3D打印个体化导向板辅助经皮椎体成形术治疗双节段骨质疏松性椎体压缩骨折: 新技术报道

A novel percutaneous vertebroplasty assisted by three dimensional printed guide template for double-segment osteoporotic vertebral compression fracture:technical report

目的介绍一种应用3D打印个体化导向板辅助下的经皮椎体成形术治疗双节段骨质疏松性椎体压缩骨折的新技术。方法以1例急性双节段骨质疏松性椎体压缩骨折(T_(12),L_(1))为例,介绍一种3D打印个体化导向板辅助下的经皮椎体成形术,该技术基于患者个体特点所制作,含4个关键步骤,包括:术前伤椎CT影像学数据的采集、MIMICS软件内模拟PVP手术操作(骨折椎体在MIMICS软件内的三维模型重建,在软件内模拟经伤椎双侧椎弓根入路穿刺路径,建立皮肤穿刺入点、穿刺针方向及穿刺针深度等关键参数)、个体化3D导板的设计及制作(根据MIMICS软件内模拟的手术数据,制作并打印导向板用于真实手术)、3D导板辅助下的真实PVP手术。结果手术共耗时(从消毒铺单开始计时到最终正侧位透视结束)25 min,术中仅需2次透视即可确定2个伤椎的皮肤穿刺入点,术中总透视次数仅20次,总放射剂量为5.55 mSv。患者VAS评分由术前的9分降至术后的2分,无任何手术并发症发生,术后透视提示骨水泥在伤椎内弥散情况良好。结论应用3D打印个体化导向板辅助经皮椎体成形术治疗双节段骨质疏松性椎体压缩骨折,是一种新的精准手术方案。相较于传统手术方案,该技术可能更有利于减少手术时间、减少患者及医生的术中放射暴露。

Objective To introduce a new technique of percutaneous vertebroplasty(PVP)assisted by 3D printed individualized guiding template for the treatment of double-segment osteoporotic vertebral compression fractures(OVCF).Methods One patient with acute double-segment OVCF(T_(12),L_(1))was used as an example to introduce the four key steps of PVP assisted by a 3D printed guide template.It included:①acquisition of CT images of the target vertebra;②simulation of the operation procedures in the software;③design and fabrication of the 3D printing guide template;④application of the template into an operation procedure.Results The operation took 25 min,only 2 times C-arm fluoroscopy were used to determine the skin penetration points.The total fluoroscopy times during the operation was 20 times,and the total intraoperative radiation dosage was 5.55 mSv.The VAS score of the patient improved from preoperative 9 points to postoperative 2 points.No surgical complications occurred.Postoperative fluoroscopy showed that the bone cement was well distributed in the vertebrae.Conclusion Compared with conventional PVP,3D printed guide plate assisted PVP is a novel and accurate surgical procedure.It can shorten the surgical time,minimize radiation times and intraoperative radiation exposure of both patients and doctors.