个体化3D打印导向模板辅助强直性脊柱炎颈椎椎弓根螺钉置入的实验研究

Experimental study of individualized 3D printing navigation template printing pedicle screw placement of cervical with ankylosing spondylitis

目的探讨个体化3D打印椎弓根螺钉导向模板辅助强直性脊柱炎颈椎椎弓根螺钉置入的准确性与安全性。方法纳入2016年1月至2019年10月太和县人民医院及蚌埠医学院第二附属医院CT影像中心7例强直性脊柱炎患者颈椎三维CT检查数据,采用3D打印技术、逆向工程原理等设计AS颈椎椎弓根导向模板。按螺钉置入的方法分为导板组和徒手组,分别利用3D打印椎弓根导板辅助置钉和X线机辅助下传统徒手置钉。根据术后CT影像结果评估两组椎弓根螺钉置入的准确性,并比较两组置钉方法术中暴露次数、单枚螺钉置钉时间等指标。结果导板组利用3D打印技术、逆向工程等设计并打印颈椎椎弓根螺钉导向模板19块,辅助置入颈椎椎弓根螺钉36枚。导板组与徒手组手术中所置入螺钉长度无统计学意义(P>0.05);导板组单枚螺钉置入时间及X线暴露次数显著少于徒手组,差异有统计学意义(P<0.05);导板组与徒手组螺钉置入成功率差异有统计学意义(P<0.05)。结论个体化3D打印导向模板辅助AS颈椎椎弓根螺钉置入,显著提高了置钉的准确性和安全性,降低螺钉置入的风险,体现了个性化置钉原则,准确度高、安全、有效、可行,尤其适用于AS合并颈椎骨折、脱位需行后路椎弓根螺钉固定者,值得进一步临床推广使用。

ObjectiveThis study aimed to investigate the accuracy and safety of individualized 3 D printing pedicle screw guide template for cervical pedicle screw placement in ankylosing spondylitis.MethodsThe threedimensional CT data of 7 patients with ankylosing spondylitis in the CT Imaging Center of Tai He County People’s Hospital and the second affiliated Hospital of Bengbu Medical College from January 2016 to October 2019 were included.The AS cervical pedicle guide template was designed by 3 D printing technology and reversed engineering principle.According to the method of screw placement,the patients were divided into two groups:guide plate group and unarmed group.3 D printing pedicle guide plate was used to assist screw placement and X-ray machine was used to assist traditional manual screw placement.According to the results of postoperative CT images,the accuracy of pedicle screw placement in the two groups was evaluated.The intraoperative exposure times and the time of single screw placement were compared between the two groups.ResultIn the guide plate group,19 cervical pedicle screw guide templates were designed and printed by 3 D printing technology and reverse engineering,and 36 cervical pedicle screws were implanted.There was no significant difference in screw length between the guide plate group and the unarmed group(P>0.05),but the single screw placement time and X-ray exposure times in the guide plate group were significantly less than those in the unarmed group(P<0.05).There was significant difference in the success rate of screw implantation between the guide plate group and the unarmed group(P<0.05).ConclusionsIndividualized3 D printing guide template assisted AS cervical pedicle screw placement significantly improves the accuracy and safety of screw placement,reduces the risk of screw placement,and reflects the principle of personalized screw placement,which is accurate,safe,effective and feasible.It is especially suitable for posterior pedicle screw fixation in AS with cervical fracture and dislocation,which is worthy of further clinical application.