3D打印导板技术在上颈椎椎弓根螺钉置入的临床应用

Clinical Study of 3D Printing Guide Plate Technique in Pedicle Screw Placement of Upper Cervical Vertebrae

【目的】评估3D打印导板技术在上颈椎椎弓根螺钉置入上的临床应用价值。【方法】回顾性分析2015年10月至2018年3月在本院脊柱外科需行后路椎弓根螺钉置入的40例寰枢椎骨折脱位患者临床资料。按置钉方法不同分为3D打印导板辅助置钉组(试验组)及传统X线透视下经椎弓根置钉组(对照组)。比较两组的术前术后疼痛视觉模拟评分(VAS)及颈椎日本骨科协会(JOA)评分、单枚螺钉置入的平均时间、术中出血量、透视次数和较置钉准确率情况。【结果】两组患者术后的临床功能(颈肩部VAS评分和颈椎JOA评分)均较术前有明显改善(P<0.05),而两组性别、年龄、术前术后VAS及JOA评分比较差异均无统计学意义(P>0.05)。两组置钉准确率、单枚螺钉置入的平均时间、透视次数、术中出血差异具有统计学意义(P<0.05).【结论】对于寰枢椎骨折脱位患者,3D打印导板技术较传统钉置技术不仅拥有更高的置钉准确率,且具有单枚螺钉置入的平均时间短、术中透视次数少及术中出血量少的优点,具有良好的临床应用价值。

【Objective】evaluate the clinical value of navigation templates by 3D printing technique in pedicle screw placement of upper cervical vertebra.【Methods】The clinical data of 40 patients with atlantoaxial fracture and dislocation required for posterior pedicle screw placement in spinal surgery in the Second Hospital of Xiangya,Central South University from October 2015 to march 2018 were retrospectively analyzed.According to the method of nail placement,it was divided into 3D printed guide plate assisted nail placement group(test group)and traditional X-ray fluoroscopy transpedicular nail placement group(control group).the preoperative and postoperative pain visual analogue scores(VAS)and the cervical vertebrae japan orthopedic association(JOA)scores,the average time of single screw placement,intraoperative bleeding,fluoroscopy times,and the accuracy of comparing nails were compared between the two groups.【Results】The clinical function of the two groups of patients after operation(neck and shoulder VAS score and cervical JOA score)was significantly improved compared with that before operation(P<0.05),but there was no significant difference in sex,age,preoperative and postoperative VAS and JOA scores between the two groups(P>0.05).The accuracy of the two groups,the average time of single screw placement,the number of fluoroscopy,and the difference of intraoperative bleeding were statistically significant(P<0.05).【Conclusion】For patients with atlantoaxial fracture and dislocation,3D printing guide plate technology not only has higher nail placement accuracy,but also has the advantages of short average time of single screw placement,less fluoroscopy times and less bleeding during operation,and has good clinical application value.