3D打印导航模板在辅助寰枢椎椎弓根螺钉置入中的应用价值
发布时间：2018-07-24 15:51
【摘要】：目的:探讨三维(3D)打印导航模板辅助寰枢椎椎弓根螺钉置钉的价值。方法:回顾性分析2013年1月~2015年10月我院收治的43例寰枢椎骨折和/或脱位患者,均行后路寰枢椎切开复位内固定术。按手术方式不同分为3D打印导航模板组(19例)和传统置钉组(24例)。3D打印导航模板组术前将患者的颈椎CT数据导入Mimics 17.0软件,行3D重建并设计带钉道的导航模板后打印、消毒;术中将导航模板与置钉椎体贴合紧密后,通过定位孔钻孔、置钉。传统置钉组在C型臂X线机透视下徒手置钉。统计并对比两种置钉方法的准确率,通过测量并比较术前预设钉道角度与术后实际钉道角度差异评估进针角度的精确性。比较两组的置钉时间、手术时间、透视次数、术中出血量及患者颈肩部疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)颈椎神经功能评分的差异情况。结果:两组患者在性别、年龄、临床诊断、病变节段、合并症及术前是否牵引复位方面均无统计学差异(P0.05)。19例3D打印导航模板辅助置入椎弓根螺钉68枚,置钉准确率94.1%,置钉时间2.2±0.4min/枚,透视次数4.6±1.1次,手术时间197±41min,术中出血量395±64ml;传统徒手置钉组置入椎弓根螺钉76枚,置钉准确率76.3%,置钉时间3.4±0.7min/枚,透视次数9.4±2.7次,手术时间245±67min,术中出血量552±79ml。两组置钉准确率、置钉时间、透视次数、手术时间及术中出血量均有统计学差异(P0.05)。3D打印导航模板组的内倾角及头倾角与预设值无统计学差异0.05),置钉角度的精确性明显优于徒手置钉组(P0.05)。术后3d、6个月及12个月患者颈肩部VAS及颈椎JOA评分较术前明显好转(P0.05),而术后6个月及12个月两组间颈肩部VAS及颈椎JOA评分无统计学差异(P0.05)。结论:3D打印导航模板辅助寰枢椎椎弓根置钉可提高置钉准确率,同时还可缩短置钉时间、手术时间,减少透视次数和术中出血量。
[Abstract]:Objective: to evaluate the value of three-dimensional (3 D) print-guided template for atlantoaxial pedicle screw placement. Methods: 43 patients with atlantoaxial fractures and / or dislocations treated in our hospital from January 2013 to October 2015 were treated with posterior open reduction and internal fixation of atlantoaxial vertebrae. According to the different operation methods, the patients were divided into 3D print navigation template group (19 cases) and traditional nail placement group (24 cases). The cervical spine CT data were imported into Mimics 17.0 software before operation. The navigation template was tightly attached to the vertebral body during the operation, and the nail was inserted through the hole. The traditional nailing group was treated with C-arm X-ray machine. The accuracy of the two methods was analyzed and compared. The accuracy of the angle was evaluated by measuring and comparing the preset angle before and after operation. The time of nail placement, the time of operation, the times of fluoroscopy, the amount of blood lost during operation, the visual analogue score of neck and shoulder pain (visual analogue scaleVAS) and the (Japanese Orthopaedic Association of Japanese Orthopaedics Association (JOA) were compared between the two groups. Results: there was no significant difference between the two groups in sex, age, clinical diagnosis, pathological segment, complication and traction reduction before operation (P0.05). The accuracy of nail placement was 94.1cm, the time of insertion was 2.2 卤0.4min/, the times of fluoroscopy was 4.6 卤1.1, the operative time was 197 卤41min, the amount of intraoperative bleeding was 395 卤64ml, the accuracy rate of pedicle screw placement was 76.3 卤0.7min/, and the times of fluoroscopy was 9.4 卤2.7 times. The operative time was 245 卤67 min and the intraoperative bleeding was 552 卤79 ml. The accuracy of nail placement, the time of nail placement, the number of times of fluoroscopy in the two groups, The time of operation and the amount of intraoperative bleeding were significantly different (P0.05). There was no significant difference in inclinations and scalp angles between the three dimensional printing navigation template group and the preset value (0.05). The accuracy of the angle of nail placement was significantly better than that of the unarmed nail group (P0.05). The VAS and JOA scores of cervical shoulder and cervical vertebrae were significantly improved at 3 days, 6 months and 12 months after operation (P0.05), but there was no significant difference in VAS and JOA score between the two groups at 6 and 12 months after operation (P0.05). Conclusion the accuracy of pedicle screw placement can be improved, the time of nail placement, the time of operation, the times of fluoroscopy and the amount of blood lost during operation can be reduced by using the 3 D navigation template to assist atlantoaxial pedicle screw insertion.
