改良3D打印导航模板辅助寰枢椎椎弓根螺钉置钉的准确性分析
发布时间：2018-11-23 09:46
【摘要】：目的 :探讨改良3D打印导航模板辅助寰枢椎椎弓根螺钉置钉的准确性。方法:选择我院2015年6月~12月期间行寰枢椎手术的患者17例,男11例,女6例;年龄25~56岁,平均43.3±8.7岁;寰枢椎骨折脱位13例,寰枢椎畸形4例。术前将患者的寰枢椎CT数据导入Mimics17.0软件,生成目标椎体的三维模型,使用逆向工程原理设计与其表面相吻合的反向模板及椎弓根螺钉最佳钉道并生成相应导向通道,标杆相对通道向内侧平移约10mm,将导向通道及标杆与模板拟合一体,设计形成带有导向通道和标杆的改良导航模板。将设计好的导板通过3D打印机打印出来。在3D模型上模拟置钉,体外试验确认方案可行后再将改良导航模板消毒、灭菌并应用于临床。术中将改良3D打印导板与寰枢椎紧密贴合。术者分别以电钻及手钻通过导向通道,以标杆为参照物及导向杆,通过导向通道钻探螺钉通道后取下导板,攻丝后顺钉道置入椎弓根螺钉。将术前规划钉道与术后螺钉配对拟合进行螺钉精确性分析,并以Kawaguchi等评价法判断螺钉位置的优劣等级。结果:手术时间106±11min,术中出血量为220±73ml。共置入68枚颈椎椎弓根螺钉,其中寰椎与枢椎各34枚。术前预设进钉点、内倾角及头倾角与术后相比差异均无统计学意义(P0.05)。术后Kawaguchi等评价法显示:0级占97.06%(66/68),Ⅰ级占2.94%(2/68),有2枚螺钉穿破骨皮质,Ⅱ、Ⅲ级螺钉数为0。结论:通过改良3D打印导板辅助寰枢椎椎弓根置钉,可提高与术前预设最佳钉道的吻合度、精确匹配术前计划,可提高临床手术置钉的准确性,减少偏差。
[Abstract]:Objective: to investigate the accuracy of modified 3 D printing navigation template for atlantoaxial pedicle screw placement. Methods: from June to December 2015, 17 patients (11 males and 6 females) underwent atlantoaxial surgery in our hospital, aged 2556 years (mean 43.3 卤8.7 years), atlantoaxial fracture and dislocation (13 cases) and atlantoaxial malformation (4 cases). Before operation, the atlantoaxial CT data were imported into Mimics17.0 software to generate a three-dimensional model of the target vertebral body, and reverse engineering principles were used to design the reverse template and the best nail path for pedicle screw, and to generate the corresponding guiding channel. The guide channel and the benchmarking bar are fitted with the template and the improved navigation template with the guide channel and the benchmark is designed. Print the designed guide plate through a 3 D printer. A 3D model was used to simulate nail placement. The improved navigation template was sterilized, sterilized and applied to clinical practice after in vitro test confirmed that the scheme was feasible. The modified 3 D printing guide was closely associated with the atlantoaxial vertebrae during the operation. Electric drill and hand drill were used to pass through the guide channel, and the standard rod was used as reference and guide rod. The guide plate was removed after drilling the screw passage through the guide channel, and the pedicle screw was placed along the nail path after tapping. The screw accuracy analysis was carried out by matching the preoperative planning nail path with the postoperative screw fitting, and the Kawaguchi evaluation method was used to judge the screw position. Results: the operative time was 106 卤11 min and the intraoperative bleeding was 220 卤73 ml. A total of 68 pedicle screws were inserted, including 34 atlas and 34 axial screws. There was no significant difference between preoperative preset point, internal inclination angle and head inclination angle compared with postoperative (P0.05). After operation, Kawaguchi et al showed that 0 grade accounted for 97.06% (66 / 68) and 鈪，
本文编号：2351129
[Abstract]:Objective: to investigate the accuracy of modified 3 D printing navigation template for atlantoaxial pedicle screw placement. Methods: from June to December 2015, 17 patients (11 males and 6 females) underwent atlantoaxial surgery in our hospital, aged 2556 years (mean 43.3 卤8.7 years), atlantoaxial fracture and dislocation (13 cases) and atlantoaxial malformation (4 cases). Before operation, the atlantoaxial CT data were imported into Mimics17.0 software to generate a three-dimensional model of the target vertebral body, and reverse engineering principles were used to design the reverse template and the best nail path for pedicle screw, and to generate the corresponding guiding channel. The guide channel and the benchmarking bar are fitted with the template and the improved navigation template with the guide channel and the benchmark is designed. Print the designed guide plate through a 3 D printer. A 3D model was used to simulate nail placement. The improved navigation template was sterilized, sterilized and applied to clinical practice after in vitro test confirmed that the scheme was feasible. The modified 3 D printing guide was closely associated with the atlantoaxial vertebrae during the operation. Electric drill and hand drill were used to pass through the guide channel, and the standard rod was used as reference and guide rod. The guide plate was removed after drilling the screw passage through the guide channel, and the pedicle screw was placed along the nail path after tapping. The screw accuracy analysis was carried out by matching the preoperative planning nail path with the postoperative screw fitting, and the Kawaguchi evaluation method was used to judge the screw position. Results: the operative time was 106 卤11 min and the intraoperative bleeding was 220 卤73 ml. A total of 68 pedicle screws were inserted, including 34 atlas and 34 axial screws. There was no significant difference between preoperative preset point, internal inclination angle and head inclination angle compared with postoperative (P0.05). After operation, Kawaguchi et al showed that 0 grade accounted for 97.06% (66 / 68) and 鈪，
本文编号：2351129
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