3D打印模型辅助后路内固定治疗儿童颈椎畸形

Individualized 3-dimensional printing model-assisted posterior screw fixation in the treatment of cervical deformity of children

目的 研究个体化3D打印模型辅助后路内固定治疗儿童颈椎畸形的方法和效果.方法 对北京儿童医院骨科2012年9月至2014年5月CT确诊并手术的29例颈椎畸形伴上颈椎不稳患儿的临床资料进行回顾性分析.其中22例采用3D打印技术建立颈椎个体化3D打印模型,在模型上进行模拟置钉及内固定手术,获得个体化置钉数据,再进一步术中辅助真实手术,采取一期后路矫形及内固定治疗.结果 22例个体化3D打印模型辅助术中置钉进行内固定手术,全部置钉成功,无椎动脉及神经根损伤,无内固定松动及断裂.所有22例术后随访时间3～23个月,平均13.5个月.术后寰椎齿突间隙（atlantodens interval,ADI）明显缩小,延髓颈髓角（cervicomedullary angle,CMA）明显增大,延髓腹侧受压明显减轻或消失.本组无手术死亡病例,1例二次植骨融合,1例同期行胸锁乳突肌切断松解术,1例行枕骨大孔减压术,1例行寰椎后弓切除减压.结论 个体化3D打印模型辅助后路螺钉内固定可提高置钉成功率,有效保护椎动脉及神经根,提高安全性,特别是对儿童颈椎畸形的治疗有很大帮助.

Objective To explore the method and efficacy of individualized 3-dimensional （3D） printing model-assisted posterior screw fixation for the treatment of cervical deformity of children.Methods A total of 29 surgical patients with cervical deformity associated with upper cervical instability as diagnosed by computed tomography （CT） were retrospectively analyzed.For 22 cases,3D printing cervical model was establisged by 3D printing technology.And screw insertion and fixation were simulated for assisting actual operations.At last implemented one-stage posterior orthomorphia plus internal fixation.Results Among them,22 patients with cervical deformity successfully underwent posterior screw fixation assisted by individual 3D printing model.Without injury to vertebral artery or nerve root,there was no internal fixation loosening or fracture.The average followup period was 13.5 （3-23） months.Postoperative atlantodens interval （ADI） significantly decreased,cervicomedullary angle （CMA） increased markedly while ventral compression of medulla oblongata diminished or even disappeared.There was no operative mortality.The procedures included secondary fusion of bone graft （n =1）,sternocleidomastoid muscle amputationlysis （n =1）,foramen magnum decompression （n =1） and posterior arch of atlas decompression （n =1）.Conclusions Posterior screw fixation operation assisted by individualized 3D printing model can improve the success rate and safety of screw insertion and effectively protect vertebral artery and nerve root.And it is particularly suitable for children with cervical deformity.