3D打印个体化椎弓根导板研制及模拟置钉的准确性

发布时间：2018-01-26 02:35

  本文关键词： 脊柱 内固定器 计算机辅助设计 组织工程 骨科植入物 脊柱植入物 椎弓根导板 D打印 模拟置钉 准确性　出处：《中国组织工程研究》2017年23期 　论文类型：期刊论文

【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(P0.05),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(P0.05);(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。
[Abstract]:Background: surgical accuracy is a guarantee of surgical success in the past pedicle screw placement process to a large extent based on the experience of the operation nail, there is a greater subjectivity. Inevitably resulting in a certain misplacement rate. 3D printing technology assisted pedicle screw placement to make the nail placement process is predictable making the operation individualized accurate and simplified. Objective: to design a 3D printed pedicle guide plate and to simulate nail placement in vitro. Methods: 11 cases of lumbar degenerative diseases treated in Hebei Provincial people's Hospital from 2016 to July were selected. Three-dimensional reconstruction of each patient's L1L3 and L5 vertebrae. According to the lumbar CT data of one patient, the pre-experiment was performed: according to the principle of intraoperative nail placement, the position and direction of the nail were designed by computer. Verify and adjust repeatedly, design the "best" guide plate model; Results and conclusion 30 pedicle guide plates were used in the experiment and 60 nails were placed. The process of simulated nail placement was smooth and the guide plate applied well. No pedicle screw perforated the pedicle cortex, the screw position was accurate and reliable, and the effect was good. (2) there was no significant difference in horizontal angle and sagittal angle between the left pedicle screw and the left pedicle screw before and after screw placement (P 0.05). There was no significant difference in horizontal angle and sagittal angle between the right pedicle screw and the right pedicle screw. The results show that the pedicle guide plate designed by the experiment is accurate and has no obvious difference in the direction of screw entry before and after simulated nail placement, which proves the feasibility of the screw placement of 3D printing individual pedicle guide plate. But it still needs further clinical verification.
【作者单位】： 河北医科大学;河北省人民医院;
【分类号】：R687.3;TP391.73
【正文快照】： 文章快速阅读:文题释义:3D打印技术:开始于20世纪80年代,经过20多年的发展,目前在逐渐成熟并得到广泛的应用,3D打印技术辅助椎弓根置钉避免了传统置钉方法的学习曲线及置钉主观性,使得置钉过程具有可预见性,使手术个体化、精确化、简单化,有望得到广泛的临床推广应用。椎弓根，

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