【作者单位】： 延安大学附属医院脊柱外科;
【基金】：延安市科技惠民项目(编号:2016HM-10-03)
【分类号】：R687.3
[Abstract]:Objective: to evaluate the value of three-dimensional (3 D) print-guided template for atlantoaxial pedicle screw placement. Methods: 43 patients with atlantoaxial fractures and / or dislocations treated in our hospital from January 2013 to October 2015 were treated with posterior open reduction and internal fixation of atlantoaxial vertebrae. According to the different operation methods, the patients were divided into 3D print navigation template group (19 cases) and traditional nail placement group (24 cases). The cervical spine CT data were imported into Mimics 17.0 software before operation. The navigation template was tightly attached to the vertebral body during the operation, and the nail was inserted through the hole. The traditional nailing group was treated with C-arm X-ray machine. The accuracy of the two methods was analyzed and compared. The accuracy of the angle was evaluated by measuring and comparing the preset angle before and after operation. The time of nail placement, the time of operation, the times of fluoroscopy, the amount of blood lost during operation, the visual analogue score of neck and shoulder pain (visual analogue scaleVAS) and the (Japanese Orthopaedic Association of Japanese Orthopaedics Association (JOA) were compared between the two groups. Results: there was no significant difference between the two groups in sex, age, clinical diagnosis, pathological segment, complication and traction reduction before operation (P0.05). The accuracy of nail placement was 94.1cm, the time of insertion was 2.2 卤0.4min/, the times of fluoroscopy was 4.6 卤1.1, the operative time was 197 卤41min, the amount of intraoperative bleeding was 395 卤64ml, the accuracy rate of pedicle screw placement was 76.3 卤0.7min/, and the times of fluoroscopy was 9.4 卤2.7 times. The operative time was 245 卤67 min and the intraoperative bleeding was 552 卤79 ml. The accuracy of nail placement, the time of nail placement, the number of times of fluoroscopy in the two groups, The time of operation and the amount of intraoperative bleeding were significantly different (P0.05). There was no significant difference in inclinations and scalp angles between the three dimensional printing navigation template group and the preset value (0.05). The accuracy of the angle of nail placement was significantly better than that of the unarmed nail group (P0.05). The VAS and JOA scores of cervical shoulder and cervical vertebrae were significantly improved at 3 days, 6 months and 12 months after operation (P0.05), but there was no significant difference in VAS and JOA score between the two groups at 6 and 12 months after operation (P0.05). Conclusion the accuracy of pedicle screw placement can be improved, the time of nail placement, the time of operation, the times of fluoroscopy and the amount of blood lost during operation can be reduced by using the 3 D navigation template to assist atlantoaxial pedicle screw insertion.
【作者单位】： 延安大学附属医院脊柱外科;
【基金】：延安市科技惠民项目(编号:2016HM-10-03)
【分类号】：R687.3
【参考文献】
相关期刊论文 前10条
1 姜良海;谭明生;董亮;杨峰;移平;唐向盛;韦z延，
本文编号：2141875
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2141875.html
最近更新
教材专著
