基于3D软组织打印技术经皮穿刺中上胸椎椎弓根入路椎体成形术导向模板的初步研制

Preliminary development of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach due to three dimentional soft tissue print technique

目的:观察数字化导向模板技术和3D软组织打印制作的个体化经皮穿刺中上胸椎椎弓根入路椎体成形术数字化导向模板的可行性。方法:回顾性选择20例中上胸椎骨折患者CT扫描数据。将数据输入3D打印机打印1∶1带软组织胸椎模型,并应用Mimics 15.0软件中3-matic模块设计中上胸椎体表椎弓根钉道及相应导向模板,3D打印机打印导向模板并固定带软组织胸椎模型后置入2.0 mm克氏针,CT扫描观察穿刺针的准确性,通过穿刺管注入骨水泥并用影像学进行验证,记录带软组织中上胸椎模型的打印时间、钉道设计及体表导向模板制作时间以及费用。结果:3D打印的一体化胸椎模型及数字化经皮穿刺中上胸椎椎弓根入路数字化导向模板能够满足中上胸椎经皮穿刺椎体成形术穿刺的要求,导板与皮肤表面贴合良好,骨水泥充盈良好。中上胸椎模型的打印时间及钉道设计、手术导向模板制作时间分别为(719.00±3.03)min,(12.30±1.01)min和(55.50±10.30)min,平均费用约为3150元。结论:基于3D软组织打印技术的个性化经皮穿刺中上胸椎椎弓根导向模板可实现经皮穿刺的精确置入。

Objective:To investigate the feasibility of a drill template for the placement of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach on digital design and 3D printing technology.Methods:The preoperative CT images of 20 patients with thoracic fracture were collected retrospectively.With the 3D soft tissue printing technology,the data was reconstructed by 3D imaging reconstruction software to produce 1∶1 three dimensional soft tissue model.The pedicle screw channel and the digital template were designed by the 3-matic module of Mimics15.0 software.After guide template was printed by 3D printer and three dimensional template was fixed on the model,2.0 mm Kirschner was placed and the accuracy of a drill template was observed by CT scans,bone cement was injected through the puncture tube and verified with images.The time of nail guide design,guide template production and cost were recorded.Results:The effectiveness of three dimensional thoracic model and digital guided template of middle and upper thoracic percutaneous vertebroplasty of thoracic fractures in thoracic pedicle approach was confirmed.Kirschner was placed and the accuracy of screw placement was confirmed with CT scanning.Template and the corresponding anatomical landmark fitted well,bone cement had showed good filling.The average printing time of upper thoracic spine model with soft tissue,the mean time of nail guide design,guide template production and cost were(719.00±3.03)min,(12.30±1.01)min,(55.50±10.30)min and RMB 3150 yuan on average respectively.Conclusion:By means of individual design and 3D soft tissue printing technology,accurate placement of guided template of middle and upper thoracic percutaneous vertebroplasty could be realized.