3D打印导航模板在颅底凹陷合并寰枢椎脱位术中的应用及疗效分析

3D Printing Technique in the Treatment of Basilar Invagination and Atlantoaxial Dislocation

目的探讨3D打印椎弓根导航模板在颅底凹陷合并寰枢椎脱位患者中的应用及疗效。方法总结2018年9月至2020年3月采用3D打印技术设计个体化的寰枢椎椎弓根置钉方案和手术方案治疗的共42例颅底凹陷合并寰枢椎脱位患者的治疗及预后情况,并进行回顾性分析。结果3D打印导航模板辅助下置入椎弓根螺钉106枚(寰椎椎弓根螺钉22枚,枢椎椎弓根螺钉84枚),其中103枚(97.17%)螺钉完全位于椎弓根内,剩余3枚螺钉穿透椎弓根皮质1mm以内。术后颈椎三维CT显示患者齿状突均复位良好,无患者出现神经和椎动脉损伤。术后3个月所有患者均完成随访,VAS和JOA评分与术前相比明显改善,且差异有统计学意义(P<0.05)。结论3D打印导向器辅助治疗颅底凹陷合并寰枢椎脱位有着显著的疗效,能大幅提升置钉准确率,降低神经、血管受损的风险和术后并发症,有效缓解症状和改善患者术后的神经功能。

Objective To explore the application and curative effects of 3D printed technique and intraoperative 3D navigation system in patients with basilar invagination and atlantoaxial dislocation.Methods From September 2018 to March 2020,a retrospective analysis was conducted,including 42 patients with basilar invagination and atlantoaxial dislocation who were performed surgical treatment.3D printing technology was used to design individualized atlantoaxial pedicle screw placement.Results 106 pedicle screws(22 atlas and 84 axial pedicle screws)were placed with the aid of 3D printed navigation system.103(97.17%)screws were completely located in pedicle.The remaining 3 screws penetrated pedicle cortex within 1mm.Postoperative three-dimensional CT showed that odontoids of all patients were in right place.There was no nerve and vertebral artery damage.All patients completed 3 months postoperative following-up,and VAS and JOA scores were significantly improved compared with those before operation with statistically significant difference(P<0.05).Conclusion 3D printed technique has a significant effect in the treatment of basilar invagination and atlantoaxial dislocation,which could significantly precise placement of screw and help to protect vertebral artery and spinal cord,reduce risk of postoperative complications.