3D打印导板引导骶髂螺钉置钉实验与临床准确性评价

Experimental and Clinical Accuracy Evaluation of Sacroiliac Screws Placement Guided By 3D Printing Navigation Template

目的 探讨个体化3D打印导板辅助骶髂关节螺钉置钉,在骨盆标本实验与临床应用中的准确性。方法 (1)采用8具骨盆标本为研究对象,其中男5具,女3具。CT薄层扫描后数据以DICOM格式导入Mimics 19.0软件,建立骨盆三维数字模型,以髂后上棘为锚定点,设计骶髂关节螺钉置钉导板。每具标本置入6枚空心螺钉,通过X线检查、CT扫描、标本剖开观察螺钉在骶椎内的位置。(2)回顾性分析2017年6月到2020年12月江西省人民医院临床上采用3D打印新型导板引导骶髂关节螺钉固定12例骨盆后环损伤病例。其中男10例,女2例;年龄19~62岁,平均(35.75±11.58)岁。术后通过X线检查、CT扫描评价骶髂螺钉位于骶椎椎体内的情况。结果 (1)实验共应用骶髂关节螺钉导板16个,双侧共计置钉48枚。参照Smith评定标准:0级45枚,准确率93.75%。3枚螺钉穿出骶骨皮质,其中Ⅰ级2枚,Ⅱ级1枚。(2)临床12例骨盆后环损伤患者共置入骶髂螺钉26枚,25枚完全位于骶椎椎体内,评为0级,准确率96.15%。仅1枚穿出骶椎进入骶管评为Ⅰ级(3.85%),但没有神经症状。术后根据Matta影像学评定复位情况:优10例,良2例。末次随访依据Majeed功能评分标准:优8例,良4例。结论 运用3D打印导板引导骶髂关节螺钉置钉准确安全;临床应用效果良好,操作简便,设备要求低,便于基层医院推广。

Objective To evaluate the accuracy of sacroiliac screw placement assisted by aindividualized threedimensional(3D)printing guide template in pelvic specimen experiment and clinical application.Methods (1)Eight cadaveric pelvic specimens were used in this experiment.Dataof thin layer CT scanning of the specimens were imported into Mimics 19.0software in DICOM format to establish 3D digital models of pelvis.With the posterior superior iliac spine as the anchor point,the sacroiliac joint screw placement navigation template was designed,and six hollow screws were inserted into each specimen.The position of the screw in the sacral vertebrawas observed by X-ray examination,CT scan and specimen dissection.(2)From June 2017to December 2020,12cases of posterior pelvic ring injury with sacroiliac screw fixation guided by 3D-printed Novel navigation template were retrospectively analyzed.There were 10males and 2females.The average age was(35.75±11.58)years,ranging from 19to 62years.The position of sacroiliac screw in the sacral vertebrawas evaluated by X-ray examination and CT scan after surgery.Results (1)A total of 16sacroiliac joint screw placement navigation templates were used in the experiment and 48screws were inserted on both sides.According to Smith’s evaluation standard,45screws were inserted at grade 0with an accuracy of 93.75%.3screws penetrated through the sacral vertebral cortex,including 2screws at gradeⅠ and 1screw at gradeⅡ.(2)A total of 26sacroiliac screws were inserted in 12patients with posterior pelvic ring injury,25of which were completely located in the sacral vertebra.These patients rated as level 0with an accuracy rate of 96.15%.In only 1patient,the screw passed out of the sacral vertebral cortex and entered the sacral canal.This cased rated as gradeⅠ(3.85%),but had no neurological symptoms.According to Matta scoring,10cases were excellent and 2cases were good.The last follow-up was based on Majeed’s functional scoring standard.It was excellent in 8cases and good in 4cases.Conclusion The screw placement of sacroiliac joint guided by 3Dprinted navigation templates is accurate and safe.The clinical curative effect is excellent,the operation is simple,the equipment requirements are low,and it is convenient for the primary hospital to popularize.