个性化导航模板辅助S2AI置钉与徒手置钉的对比

Comparison of S2AI Nail Placement Assisted by Personalized Navigation Template and Manual Nail Placement

目的探讨3D打印导航模板辅助经后路第2骶椎髂骨(S2AI)螺钉置入的可行性与准确性。方法回顾性分析2017年9月至2019年9月接受初次S2AI置钉患者30例。其中男14例,女16例;年龄42~74岁。根据治疗方法的不同将其分为导板组和徒手组,每组15例。导板组患者术前行骨盆CT三维重建,设计导航模板并在术中使用,徒手组采用常规手术徒手置钉。所有患者术后复查骨盆CT,三维重建后观察螺钉与皮质的关系,并对比两组患者术后CT在矢状面上尾向偏角(SA)、横断面与正中线夹角(TA)、进钉点与骶正中嵴的距离(HD)以及与第1骶后孔下缘的垂直距离(VD)。记录并比较两组手术S2AI置钉时间、术中置钉所需透视C型臂次数。结果导板组15例患者共置入S2AI钉30枚,所有螺钉均穿过骶髂关节,无侵犯及穿出皮质。徒手组15例患者共置入S2AI钉30枚,所有螺钉均穿过骶髂关节,无侵犯及穿出皮质。导板组患者术后SA(30.00±3.49)°、TA(40.43±2.10)°、HD(19.44±0.85)mm、VD(4.97±0.43)mm,与徒手组患者术后SA(30.72±3.34)°、TA(39.71±2.12)°、HD(19.15±1.31)mm、VD(5.02±0.53)mm比较,差异无统计学意义(均P>0.05)。导板组测量置钉时间(19.60±1.30)min、透视次数(4.20±0.41)次低于徒手组测量置钉时间[(52.93±9.22)min]、透视次数[(13.80±2.81)次],差异有统计学意义(均P<0.05)。结论成人骨盆固定中,应用3D打印导板与徒手置钉的准确性无明显差异,但3D导板组手术时间更短,术中透视次数也更少。

Objective To evaluate the feasibility and accuracy of S2 alar-iliac(S2AI)screwing assisted by an individualized navigation template in clinic.Methods Thirty patients underwent initial S2AI nail placement from September 2017 to September 2019.There were 14 males and 16 females,aged from 42 to 74 years old.They were divided into navigation template group and free-handed group according to different treatment methods,with 15 cases in each group.Patients in the navigation template group underwent 3D pelvic CT reconstruction before operation,and their individualized navigation template were designed and used to assist the implantation of S2 alar-iliac screws.The free-handed group accepted conventional surgery which placed nails by hand.After operation,their postoperative CT data were reviewed.Through 3D reconstruction,the relationship between the screw and the cortex was observed.The postoperative CT of the two groups was compared in the sagittal plane(SA),lateral angulation on the transverse plane(TA),horizontal distance to the median sacral crest(HD)and vertical distance to the first posterior sacral foramen’s inferior margin(VD).Record the S2AI nail placement time and the number of C-arm fluoroscopy required for intraoperative nail placement in the two groups.Results A total of 60 S2AI nails were placed in 30 patients.All the screws implanted through the sacroiliac joint without piercing the iliac bone cortex.There were no significant difference between the navigation template group and free-handed group in terms of SA[(30.00±3.49)°versus(30.72±3.34)°],TA[(40.43±2.10)°versus(39.71±2.12)°],HD[(19.44±0.85)mm versus(19.15±1.31)mm],VD[(4.97±0.43)mm versus(5.02±0.53)mm](P>0.05).There were statistical differences between navigation template group and free-handed group in terms of the nail setting time[(19.60±1.30)min versus(52.93±9.22)min]and the number of fluoroscopy[(4.2±0.41)times versus(13.80±2.81)times](P<0.05).Conclusion In adult pelvic fixation,there is no significant difference in the accuracy between 3D printed guides and manual nail placement,but the 3D guide group has shorter operation time and fewer intraoperative fluoroscopy times.