3D打印个体化定位导板与计算机导航系统治疗颈椎骨折脱位的疗效比较

Fracture and Dislocation of the Cervical Spine Treated with Individualized Navigation Templates by Three-dimensional Printing Technique or Computer-aided Navigation System:A Comparative Study

目的比较3D打印个体化定位导板与计算机导航系统治疗颈椎骨折脱位的临床效果。方法 2012年2月至2013年12月,23例颈椎骨折脱位行后路椎弓根螺钉内固定术患者被纳入研究,随机分为3D打印个体化椎弓根定位导航模板辅助置钉组(导板组)12例,二维红外线引导计算机辅助导航系统置钉组(导航组)11例。两组患者性别、年龄、致伤原因、损伤节段、神经功能分级等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录两组患者手术时间、出血量,通过术后CT记录矢状面螺钉置入角(SSA)、椎弓根皮质与螺钉的关系(PSR)及置钉成功率。结果两组手术时间和出血量比较差异有统计学意义(P<0.05);导板组和导航组SSA分别为(3.7±0.9)°和(3.5±1.7)°,差异无统计学意义(P>0.05)。导板组和导航组置钉成功率分别为93.8%(45/48);和93.1%(41/44),差异无统计学意义(P>0.05)。结论应用3D打印个体化定位导板和计算机导航系统辅助颈椎弓根螺钉的置入均有较高置入准确率。个体化定位导板手术时间及术中出血量更少,临床应用证实该方法完全可行,应该具有较好的应用前景。

Objective To compare and evaluate the clinical effects of fracture and dislocation of the cervical spine treated with individualized navigation templates by Three-dimensional printing technique with computer-aided navigation system. Methods During February 2012 to December 2013,23 patients undergoing cervical pedicle screw fixation were divided into tow groups：the individualized navigation templates group was used in 12 cases（ the templates group ） and the computer-assisted group in 11 cases （ the navigation group ）. There was no significant difference in gender,age,causes of injury,segment of injury and the Frank score between 2 groups（P〉0. 05）. The operating time,blood loss,the sagittal screw angle（SSA）,the relationship between the pedicle cortex and screw（ PSR） and the accuracy rate of pedicle screw were observed. Results There was significant difference in the op-erating time and the blood loss between 2 groups（P〈0. 05）. The SSA in navigation templates group（3. 7 ±0. 9）°was significant-ly less than those in computer-assisted group（3. 5 ±1. 7）°. There was no significant difference in the SSA between 2 groups（P〉0. 05）. 45（93. 8%） were inserted successfully in navigation templates group and 41（93. 1%） were inserted successfully in com-puter-assisted group. There was no significant difference in the accuracy rate of pedicle screw between 2 groups（P〉0. 05）. Con-clusion Cervical pedicle screw insertion assisted by individualized navigation templates and computer-aided navigation system are highly accurate. Operation time and bleeding with individualized navigation template are less,clinical application proved that this method is entirely feasible which should have good application prospects.