3D打印个体化导航模板在胸椎和颈椎椎弓根螺钉植入的临床应用

Application of Patient-Specific Drill Template in the Thoracic and Cervical Pedicle Screw Implantation: a Clinical Study

目的研究数字化(3D)打印技术的个性化导航模板设计在胸椎和颈椎手术个性化置钉应用的准确性和安全性。方法 2014年7月至2014年11月,对7例需要行胸椎、颈椎椎弓根螺钉植入手术的患者术前通过CT扫描、Mimics软件三维重建建立三维仿真模型。并使用Geomagic软件设计最佳的内固定钉道,然后根据钉道设计导航模板,用3D打印机打印导航模板,用于手术时辅助置钉;术中辅助植入胸椎、颈椎椎弓根螺钉共24枚,术后CT扫描评价螺钉位置,记录有无与螺钉植入的相关并发症。结果通过导航模板辅助植入的24枚椎弓根螺钉,23枚完全在椎弓根内,1枚穿破椎弓根外壁,穿出距离均小于1.2 mm,椎弓根穿破率为4%,植钉准确率为96%,螺钉位置可接受率为100%。无一例出现螺钉植入有关的神经、血管损伤等并发症。结论 3D打印个体化导航模板辅助胸椎、颈椎椎弓根螺钉植入的植钉准确性高、安全。

Objective To investigate the accuracy and safety of patient-specific drill template in the thoracic and cervical pedicle screw implantation. Methods From July 2014 to November 2014,7 patients needed cervical and thoracic pedicle screw placements underwent CT scan,then Mimics 15.0 was used to reconstruct 3D model of cervical and thoracic spine. The best drilling tracts and 3D model of patient-specific drill template were designed by Geomagie software. The 3D models above were used to print out with a rapid prototyping （RP） machine and the real drill templates were used to guide screws placement. 24 transpedicular screws were implanted into cervical and thoracic pedicle. The complications related to screws placement were recorded. Results 23 of the 24 screws implanted by drill plate guidance were completed located in the pedicle. Just 1 screw violation was observed ,but the violation distance was less than 1.2 mm. The placement accurate rate was 96%. The accuracy acceptance rate was 100%. No neurovascular and visceral injury related-complications was noted. Conclusion Patient-specific biocompatible drill template is reliable and safe in the thoracic and cervical pedicle screw implantation.