3D打印导板在经椎间孔内镜技术定位穿刺中的初步应用

Application of 3D printing guide system in puncture of transforaminal percutaneous endoscopic lumbar discectomy

目的探讨3D打印导板在椎间孔镜手术穿刺中的定位效果。方法选择2016年10月至2017月2月在滨州医学院附属医院神经外科接受椎间孔镜手术的4例患者,其中男2例,女2例。通过Mimics软件获得腰椎的三维立体图形,设计最佳的穿刺路径并制作个性化穿刺导板。术中将导板严密贴合于穿刺部位,沿3D打印导板定位穿刺,通过C型臂透视机观察进针的准确性。结果 4例患者顺利制作了3D打印穿刺定位导板,并在导板引导下完成定位穿刺操作。4例患者中穿刺精准度满意者2例,合格者1例,差者1例。术中C型臂X光机透视定位均显示穿刺成功,未出现重要组织及血管的损伤。结论 3D打印导板可以有效提高椎间孔镜穿刺的准确性,降低透视次数以及有效提高手术率。

Objective To study 3D printing guide system on puncture accuracy and fluoroscopic exposure as well as surgical efficiency of transforaminal percutaneous endoscopic lumbar diseectomy （PELD）. Methods Four patients with Lumbar disc herniaion, admitted to our hospital from October 2016 to February 2017 and aged from 45 to 78 years old （with the average age of 58. 5）,including 2 males and 2 females, were chosen as study objects. The 3-dimensional image was obtained with Mimics Medical 17. 0 software. A perfectly personal navigation module included puncturing-guidance-channel was designed and printed by 3D-printing technology. The printing module was tested in surgery. The module was tightly attached to the puncturing area, and the puncturing was performed following the guide system during the surgery. The accuracy of the needle was observed with the C arm X-Ray machine. Results All the 4 patients successfully received surgery. Intraoperative fluoroscopy showed satisfied results which were classified based on accuracy： 2 highly accurate results, one qualified result and one acceptable result. No puncture failure and no injuries of important organs or blood vessels were found. Conclusion 3D printing guide system can significantly improve the puncture accuracy of PELD and reduce its fluoroscopy exposure as well as operation time, which indicates its great potential in the future clinical applications.