摘要
目的探讨3D打印、逆向工程技术结合体外模拟手术辅助寰枢椎置钉治疗Ⅱ型齿突骨折的准确性和安全性。方法回顾性分析2010年1月—2018年3月接受椎弓根螺钉内固定治疗的23例Ⅱ型齿突骨折患者临床资料。其中12例常规徒手置入C1,2椎弓根螺钉(徒手组);11例在利用3D打印和逆向工程技术实施体外模拟手术成功后,术中利用导航模板辅助置入C1,2椎弓根螺钉(导航组)。记录手术时间、术中出血量、住院时间及置钉偏差率。手术前后采用疼痛视觉模拟量表(VAS)评分和美国脊髓损伤协会(ASIA)分级评估疗效。结果所有手术顺利完成,术中无脊髓损伤、椎动脉损伤等严重并发症发生。所有患者随访超过6个月。导航组手术时间、术中出血量及置钉偏差率均低于徒手组,差异均有统计学意义(P<0.05)。2组术后6个月VAS评分均较术前显著改善,差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05)。徒手组术前ASIA分级D级4例、E级8例,导航组术前D级3例、E级8例,术后均为E级。结论3D打印、逆向工程技术结合体外模拟手术辅助寰枢椎置钉治疗Ⅱ型齿突骨折,置钉方案完全个性化,提高了置钉的准确性和安全性,是一种安全有效的辅助置钉手段。
Objective To explore the accuracy and safety of 3D printing and reverse engineering techniques and extracorporeal simulated surgery assisted atlantoaxial screw placement in the treatment of typeⅡodontoid fractures.Methods From January 2010 to March 2018,data of 23 patients with typeⅡodontoid process fracture treated by pedicle screw fixation were analyzed retrospectively.Among them,12 patients were fixed with C1,2 pedicle screws by freehand(freehand group)and 11 with 3D printing and reverse engineering technology combined with extracorporeal simulation surgery,and C1,2 pedicle screws were inserted with navigation template during the operation(navigation group).The operation time,intraoperative blood loss,hospital stay and deviation rate of pedicle screws were recorded.The pain visual analogue scale(VAS)score and American Spinal Injury Association(ASIA)classification were recorded at pre-operation and postoperative 6 months.Results All the operations were successfully completed.No serious complications such as spinal cord injury and vertebral artery injury occurred during the operation.The patients were followed up for more than 6 months.The operation time,intraoperative blood loss and deviation rate of pedicle screws were lower in navigation group than in the freehand group,all with a statistical significance(P<0.05).The VAS scores of the 2 groups were significantly improved at postoperative 6 months compared with pre-operation,with a statistical significance(P<0.05);and there was no significant difference between the 2 groups(P>0.05).In the freehand group,there were 4 cases in ASIA grade D and 8 in grade E;in the navigation group,there were 3 in grade D and 8 in grade E at pre-operation;and all of them achieved grade E post-operation.Conclusion 3D printing and reverse engineering techniques and extracorporeal simulated operation assisted atlantoaxial screw placement for the treatment of typeⅡodontoid fractures,the screw placement scheme is completely individualized,can improve the accuracy and safety of sc
作者
李阳
王静
宗海洋
林玮
徐永清
LI Yang;WANG Jing;ZONG Hai-yang;LIN Wei;XU Yong-qing(Department of Orthopaedics,No 920 Hospital of Joint Logistics Support Force of China PLA,Kunming 650032,Yunnan,China)
出处
《脊柱外科杂志》
2020年第4期237-242,共6页
Journal of Spinal Surgery
关键词
寰椎
枢椎
脊柱骨折
内固定器
计算机辅助设计
成像
三维
Atlas
Axis
Spinal fractures
Internal fixators
Computer-aided design
Imaging,three-dimensional
