Quadrant系统下3D打印导航模块辅助腰椎精准植钉的应用研究

发布时间：2018-06-09 14:28

本文选题：Quadrant系统 + 腰椎弓根螺钉　；参考：《中国修复重建外科杂志》2017年02期

【摘要】：目的探讨Quadrant系统微创通道下3D打印导航模块辅助腰椎精准植钉的可行性及疗效。方法取12具成人尸体腰椎(L1~5)标本,经CT扫描及三维重建,于Mimics软件中构建通过椎弓根中心长轴的钉道,根据骨面可剥离范围设计并3D打印导航模块。在尸体标本上实施导航模块辅助下腰椎椎弓根螺钉植入后,再次CT扫描并三维重建,对手术前后重建模型进行三维配准,评价植钉符合率。2014年11月—2015年11月,对31例退行性腰椎不稳患者行Quadrant系统微创通道下3D打印导航模块辅助植钉术。男14例,女17例;年龄42~60岁,平均45.2岁。病程6~13个月,平均8.8个月。单节段15例,两节段13例,三节段3例。术前疼痛视觉模拟评分(VAS)为(7.59±1.04)分,Oswestry功能障碍指数(ODI)评分为(76.21±5.82)分,日本骨科协会(JOA)评分(9.21±1.64)分。结果12具标本共植入120枚螺钉,三维配准显示植钉符合率100%。临床31例患者共植入162枚螺钉。手术时间65~147 min,平均102.23 min;术中出血量为50~116 m L,平均78.20 m L;术中辐射暴露时间为8~54 s,平均42 s。术后3~7 d三维配准显示植钉符合率为98.15%(159/162)。术后4周VAS评分为(2.24±0.80)分,ODI评分为(29.17±2.50)分,JOA评分为(23.43±1.14)分,与术前比较差异均有统计学意义(t=14.842,P=0.006;t=36.927,P=0.002;t= 36.031,P=0.001)。31例患者均获随访,随访时间8~24个月,平均18.7个月。术后切口均Ⅰ期愈合,无手术并发症发生。随访期间复查腰椎X线片及CT显示椎弓根螺钉准确在位,无松动、断裂,椎间植骨融合良好。结论Quadrant系统微创通道下采用3D打印导航模块可以实现手术微创、少辐射及精准植钉目的。
[Abstract]:Objective to investigate the feasibility and efficacy of 3 D print navigation module assisted precise screw implantation in Quadrant system. Methods 12 adult cadavers with L1 ~ (5) lumbar vertebrae were examined by CT scanning and 3D reconstruction. The nail passage through the long axis of the pedicle was constructed in the mimics software. According to the range of bone dissection, the navigation module was designed and 3D printed. After the pedicle screw implantation was performed on the cadavers, CT scanning and 3D reconstruction were performed again, the reconstruction model before and after operation was registered, and the coincidence rate of screw implantation was evaluated. November 2014 to November 2015. Thirty-one patients with degenerative lumbar spine instability were treated with 3 D print navigation module under Quadrant system. There were 14 males and 17 females, aged 42 to 60 years (mean 45.2 years). The course of disease ranged from 6 to 13 months (mean 8.8 months). There were 15 cases with single segment, 13 cases with two segments and 3 cases with three segments. The preoperative pain visual analogue score (VAS) was 7.59 卤1.04, and the Oswestry dysfunction index (ODI) score was 76.21 卤5.82, and the Japanese Orthopedic Association (JOAA) score was 9.21 卤1.64. Results 120 screws were implanted in 12 specimens. A total of 162 screws were implanted in 31 patients. The operative time was 65 ~ 147min (mean 102.23 mins), the blood loss was 50 ~ 116mL (mean 78.20mL), the radiation exposure time was 854 s (mean 42s). Three dimensional registration on 3 ~ 7 days after operation showed that the coincidence rate of implant nail was 98.15 / 162%. At 4 weeks after operation, the VAS score was 2.24 卤0.80 and the ODI score was 29.17 卤2.50. The JOA score was 23.43 卤1.14, and the difference was statistically significant compared with that before operation. The difference was statistically significant (t = 36.927p 0.002t = 36.031P0.001P 0.002t = 36.031P 0.001n = 36.031), and the follow-up time was 824 months (mean 18.7 months). All the incisions healed in one stage, and no complications occurred. During the follow-up period, X-ray and CT findings showed that the pedicle screw was in the correct position, no loosening and fracture, and good fusion of intervertebral bone graft. Conclusion using 3D print navigation module in Quadrant system can achieve minimally invasive, less radiation and precise nail implantation.
【作者单位】：福建医科大学莆田学院附属医院教学医院骨科南方医科大学附属莆田医院骨科莆田学院附属医院骨科;
【基金】：福建省中青年教师教育科研项目(JA14274) 福建省自然科学基金项目(2016J01607) 福建省卫生和计划生育委员会青年科研课题(2015-2-32) 福建省医学创新课题(2012-CX-34)~~
【分类号】：R687.3

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