摘要
背景:手术精准度是外科手术成功的一项保证,以往椎弓根置钉过程在很大程度上凭借术者经验置钉,存在较大的主观性,不可避免地造成一定的误置率。3D打印技术辅助椎弓根置钉使得置钉过程具有可预见性,使手术个体化、精确化、简单化,有望得到广泛的推广应用。目的:设计3D打印的个体化椎弓根导板,体外模拟置钉,探讨其在椎体椎弓根置钉术中的可行性。方法:选择河北省人民医院2016年4至7月收治的11例腰椎退行性病变患者的腰椎薄层CT扫描数据,三维重建每例患者的L1、L3及L5三个椎体。根据1例患者的腰椎CT数据先行预实验:按照术中置钉原则计算机设计钉道进钉位置、方向,反复验证及调整,设计出"最佳"导板模型;然后体外模拟置钉,并电锯剖开验证置钉效果。结果与结论:(1)实验共应用椎弓根导板30个,置钉60枚,模拟置钉过程顺利,导板贴服良好,未出现椎弓根螺钉穿破椎弓根皮质,螺钉位置准确可靠,效果良好;(2)置钉前后左侧椎弓根进钉的水平面角度及矢状面角度变化差异均无显著性意义(P>0.05),右侧椎弓根进钉的水平面角度及矢状面角度变化差异亦无显著性意义(P>0.05);(3)结果表明,实验设计出的椎弓根导板置钉准确,模拟置钉前后进钉方向变化无明显差异,证实了3D打印个体化椎弓根导板的置钉可行性,但尚需进一步临床验证。
BACKGROUND： Surgical accuracy is a key to surgical success. The traditional positioning method mainly depends on surgeons＇ experience, which is too subjective to cause screw misplacement. Three-dimensional （3D） printing technology-assisted pedicle screw placement can make individualized surgical scheme, most importantly, it is accurate and simple showing promising application prospect. OBJECTIVE： To design an individualized pedicle guide plate with 3D printing and to simulate screw placement in vitro, and to explore its feasibility in vertebral pedicle screw placement. METHODS： Lumbar spine CT data of 11 patients with degenerative lumbar spine were selected from April 2016 to July 2016 at Hebei General Hospital, and 3D reconstruction of L1, L3 and L5 vertebrae of each case was performed. Pre-experiment was conducted based on one patient＇s lumbar CT data： according to the principle of screw placement, the screw position and orientation were designed to prepare the best pedicle guide plate model. Afterwards, the screw placement in vitro was simulated, and was then cut by chainsaw to verify the accuracy of screw placement. RESULTS AND CONCLUSION： （1） A total of 30 pedicle guide plates were used, and 60 screws were inserted in the patients, and the placement process was successful. The guide plates adhered well, none appeared with screw perforating the pedicle cortex, and the screw position was accurate and reliable. （2） There were no significant changes in the transverse section and sagtial section angles of the left and right pedicle screws before and after placement （P 〉 0.05）. （3） These results suggest that the 3D-printed individualized pedicle guide plate holds a good accuracy of placement, which can be applied in the vertebral pedicle screw placement, but further clinical trials are needed.
出处
《中国组织工程研究》
CAS
北大核心
2017年第23期3724-3729,共6页
Chinese Journal of Tissue Engineering Research
