复合型3D打印导航模板辅助枢椎椎弓根或椎板置钉的临床研究

Use of compound 3D printing navigation template to assist pedicle or laminar screw placement in axis

目的:探讨复合型3D打印导航模板辅助枢椎椎弓根螺钉或椎板螺钉置钉的可行性及临床疗效。方法:回顾性分析2015年1月~2017年5月我院收治的32例枢椎后路内固定手术患者资料,男20例,女12例;年龄21~77岁,平均57.3±9.0岁;随访12个月以上。根据置钉方法的不同进行分组,观察组(18例)采用术前计算机模拟置钉、设计并3D打印个体化导航模板辅助枢椎椎弓根或椎板螺钉置钉;对照组(14例)采用徒手方法置入枢椎椎弓根螺钉。记录两组置钉时间、术中出血量,以Kawaguchi评价法判断螺钉置钉成功率,计算术前模拟置钉和术后实际螺钉进钉点和进钉角度在X、Y、Z轴上的偏差,并进行统计学分析。结果:所有患者均顺利完成手术,无神经、重要血管损伤等严重并发症发生。观察组共置入螺钉36枚,其中枢椎椎弓根螺钉22枚,枢椎板螺钉14枚,置钉时间31.5±6.5min,术中出血量45.0±19.2ml,Kawaguchi评价法0级32枚,Ⅰ级4枚,Ⅱ级0枚,置钉成功率100%。对照组共置入28枚椎弓根螺钉,置钉时间57.6±6.9min,术中出血量228.5±57.9ml,以Kawaguchi评价法0级18枚,Ⅰ级6枚,Ⅱ级4枚,置钉成功率85.7%;两组置钉时间、术中出血量、置钉成功率相比差异均有统计学意义(P<0.05)。术后实际钉道相对于术前模拟钉道偏差角度为0.69°±1.34°,术后实际进钉点相对于术前模拟进钉点在X、Y、Z轴上分别偏移0.50±2.13mm、0.75±2.18mm、0.43±2.39mm,偏移量与术前设计相比差异均无统计学意义(P>0.05)。结论:通过复合型3D打印导航模板辅助枢椎椎弓根或椎板螺钉置钉,能减少置钉时间及术中出血,提高置钉成功率。

Objectives:To explore the feasibility and efficacy of the compound 3D printing navigation template in assisting the axis pedicle or laminar screw placement.Methods:32patients,20males and 12females,aging from 21to 77,with an average age of 57.3±9.0,with posterior internal fixation from our hospital during January 2015to May 2017were retrospectively analyzed;all of them were followed for more than 12 months.Among them,18cases of pediclc or laminar screws placement were operated by using compound 3D printing navigation template which was designed according to preoperative simulated nailing(observation group). 14cases of pedicle screw placement were operated by free hand(control group).The blooding and nailing duration were recorded;the accuracy of screw placement was evaluated by Kawaguchi criteria;the deviation of nailing point and nailing direction between simulated screw and postoperative screw were calculated;all above parameters were statistically analyzed.Results:All patients underwent surgeries without serious complications such as nerve or blood vessel injury.A total of 36screws were placed in the experimental group,including 22pedicle screws and 14laminar screws,nailing duration was 31.5±6.5min,blood loss was 45.0±19.2ml,ac-cording to Kawaguchi criteria,32screws were in grade 0,4screws in grade Ⅰ and 0screw in grade Ⅱ, and nailing accuracy was 100%.A total of 28screws were placed in the control group.Nailing duration was 57.6±6.9min,blood loss was 228.5±57.9ml,according to Kawaguchi criteria,18screws were in grade 0,6 screws in grade I and 4screw in grade Ⅱ,nailing accuracy was 85.7%.There were no significant differences between the two groups in the nailing duration,blood loss and nailing accuracy (P<0.05).Angle deviation between postoperative nailing and simulated nailing was 0.69°±1.34°;the deviation between the postoperative nailing point and the simulated nailing point on the X,Y and Z axes was 0.50±2.13mm,0.75±2.18ram,0.43±2.39mm,respectively.There was no significant difference of above deviations between postoperative and preoperative design(P>0.05).Conclusions:Use of compound 3D printing navigation template in assisting in the placement of pedicle screws or laminar screws can reduce nailing duration and blood loss and improve nailing accuracy.It is an alternative measure for arthroscopic pedicle screw placement failure.