计算机辅助设计——快速成型技术在经口减压内固定手术中的应用

Computer-aided design-rapid prototype used in trans-oralpharyngeal atlantoaxial reduction plating

目的探讨计算机辅助设计——快速成型技术（CAD—RP）在经口前路复位钢板内吲定（TARP）手术中的应用。方法2008年3月至2010年3月采用常规TARP手术（A组）与TARP手术结合CAD—RP技术（B组）治疗86例寰枢椎脱位患者，男49例，女37例；年龄6～62岁，平均43岁。采用日本矫形外科协会（JOA）评分标准评定脊髓功能情况，并计测和统计两组患者的手术时间、手术出血量、术后脊髓压迫解除率及螺钉穿出率。结果患者术后获13～28个月（平均15．8个月）随访。两组患者手术时间平均分别为（105±23）、（135±21）min，差异有统计学意义（P〈0．05）；手术出血革分别为（25±12）、（30±10）mL，比较差异无统计学意义（P〉0．05）。A组JOA评分由术前平均（8．5±0．8）分恢复至术后（15．1±0．9）分，脊髓功能改善率为77．6％；B组JOA评分由术前平均（9．2±0．8）分恢复至术后（15．3±0．7）分，脊髓功能改善率为78．2％，两组比较差异无统计学意义（P〉0．05）。A组脊髓受压改善率为88．7％，B组为83．6％，差异无统计学意义（P〉0．05）。术后钉道扫描显示A组83枚寰枢椎螺钉有5枚穿出，其中寰椎侧块螺钉2枚向外偏入椎动脉孔内，3枚枢椎螺钉向外偏入椎动脉孔内，但均未出现临床症状；B组仅1枚枢椎螺钉偏入椎动脉孔，未出现临床症状。结论住TARP手术中，灵活应用CAD—RP技术可以提高置钉成功率和TARP手术效率，降低手术并发症。

Objective To investigate clinical application of computer-aided design-rapid prototype （CAD-RP） in trans-oralpharyngeal atlantoaxial reduction plating （TRAP）. Methods From March, 2008 to March, 2010, 86 cases of atlas-axis dislocation were randomly assigned into conventional TRAP （group A） and CAD-RP assisted TARP （group B）. They were 49 men and 37 women, aged from 6 to 62 years （average, 43 years） . Functional improvement of spinal cord was evaluated in all cases according to Japanese Orthopaedics Association （JOA） scale system. The operation time, operative blood loss, postoperative compression improvement and violation of screws were recorded and compared between the 2 groups. Results All patients were followed up for 13 to 28 months （average, 15.8 months）. There was no significant difference in the blood loss between group A （25±12mL） and groupB （30±10 mL） （P〉 0.05）, but there wasa significant difference in operation time between group A （105 ± 23 min） and group B （135 ± 21 min） （P 〈 0. 05） . In group A, JOA scores changed from 8.5 ±0. 8 preoperation to 14. 9 ±0. 9 postoperation, with a functional improvement rate of 75.3% ; in group B, JOA scores changed from 9.2 ± 0.8 preoperation to 15.3 ± 0. 7 postoperation, with a functional improvement rate of 76.9%. The compression improvement rates were 88.7% in group A and 83.6% in group B. The differences between the 2 groups were not significant （ P 〉 0. 05）. There were 5 screw violations in group A but only one in group B. Conclusion CAD-RP can help enhance efficacy of TARP procedures, increasing success of screw placement and reducing operative complications.