基于3D打印技术构建个体化椎间孔镜穿刺导向器的设计与应用

Design and application of an individual puncture guide device fabricated by three-dimensional printing technology

背景:椎间孔镜手术频繁的术前透视定位对于医患而言都是有害的,因此应尽量减少或避免术前透视次数。目的:利用3D打印技术构建出一种新型个体化椎间孔镜技术穿刺定位导向器,初步探索其临床应用的可行性,以及其对椎间孔镜手术穿刺准确性、手术时间、透视次数的影响。方法:根据患者术前CT扫描数据,利用Mimics软件建模,模拟手术时工作通道的方向和位置,测量出工作通道的角度,旁开距离等数据,根据这些数据利用建模软件构建出个体化的穿刺定位导向器,之后采用3D打印技术打印出导向器。回顾性分析接受椎间孔镜下髓核摘除术的患者45例,其中导向器组22例使用导向器定位穿刺,传统组23例采用传统方法穿刺。记录并比较2组患者手术时间、穿刺次数、透视次数、目测类比评分和日本骨科协会评分的差异。结果与结论:(1)穿刺次数方面,导向器组(1.27±0.63)次,传统组(3.69±0.70)次,2组间差异有显著性意义(P<0.001);(2)透视次数方面,导向器组(11.59±2.04)次,传统组(20.39±1.80)次,2组间差异有显著性意义(P<0.001);(3)手术时间方面,导向器组(75.44±11.89)min,传统组(87.39±12.51)min,2组间差异有显著性意义(P=0.001)。(4)在临床疗效方面,术前、术后1 d、3个月、6个月腰痛及下肢痛目测类比评分和日本骨科协会评分差异并无显著性意义;(5)结果提示,利用3D打印技术可以根据患者的影像学资料构建出个体化的椎间孔镜穿刺定位导向器,此种导向器可以提高椎间孔镜术中穿刺的准确性,有效减少透视次数和穿刺次数,具备一定的临床应用可行性。

BACKGROUND： Frequent preoperative fluoroscopic localization of transforaminal endoscopic surgery is harmful to both doctors and patients, so it is necessary to minimize or avoid preoperative fluoroscopy. OBJECTIVE： To design and built an individual transforaminal endoscopic puncture positioning device using three-dimensional（3 D） printing technology and to explore its feasibility of clinical application, the accuracy of the puncture, operation time and the fluoroscopy times.METHODS： We used Mimics 19.0 to build lumbar model based on the preoperative CT scan data. We simulated the direction and position of the working channel and measured the angle of the working channel, and then puncture guide device was built by 3 D printing technology. Forty-five patients undergoing percutaneous endoscopic lumbar discectomy were included in this retrospective study. These patients were divided into two groups. Those received individual puncture guide device were regarded as guide device group（n=22）, and those undergoing conventional method were considered as traditional group（n=23）. The operation time, puncture times, fluoroscopy times, Visual Analogue Scale scores and Japanese Orthopaedic Association scores were recorded and compared. RESULTS AND CONCLUSION：（1） The average puncture times was 1.27 ± 0.63 in guide device group and 3.69 ± 0.70 in traditional group, and there were significant differences between two groups（P 0.001）.（2） The fluoroscopy times was 11.59 ± 2.04 in guide device group and 20.39 ± 1.80 in traditional group, and there were significant differences between two groups（P 0.001）.（3） The operation time was 75.44 ± 11.89 minutes in guide device group and 87.39 ± 12.51 minutes in traditional group; there were significant differences between the two groups（P=0.001）.（4） Regarding curative effect, there was no significant difference in low back pain and lower extremity pain Visual Analogue Scale and Japanese Orthopaedic Association scores between two groups.（5） The transforaminal endoscopic individual puncture guide device can be constructed by 3 D printing technology according to preoperative imaging data. The guiding device can improve the accuracy of puncture during surgery, and effectively reduce the fluoroscopy and puncture times. Thus, it has certain clinical application feasibility.