个体化3D打印导向模板辅助上颈椎椎弓根螺钉置入的实验研究

doi:10.3760/cma.j.issn.2095-7041.2017.05.004

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摘要目的评价个体化3D打印导向模板辅助上颈椎椎弓根螺钉置入的准确性和安全性。方法纳入2013年10月—2015年9月蚌埠医学院第二附属医院CT中心的13例上颈椎疾病患者术前CT检查数据,利用Mimics 15.0、Geomagic Studio 2013、NX 8.5三种计算机软件设计出寰枢椎椎弓根螺钉置钉导向模板,并运用3D打印技术打印出颈椎等比例实体模型和上颈椎椎弓根置钉导向模板。每例颈椎模型3D打印2份,分为两组:实验组利用导向模板辅助置入寰枢椎椎弓根螺钉;对照组采用影像学透视徒手置入寰枢椎椎弓根螺钉。两组上颈椎椎弓根螺钉均由同一名脊柱外科主任医师负责置入。以术后CT扫描数据评估上颈椎椎弓根螺钉置钉导向模板辅助置钉的准确性,对螺钉置入情况分类,依据螺钉在矢状面和横断面穿破椎弓根皮质程度以及是否需要翻修将其分为3类,其中Ⅰ类和Ⅱ类螺钉为可接受置钉,Ⅲ类螺钉为不可接受置钉。结果实验组设计并打印出上颈椎3D打印导向模板19块,辅助置入螺钉37枚,其中Ⅰ类33枚(86.49%)、Ⅱ类2枚(8.11%)、Ⅲ类2枚(5.40%);模拟手术置入1枚螺钉平均时间为(5.37±1.26) min,X线机透视次数为(5.48±1.19)次,螺钉长(28.38±2.98)mm。对照组使用C形臂X光机透视下徒手置入上颈椎椎弓根螺钉合计37枚,其中Ⅰ类23枚(62.16%)、Ⅱ类3枚(8.11%)、Ⅲ类11枚(29.73%);模拟手术置入1枚螺钉平均时间为(11.48±2.32) min,X线机透视次数平均为(17.85±2.96)次,螺钉长(28.65±2.83)mm。实验组与对照组螺钉置入的成功率分别为94.60%(35/37)和70.27%(25/37),差异有统计学意义(Z=-5.790, P<0.05);实验组与对照组使用螺钉长度差异无统计学意义(t=0.399, P>0.05);实验组置入单枚螺钉用时和X光机透视次数均明显少于对照组,差异均有统计学意义(t=-14.078、-23.586, P值均<0.01)。结论个性化导向模板辅助上颈椎置钉显著提高了置钉的安全性和准确性,尤其适用于严重畸形的上颈椎椎体。3D打印个体化上颈椎椎弓根螺钉置钉导板体现了个体化置钉原则,置钉成功率高、安全、有效、可行,有临床推广价值。

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	牛国旗
	代建昊
	汪东
	周功
	张井泉
	张跃
	刘涛
	陈辉
	聂虎
	周建生

关键词 ：颈椎, 治疗,计算机辅助, 椎弓根螺钉, 导向模板

Abstract：Objective To evaluate the accuracy and safety of individualized 3D printing-oriented template in the treatment of upper cervical pedicle screw placement.Methods The preoperative data of CT scan of 13 patients with cervical diseases in the CT Center of the Second Affiliated Hospital of Bengbu Medical College from October 2013 to September 2015 were analyzed by Mimics 15.0, Geomagic Studio 2013 and NX 8.5, and the use of 3D printing technology to print out the cervical and other proportional solid model, the upper cervical pedicle screw placement guide template. Two copies of each cervical spine model were divided into two groups: the experimental group was inserted into the atlantoaxial pedicle screw with the guide template. The control group was implanted with atlantoaxial pedicle screw by using imaging X-ray method. Two groups of upper cervical pedicle screw were placed by the same chief physician of spinal surgery. To evaluate the accuracy of screw placement in the sagittal plane and the cross-section of the pedicle by postoperative CT data, and whether the need for renovation, the accuracy of the fixation of the upper cervical pedicle screw was divided into 3 classes, in which class Ⅰ and Ⅱ type screws were acceptable nail, Ⅲ type screws were unacceptable nail.Results The experimental group: 19 blocks of upper cervical 3D printing screw guide templates were designed and printed, 37 pedicle screws of atlas and axis were inserted, including classⅠ 33 screws (86.49%), classⅡ 2 screws (8.11%) and classⅢ 2 screws (5.40%). The mean time of implanting a screw into upper cervical pedicle was 5.37±1.26 minutes. The average number of X-ray machine fluoroscopy of placing a screw was (5.48±1.19) times and the length of the screw was (28.38 ± 2.98) mm. The control group were implanted with the method of C-arm X ray fluoroscopy on a total of 37 upper cervical pedicle screws, of which class Ⅰ 23 screws (62.16%), Ⅱ 3 screws (8.11%), Ⅲ 11 screws (29.73%). The mean time of implanting a screw into upper cervical pedicle was 11.48±2.32 minutes. The average number of X-ray machine fluoroscopy of place a screw was (17.85±2.96) times and the length of the screw was (28.65±2.83) mm. The success rates of the screws in the experimental group and the control group were 94.60% (35/37) and 70.27% (25/37), respectively, the difference was statistically significant (Z=-5.790, P<0.05); There was no statistical difference in the length of screws between the experimental group and the control group (t=0.399, P>0.05). The number of fluoroscopy in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (t=-14.078, -23.586, all P values<0.01).Conclusions The personalized guide template assisted the superior cervical fixation significantly improved the safety and accuracy of the nail fixation, especially for the severe deformity of the upper cervical vertebral body. 3D print individualized cervical pedicle screw fixation nail guide plate shows the principle of individualized nailing. It can be clinically promoted with high success rate, safety, effectiveness and feasibility.

Key words： Cervical vertebrae Therapy, computer-assisted Pedicle screws Navigation template

收稿日期: 2017-02-23

通讯作者: 牛国旗,Email: ssngq@163.com

引用本文:

牛国旗, 代建昊, 汪东, 周功, 张井泉, 张跃, 刘涛, 陈辉, 聂虎, 周建生. 个体化3D打印导向模板辅助上颈椎椎弓根螺钉置入的实验研究[J]. 中华解剖与临床杂志, 2017, 22(5): 366-372.
Niu Guoqi, Dai Jianhao, Wang Dong, Zhou Gong, Zhang Jingquan, Zhang Yue, Liu Tao, Chen Hui, Nie Hu, Zhou Jiansheng.. Experimental study of individualized 3D printing navigation template in the treatment of upper cervical pedicle screw placement. Chinese Journal of Anatomy and Clinics, 2017, 22(5): 366-372.

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