3D打印钻孔导板在先天性脊柱侧凸手术置钉中的应用

发布时间：2018-11-04 08:45

【摘要】：目的:研究3D打印钻孔导板辅助先天性脊柱侧凸中具有严重形态畸形的椎体置钉,评价应用效果,并比较其与徒手置钉组在置钉准确率上的差异。方法:从我院2015年12月以前收治的先天性脊柱侧凸患者中筛选出具有完整术前术后CT,共66例,应用计算机随机化处理,选取8例。其中5位患者为女性,3位为男性。将他们的术前CT数据导入到计算机,选取各患者具有明显形态畸形的畸形椎及其相邻的椎体,进行三维建模,制作出相应的仿真骨模型,以及对应的3D打印钻孔导板。模拟实际手术操作流程,在仿真骨模型上使用3D打印钻孔导板辅助置钉。之后行CT扫描评价其螺钉置入的情况,并将之与实际徒手置钉的术后CT进行比较。结果:除4处由于畸形严重而无法制作导板外,其余的3D打印导板均体现了良好的适配性。两组各置钉68枚,其中畸形椎置钉36枚,邻椎(非畸形椎)置钉32枚。导板置钉组66枚未突破椎弓根皮质,仅2枚突破椎弓根皮质。徒手置钉组49枚椎弓根螺钉未穿破骨皮质,19枚穿破骨皮质。导板组总的置钉准确率为97.1%显著优于徒手置钉组的72.1%。在畸形椎上置钉两组各36枚,徒手置钉组21枚椎弓根螺钉未穿破骨皮质,15枚穿破骨皮质;导板置钉组34枚未穿破骨皮质,2枚穿破。导板置钉组的畸形椎的置钉准确率94.4%,显著优于徒手置钉组的58.3%。结论:1.该类型的3D打印钻孔导板辅助先天性脊柱侧凸手术畸形椎置钉,其置钉准确率高,且优于徒手置钉的置钉准确率。2.该类型的3D打印钻孔导板,可应用于大多数的畸形椎,但可能需要选择性回避那些阻碍导板与骨表面形成有效嵌合的畸形椎体。
[Abstract]:Objective: to study the effect of 3D print drilled guide plate assisted spinal screw placement with severe deformities in congenital scoliosis, and to compare the accuracy of nail placement between the two groups. Methods: 66 cases of congenital scoliosis with complete preoperative and postoperative CT, were selected from patients with congenital scoliosis treated in our hospital before December 2015. Five of the patients were women and three were men. Their preoperative CT data were imported into the computer. The deformed vertebrae with obvious deformities and their adjacent vertebrae were selected for 3D modeling. The corresponding simulated bone model and the corresponding 3D printing borehole guide plate were made. In order to simulate the actual operation procedure, 3D print drilling guide plate was used to assist nail placement on the simulated bone model. Then CT scan was performed to evaluate the screw placement and to compare it with the actual CT. Results: with the exception of 4 places which could not make the guide plate due to serious malformation, the other 3 D printed guide boards showed good adaptability. There were 68 screws in each group, including 36 deformities and 32 adjacent vertebrae (non-malformed vertebrae). The pedicle cortex was not broken through in the plate nail group, but only 2 were broken through the pedicle cortex. 49 pedicle screws did not penetrate the osteoclast cortex and 19 perforated the osteoclast cortex in the bare hand nail group. The total accuracy of nail placement in the plate group was 97.1%, which was significantly higher than that in the bare hand nail group (72.1%). There were 36 screws in each group, 21 pedicle screws were not perforated with osteoclastic cortex, 15 were perforated with osteoclast cortex, 34 were not perforated with osteoclastic cortex, and 2 were perforated by plate nail. The accuracy rate of deformable vertebrae nailing in the guide plate group was 94.4, which was significantly better than that in the bare hand nail group (58.3%). Conclusion: 1. This type of 3D print drilled guide plate assisted with congenital scoliosis surgical deformity screw placement, its nail placement accuracy is high, and better than the unarmed nail placement accuracy. 2. This type of 3D print drilled guide can be applied to most deformed vertebrae, but may require selective avoidance of malformed vertebrae that hinder the effective chimera between the guide plate and the bone surface.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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