摘要
目的设计并打印改良版颈椎前路椎弓根螺钉（ATPS）导航模板，研究模板辅助下置钉的准确性及导板的钉道控制能力。方法选取正常成人颈椎（C，一C，）湿性标本8具，男女各4具，薄层CT密扫后获取其DICOM格式数据导入Mimics17．0软件，三维重建颈椎模型后在透明模式下选取下颈椎ATPS的最佳钉道，设计普通导板及改良导板并通过3D打印机快速打印成型，随机于椎体两侧在两种导板指导下共置入64枚ATPS（n=32）；术后通过CT评价螺钉的准确性，比较两种导板螺钉理想钉道与实际钉道在进针角度（外倾角偏差、头倾角偏差）与进针点上（X轴偏移、Y轴偏移）的差异。结果改良导板组有1枚螺钉穿破椎弓根内侧皮质，普通导板组共有4枚螺钉穿破椎弓根，准确率分别为96．9％、87．5％。改良导板组的外倾角偏差（0．72°±0．69°）、头倾角偏差（0．91°＋0．70°）、X轴偏移【（0．53±0．40）mm】、Y轴偏移[（0．54±0．42）mm]均小于普通导板组【1．16°±0．70°、1．49°±0．68°、（0．88±0．40）mm、（1．22±0．42）mm】，差异有统计学意义（P〈0．05）。结论相比普通ATPS导板，改良版导板在运用时具有更好的贴合性及稳定性，增加螺钉准确性的同时能够保护邻椎椎间盘，有临床应用价值。
Objective To evaluate the accuracy in placement of cervical anterior transpedieular screws （ATPS） under the guidance of our modified drilling template. Methods Eight wet cadaveric specimens of adult cervical spine, 4 male and 4 female ones, were used for this experiment. Data of CT thin layer scanning of the cervical specimens in DICOM format were imported into software Mimics 17.0. After 3D models of the cervical vertebrae were reconstructed, the optimal trajectory was designed for ATPS placement in the transparent mode of the 3D models. Normal and our modified drilling templates for ATPS placement were designed and manufactured by 3D printing. The 2 kinds of drilling templates were used to assist ATPS placement onto one cervical vertebra, with laterality randomized. Altogether 64 pieces of ATPS were placed, with 32 ones for each drilling template. Postoperative CT scanning was conducted to evaluate the accuracy in ATPS placement. The 2 kinds of ATPS template were compared in terms of the deviations between actual and ideal trajectories in direction （caudal-angle and extroversive-angle） and position （X and Y axes） of the entry point. Results Our modified drilling template led to one screw penetrating the pedicle cortical bone while the normal drilling template led to 4 screws penetrating the pedicle cortical bone, yielding an accuracy rate of 96. 9% and of 87.5% respectively. The extroversive-angle deviation （0. 72°± 0.69°）, caudal-angle deviation （0. 91°±0.70°）, X axis shift （0.53 ±0.40 mm） and Y axis shift （0.54 ±0.42 mm） related to the modified template were all significantly smaller than those related to the normal template （1.16°± 0. 70°, 1.49°±0.68°, 0.88±0.40mm, 1.22±0.42mm, respectively） （P 〈0.05） . Conclusion Com- pared with a normal ATPS template, our modified drilling template for ATPS may be advantageous in better fitness, greater stability, increased accuracy in screw placement, and protection of adjacent discs.
作者
王力冉
赵刘军
顾勇杰
于亮
洪锦炯
张吉辉
王雷宁
刘观燚
马维虎
Wang Liran;Zhao Liujun;Gu Yongjie;Yu Liang;Hong Jinjiong;Zhang Jihui;Wang Leining;Liu Guanyi;Ma Weihu(Department of Spinal Surgery, The Sixth People＇ s Hospital of Ningbo, Ningbo 315040, China;Ningbo University School of Medicine, Ningbo 315211, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2018年第6期504-509,共6页
Chinese Journal of Orthopaedic Trauma
基金
浙江省自然科学基金（Y14C100003）
关键词
颈椎
骨钉
3D打印技术
导板
Cervical vertebrae
Bone screws
3D printing technology
Template
