.46±11.92)岁;病程(19.52±9.17)个月。观察比较两组术中出血量、手术时间和术后引流量等指标。通过CT扫描评价术后寰枢椎置钉准确率。术前和术后1年,采用疼痛视觉模拟评分(visual analogue scale,VAS)评价患者颈部疼痛,采用日本骨科学会(Japanese Orthopaedic Association,JOA)评分评价神经功能变化,采用美国脊髓损伤学会(American Spinal Injury Association,ASIA)损伤量表评估脊髓损伤程度。结果:所用患者获得随访,时间(25.31±1.21)个月。导板组的手术时间(112.00±20.48)min短于徒手组(124.29±15.24)min(P<0.05)。两组术中出血量、术后引流量、住院时间差异均无统计学意义(P>0.05)。术后1年导板组和徒手组VAS[(2.88±0.86)分,(2.90±0.83)分]和JOA评分[(14.94±1.82)分,(14.62±2.19)分]较术前[VAS(4.71±0.92)分,(4.86±0.79)分;JOA(12.18±2.30)分,(11.95±2.31)分]均明显改善(P<0.05),但是两组间比较差异无统计学意义(P>0.05)。两组ASIA评级在术后1年均未见明显改善(P>0.05),两组间比较差异无统计学意义(P>0.05)。导板组在寰椎椎弓根进行置钉的准确度明显优于徒手组(P<0.05),但是两组在枢椎的置钉准确度方面差异无统计学意义(P>0.05)。结论:在后路椎弓根螺钉内固定治疗陈旧性Ⅱ型齿状突骨折中,3D打印导板辅助技术能够显著缩短手术时间,实现和徒手置钉相似的临床疗效,并且能够显著提高寰椎椎弓根螺钉置入的准确性。Objective To compare the safety and clinical efficacy of freehand and 3D printing navigation template assisted screw placement in patients with old odontoid fractures of typeⅡ.Methods Total of 38 patients with old odontoid fractures of typeⅡwere treated from November 2018 to December 2022,all of which presented as chronic neck pain.According to the different methods of screw insertion into the pedicle,the patients were divided into a navigation template group and a freehand group.In the navigation template group,there were 17 patients including 9 males and 8 females with an average age of(51.30±13.20)years old,disease duration was(22.18±7.59)months.In the freehand group,there 21 patients including 7 males and 14 females with an average age of(49.46±11.92)years old,disease duration was(19.52±9.17)months.The intraoperative blood loss,operation time,and postoperative drainage output were recorded and compared between two groups.The accuracy of screw placement was evaluated by CT scan.Before operation and 1 year after operation,cervical pain was assessed by visual analogue scale(VAS),neurological changes were evaluated by the Japanese Orthopaedic Association(JOA)score,and the degree of spinal cord injury was assessed by the American Spinal Injury Association(ASIA)injury scale.Results All patients were followed up for(25.31±1.21)months.The operation time of template group(112.00±20.48)min had significantly shorter than that of the freehand group(124.29±15.24)min(P<0.05),while there were no significant differences between two groups in terms of intraoperative blood loss,postoperative drainage,and hospital stay(P>0.05).At 1 year after operation,in template group and freehand group,the VAS[(2.88±0.86),(2.90±0.83)]and JOA[(14.94±1.82),(14.62±2.19)]improved with preoperative[VAS(4.71±0.92),(4.86±0.79)and JOA(12.18±2.30),(11.95±2.31)](P<0.05),with no significant difference between two groups(P>0.05).No significant improvement was observed in ASIA grading in either group at 1 year after operation(P>0.05),a

关 键 词：陈旧性齿状突骨折 导板 徒手 准确性 内固定 

分 类 号：R683.2[医药卫生—骨科学]