3D打印导航模板在颈椎压缩骨折后路椎弓根钉内固定术中的应用

Application of 3D printed navigation template in posterior pedicle screw fixation for cervical spine compression fractures

目的探讨3D打印导航模板辅助颈椎后路椎弓根钉内固定术治疗颈椎压缩骨折的临床疗效。方法回顾性分析自2015-01—2018-03采用颈椎后路椎弓根钉内固定术治疗的32例颈椎压缩骨折,术前3D打印个性化导航模板,术中在导航模板辅助下置入椎弓根钉。比较术前模拟与术后C_(1~7)椎弓根置钉角度,以及手术前后疼痛VAS评分、JOA评分。结果 32例均获得至少12个月随访,平均14个月。随访期间所有患者未出现神经系统感觉运动障碍、内固定断裂。术后CT显示C_(1~7)椎弓根置钉角度与术前模拟时比较差异无统计学意义(P>0.05)。术后3个月疼痛VAS评分为(1.2±0.5)分,较术前(7.2±3.7)分明显降低,差异有统计学意义(P <0.05)。术后3个月JOA评分为(15.2±3.4)分,较术前(9.3±4.2)分明显提高,差异有统计学意义(P <0.05)。结论颈椎后路椎弓根钉内固定联合个性化3D打印导航模板治疗颈椎压缩骨折可以显著提高手术精确性和安全性,减少置钉次数,缩短手术时间。

Objective To investigate the clinical efficacy of 3D printed navigation template assisted posterior cervical pedicle screw fixation in the treatment of cervical spine compression fractures.Methods A retrospective analysis of 32 cases of cervical compression fractures treated by cervical posterior pedicle screw fixation from January 2015 to March 2018 was conducted.The personalized navigation template was printed 3 days before operation,and the pedicle screw was placed under the aid of the navigation template.The preoperative simulation and postoperative C1~7 pedicle screw angle were compared as well as pain VAS scores and JOA scores before and after surgery.Results Thirty-two patients were followed up for at least 12 months,with an average of 14 months.Postoperative CT showed good position of pedicle screws,and no penetration through the lateral and internal sidewalls.During follow-up there was no neurological sensory dyskinesia or internal fixation fracture.Postoperative CT showed no significant difference in C1~7 pedicle screw placement angle compared with preoperative simulation(P>0.05).The VAS score 3 months after operation was(1.2±0.5)points,which was significantly lower than that before surgery(7.2±3.7).The difference was statistically significant(P<0.05).The JOA score was(15.2±3.4)points after 3 months,significantly improved compared with that before operation(9.3±4.2),the difference was statistically significant(P<0.05).Conclusion Cervical posterior pedicle screw fixation combined with 3D printed personalized navigation templates for treatment of cervical compression fractures can significantly improve surgical accuracy and safety,reduce the number of pedicle screws,and shorten the operation time.