3D打印导航模板在脊柱侧凸矫形术中的初步应用

Preliminary Application of 3D Printing Navigation Template in Scoliosis Orthopedics

目的评估3D打印导航模板在脊柱侧凸矫形术中置钉的准确性及安全性。方法选择我院收治的应用3D打印导航模板辅助脊柱侧凸行选择性椎弓根螺钉固定矫形术12例,术前均行全脊柱薄层CT扫描,将原始图像数据以Dicom格式保存,导入mimics17.0软件中进行全脊柱三维模型重建,最终生成导航模板。术中应用导航模板判断置钉的位置,记录置钉数量、置钉准确率、并发症发生情况、术前及术后脊柱主弯Cobb角变化。结果本组共置入螺钉168枚,其中Ⅰ级螺钉136枚(80.95%),Ⅱ级螺钉25枚(14.88%),Ⅲ级螺钉7枚(4.17%),置钉准确率为95.83%。术中无置钉相关的神经、血管损伤等并发症发生。脊柱主弯Cobb角术前、术后分别为(55.8±20.4)、(20.6±13.9)度,差异有统计学意义(P<0.05)。结论3D打印导航模板辅助脊柱侧凸矫形术选择性椎弓根螺钉置入的准确率高,矫正效果显著,安全性好。

Objective To assess the accuracy and safety of 3 D printing navigation templates in screw placement in scoliosis orthopedics. Methods Twelve patients with scoliosis undergoing selective pedicle screw fixation and orthopedic surgery in our hospital were recruited in our study. All patients underwent preoperative thin-section CT scan of the spine. The original total spine image data were saved in the Dicom format and introduced into mimics17. 0,to reconstruct a three dimensional（ 3 D） model of total spine,thereby generating a navigation template. Intraoperative navigation templates were used to determine the location of the pedicle screw placement. The number and accuracy of pedicle screw placement,the incidence of complications,and changes in preoperative and postoperative spinal primary Cobb angle were recorded. Results A total of 168 screws were placed in this group,including 136 gradeⅠscrews（ 80. 95%）,25 gradeⅡscrews（ 14. 88%） and 7 gradeⅢscrews（ 4. 17%）. The accuracy of screw placement was 95. 83%. No complications related to screw placement,such as neurovascular injury,were noted intraoperatively. The Cobb angle of primary curvature of the spine pre and post-operatively was（ 55. 8 ± 20. 4） degrees and（ 20. 6 ± 13. 9） degrees respectively,showing significant differences（ P〈0. 05）. Conclusion Selective pedicle screw placement for scoliosis orthopedics assisted by 3 D printing navigation template provides high accuracy rate and high degree of accuracy,with superior effect and safety.