3D打印金属手术导板在复杂上颈椎手术中的应用

Clinical application of a 3D-printed metal drilling template in surgery for complex upper cervical disorders

目的探讨3D打印个体化金属手术导板在复杂上颈椎手术中的应用效果。方法对2015年8月至2017年6月期间收治的5例上颈椎患疾合并复杂颅颈交界区畸形患者资料进行回顾性研究。男4例，女1例；年龄3～36岁。术前均行薄层CT扫描，将数据导入计算机后，建立三维仿真模型，并设计置钉导航模板。在置钉导板引导下共实施后路手术2例，前后联合手术3例。通过术后CT评价螺钉位置是否正确。结果5例患者均顺利施行手术，共置入椎弓根螺钉5枚，椎板螺钉5枚。术后CT证实10枚螺钉位置均准确。未出现脊髓神经损伤、椎动脉损伤等并发症。结论3D打印个体化金属手术导板引导上颈椎置钉手术准确率及安全性较高，对合并复杂颅颈交界畸形的患者可有效降低手术风险，提高手术的成功率。

Objective To report the clinical effects of a 3D-printed metal drilling template used in surgery for complex upper cervical disorders. Methods Between August 2015 and June 2017, 5 patients with upper cervical disorder complicated with complex cranial cervical junction deformity underwent instrumentation and fusion. They were 4 males and one female, aged from 3 to 36 years. All the patients underwent thin slice CT scan before operation. The CT image data were imported into a computer workstation for three dimensional reconstruction of individualized models of the upper cervical spine on which individualized drilling templates were designed. Guided by each of the individualized metal drilling templates manufac- tured by 3D printing, surgery via the posterior approach was performed in 2 cases and surgery via the combined anterior and posterior approach in 3 cases. After surgery, the screw trajectory was evaluated by CT scan. Results Surgery succeeded in all the 5 patients. A total of 5 pedicle screws and 5 laminar screws were drilled. Postoperative CT scan showed accurate placement of all the 10 screws. The patients re- covered with no neurovaseular complications. Conclusion Since an individualized 3D-printed metal drilling template can improve the accuracy and safety of screw placement, it can reduce surgical risks and enhance surgical success in the surgery for complex upper cervical disorders.