3D打印模型辅助后路内固定治疗儿童颈椎畸形

Individualized 3D printing model-assisted posterior screw fixation for the treatment of the 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CT确诊的22例颈椎畸形伴上颈椎不稳患儿进行回顾性分析。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例均采取个体化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，术后随访时间3～23个月，平均13．5个月。术后寰椎齿突间隙（ADI）明显缩小，延髓颈髓角（CMA）明显增大，延髓腹侧受压明显减轻或消失，无手术死亡，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。

Objetive To study the method and effect of individualized 3D priming model--assisted pos- terior screw fixation for the treatment of the cervical deformity of children. Methods 22 patients with cervical deformity associated with upper cervical instability diagnosed by CT were retrospectively analyzed in Department of Orthopedics at Beijing Children＇ s Hospital. First, a 3D printing model of cervical was made with 3D printing technology, then simulated screw insertion and fixation operation on the model to obtain the individual screw in- sertion data to assist the real operation. At last implemented one-stage posterior orthomorphia combined with in- ternal fixation. Results 22 patients with cervical deformity successfully underwent the posterior screw fixation operation assisted by individual 3D printing models, without injury to the vertebral artery and nerve root, without internal fixation loosening and fracture, postoperative follow-up time ranged from 3 to 23 months, average 13.5 months. Postoperative ADI was significantly reduced, CMA increased significantly, the medulla oblongata ventral compression significantly reduced or disappeared, no death in operation, 1 case with two times the fusion of bone graft, 1 case underwent sternocleidomastoid muscle amputation lysis, 1 case of foramen magnum decompression, 1 cases of posterior arch of atlas decompression. Conclusions Posterior screw fixation operation assisted by individualized 3 D printing model can improve the success rate and safety of screw insertion, and effectively pro-tect the vertebral artery and nerve root avoiding damage, especially is of great help to the treatment of children with cervical deformity.