基于3D打印导航模块腰椎椎弓根螺钉置入的精确性

Accuracy of lumbar pedicle screw implantation based on three-dimensional printing navigation modules

背景:椎弓根螺钉置入腰椎的手术过程需要长时间应用X射线影像确认椎弓根螺钉的置入位置,而计算机辅助手术导航技术由于辅助导航系统的费用昂贵、工序操作复杂等因素在临床应用上受到限制。目的:基于3D打印导航模块的腰椎椎弓根螺钉置入腰椎骨折患者,验证导航模块置入腰椎椎弓根螺钉的精确性与可行性。方法:根据50例腰椎骨折患者的CT数据,将数据信息导入Mimics中,建立三维腰椎模型。再依据建立的腰椎模型设计螺钉导航模块的模型,并采用3D打印技术分别制造出导航模块及腰椎实体模型。首先,在术前将导航模块置入腰椎标本实体上进行模拟椎弓根螺钉试验;其次,术中再应用螺钉导航模块辅助椎弓根螺钉置入腰椎;最后,术后通过CT检查与X射线评估螺钉置入的效果。结果与结论:(1)设计的导航模块辅助12枚椎弓根螺钉置入腰椎,经过CT检查置入螺钉位置良好,都处于腰椎椎弓根内部,无螺钉穿破椎弓根皮质现象;(2)试验证明,椎弓根螺钉置入腰椎的精确性相对较高,全部螺钉的进钉方向、进钉点均与术前模拟效果基本一致;(3)提示基于3D打印导航模块的椎弓根螺钉置入腰椎的精确性高,能实现微创个体化椎弓根螺钉精确置入,操作方法较为简单,具有十分重要的意义。

BACKGROUND:The surgical procedure of pedicle screw placement in the lumbar spine requires a long time to confirm the insertion position of the pedicle screw by using X-ray images.The clinical application of computer-aided navigation techniques is limited,due to the high cost of auxiliary navigation system and complicated operation.OBJECTIVE:Based on three-dimensional printing navigation module of lumbar pedicle screw implantation in patients with fracture of lumbar spine,to verify the accuracy and feasibility of the navigation module into lumbar pedicle screws.METHODS:According to CT data of 50 patients with fracture of lumbar vertebra,the data were loaded into Mimics to establish a three-dimensional model of the lumbar spine.On the basis of the established model of pedicle screw navigation module,lumbar entity model and navigation module were made using three-dimensional printing technology.First of all,navigation module was preoperatively embedded in the lumbar spine specimen entity to simulate pedicle screw test.Second,screw navigation module was applied to assist lumbar pedicle screw insertion in lumbar vertebra during the operation.After operation,the effectiveness of the screw implantation was assessed using CT examination and X-ray.RESULTS AND CONCLUSION:(1)The designed navigation module with 12 pedicle screws was inserted into lumbar vertebra.CT examination showed that screw position was good on the internal side of lumbar pedicle;no screws perforated the pedicle cortex.(2)Experiments showed that the accuracy of pedicle screws inserted into lumbar vertebra was relatively high.The direction and the site of the screws were basically identical to the preoperative simulation results.(3)Based on three-dimensional printing navigation module,the accuracy of pedicle screw implantation into the vertebral vertebra was high,and could realize accurate implantation of individualized pedicle screws.The minimally invasive surgery method is relatively simple and has the very vital significance.