3D打印个体化导航模板引导S2AI螺钉固定在退变性脊柱侧凸中的应用

Application of 3Dprinting individualized navigation template guided S2 Alar Iliac screw fixation in degenerative scoliosis

目的探讨3D打印个体化导航模板引导经S2椎体骶髂螺钉(S2 Alar Iliac,S2AI)固定技术在退变性脊柱侧凸畸形矫形术中的临床疗效。方法自2014年7月-2016年10月采用3D打印个体化导航模板引导S2AI固定技术治疗21例退变性脊柱侧凸患者,术中行侧凸矫形及常规置钉,使用导航模板辅助置入S2AI螺钉。比较术前、术后及末次随访时侧凸Cobb角、C7铅垂线到骶骨中垂线的距离(C7 plumb line-center sacral vertical line,C7PL-CSVL)、局部后凸Cobb角、矢状面C7铅垂线与骶骨后上缘间的水平距离(sagittal vertical axis,SVA)、骨盆倾斜角及并发症情况。结果导板辅助下置入S2AI螺钉42枚,1例S2AI螺钉前端穿破髂骨内侧壁。21例术后1周、末次随访的侧凸Cobb角、C7PL-CSVL、RK Cobb角、SVA和骨盆倾斜角,均较术前得到显著矫正,差异有统计学意义(P<0.05);上述角度在术后1周与末次随访时比较,差异无统计学意义(P>0.05)。结论应用3D打印导航模板引导经S2AI固定技术治疗退变性脊柱侧凸畸形,个体化精准置钉,既能达到坚强的内固定需要,又能获得持久满意的冠状面和矢状面矫形效果。

Objective To investigate the clinical effect of 3D printing individualized navigation template guided S2 Alar Iliac (S2AI) screw fixation technique in degenerative scoliosis.Methods From July 2014 to October 2016,3D printed individualized navigation templates were used to guide 21 patients with degenerative scoliosis treated with S2AI fixation technique.During the operation,the scoliosis and conventional screws were performed,and the navigation template was used to assist the insertion of the S2AI screws.The coronal parameters including Cobb angle and distance between C7 plumb line-center sacral vertical line (C7PL-CSVL),pelvic obliquity angle,as well as the sagittal parameters including regional kyphosis (RK) and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and at the last follow-up.Results Forty-two S2AI screws were placed under the guidance of the navigation plate.One of the front end of the S2AI screw penetrated the inner wall of the humerus.The Cobb angle,C7PL-CSVL,RK Cobb angle,SVA and pelvic inclination angle of the 21 patients with scoliosis at 1 week after operation and the last follow-up were all significantly corrected compared with before operation,and the differences were statistically significant (P < 0.05).There were no statistically significant differences in the above angles between 1 week after operation and the last follow-up (P>0.05).Conclusions The 3D printed navigation template is used to guide the degenerative scoliosis deformity through S2AI fixation technique.Individualized and accurate screw placement can achieve strong internal fixation and long-lasting satisfactory correction of coronal and sagittal balance.