CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值评估

The application value of CT three-dimensional reconstruction combined with 3D printing technology in atlantoaxial pedicle screw placement operation

目的:探讨CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值。方法:通过CT三维重建的多种后处理技术明确寰枢椎病变13例作为观察组,再将CT三维重建、逆向工程原理及快速成形技术相结合,设计出一种新型的导航模板,辅助椎弓根螺钉置入,并与13例之前已通过X线透视置钉法的病例(对照组)进行置钉效果比较。结果:对照组13例共置椎弓根螺钉41枚,其中Ⅰ类置钉9枚,Ⅱ类置钉18枚,Ⅲ类置钉14枚,成功率65.9%;观察组共打印颈椎模型13例,设计导向模板21个,5例由于先前通过X线透视仅在枢椎两侧的椎弓根内置钉,只制作出枢椎的导航模板;模拟手术同样置钉41枚,其中Ⅰ类置钉15枚,Ⅱ类置钉21枚,Ⅲ类置钉5枚,成功率87.8%。结论:CT三维重建的各种后处理技术不仅能够准确的判断寰枢椎病变,并能配合3D打印技术,制作出个体化的导航模板,使上颈椎椎弓根螺钉的置入变得既安全又省时,并能在术后准确评估置钉效果。

Objective： To investigate the application value of CT three-dimensional reconstruction combined with 3D printing technology in atlantoaxial pedicle screw placement operation. Methods： Thirteen atlantoaxial？ lesions patients diagnosed by postprocessing methods of CT three-dimensional reconstruction were set as the observation group. A kind of new navigation template guiding the atlantoaxial pedicle screw placement operation was designed through CT three-dimensional reconstruction,principle of reverse engineering and rapid prototyping technology. Thirteen patients treated with pedicle screw fixation by X-ray fluoroscopy were set as the control group. The treatment effect between two groups was compared. Results： Forty-one pedicle screws in control group were implanted,which included 9 cases of level-I,18 cases of level-II and 14 cases of level-III pedicle screws,and the success rate of which was 65. 9%. Twenty-one guiding templates were designed in observation group,and 5 cases were treated with X-ray fluoroscopy for the internal fixation of pedicle screws. Forty-one pedicle screws in simulated operation were implanted,which included 11 cases of level-Ⅰ,21 cases of level-Ⅱ and 5 cases of level-Ⅲ pedicle screws,and the success rate of which was 87. 8%. Conclusions： The postprocessing methods of CT three-dimensional reconstruction can accurately diagnose the atlantoaxial vertebral lesions,which combining with 3 D printing technology in cervical pedicle screw placement operation is safe and short time,and can accurately evaluate the effect of pedicle screw insertion after surgery.