3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入与徒手置钉的准确性对比

发布时间：2018-05-04 06:31

本文选题：颈椎 + 内固定器　；参考：《中国组织工程研究》2017年03期

【摘要】：背景:下颈椎前路椎弓根钉内固定技术整合了前路和后路手术的优势,仅通过一次前路手术可解决减压和重建两个问题,但该技术固定难度风险大,而3D打印组合式导板的设计可以提高此技术置钉的安全性和准确性。目的:探讨3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入的可行性及准确性,并与徒手置钉进行对比。方法:选取6具成人防腐尸体的颈椎标本,男性2具,女性4具,年龄53-64岁,平均58.5岁,随机分为2组,每组3具颈椎标本。徒手置钉组行徒手置钉;导板辅助置钉组颈椎标本采用CT扫描后获得DICOM格式数据,将原始数据导入Mimics软件三维重建后进行下颈椎(C3-C7)前路椎弓根钉模拟安全钉道的计算机辅助设计,在Pro-E软件中设计出与模拟安全钉道匹配的克氏针定位圆柱帽和可拆分空心钉导向管,并建立与下颈椎椎体前缘贴合的基座,利用3D打印技术制作出导板,在该导板辅助下置钉。置钉后行颈椎CT扫描评价2种置钉方法的置钉可接受率。结果与结论:(1)徒手置钉组共置入30枚螺钉,术后CT扫描Grade 1级22枚,Grade 2级6枚,Grade 3级2枚,位置可接受的(Grade 1-2级)28枚(93%);导板辅助置钉组共置入30枚螺钉,术后CT扫描Grade 1级25枚,Grade 2级4枚,Grade 3级1枚,位置可接受的(Grade 1-2级)29枚(97%),2组下颈椎置钉的可接受率差异无显著性意义(P0.05);(2)结果表明,3D打印组合式导板的双重定位导向功能使下颈椎前路椎弓根螺钉的置入安全准确,与传统徒手置钉相比,3D打印组合式导板操作简单、易于掌握,体现了置钉的个体化。
[Abstract]:Background: anterior pedicle screw fixation of the lower cervical spine integrates the advantages of anterior and posterior approaches. Only one anterior approach can solve the two problems of decompression and reconstruction, but this technique is difficult and risky. The design of 3D printing combined guide plate can improve the safety and accuracy of this technique. Objective: to investigate the feasibility and accuracy of 3 D printing combined guide plate assisted anterior cervical pedicle screw placement. Methods: 6 cervical vertebrae specimens of adult embalmed cadavers, male 2 and female 4, aged 53-64 years (mean 58.5 years), were randomly divided into 2 groups with 3 cervical vertebrae in each group. DICOM data were obtained by CT scanning in the cervical vertebrae specimens in the plate assisted nail group, and in the bare hand nail group, the cervical spine specimens in the guide plate assisted nail placement group were obtained by CT scanning. The original data were imported into Mimics software and then reconstructed by computer aided design (CAD) of the anterior pedicle screw of the lower cervical vertebrae (C3-C7) to simulate the safety of the nail. The Kirschner pin positioning cylindrical cap and the detachable hollow nail guide tube were designed in Pro-E software, and the base was built to fit with the anterior edge of the lower cervical vertebra. The guide plate was made by 3D printing technique, and the guide plate was used to assist the lower cervical nail. To evaluate the acceptability of the two methods by cervical CT scanning after nailing. Results and conclusion: a total of 30 screws were placed in the unarmed nail group, 22 Grade grade 2 grade 6 grade 2 grade 3 screws, 28 grade 1 grade 1-2 grade (933) screws and 30 screws were placed in the guide plate assistant nail group after operation, and CT scan was performed on 22 cases of grade 1 grade 2 grade 2 grade 3 and 2 grade 2 grade 2 grade 2 and grade 2 grade 2, respectively. Grade grade 1, grade 2, grade 2, grade 3, grade 3, CT scan after operation, one of them was of grade 1, grade 2, grade 3, grade 3, grade 3. There was no significant difference in the acceptable rate of lower cervical screw placement between the two groups (P 0.05). The results showed that the dual positioning and guiding function of 3D printing combined guide plate made the placement of anterior pedicle screw of lower cervical spine safe and accurate. Compared with the traditional manual nailing, the 3D printing combined guide board is simple to operate and easy to master, which reflects the individualization of nail placement.
【作者单位】：徐州医科大学研究生学院;徐州医科大学附属医院骨科;
【基金】：江苏省卫生厅课题(H201129)~~
【分类号】：R687.3;TP391.73

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