改良3D打印导航模板辅助颈椎后路经椎弓根置钉的效果观察

目的观察改良3D打印导航模板辅助颈椎后路经椎弓根置钉的精准性,分析实际置钉角度误差,明确其在临床应用中的优缺点。方法2021年1月至2022年2月收治经颈椎椎弓根固定患者12例,共置入螺钉44枚,按手术置钉方式不同分为改良3D打印导航模板组(20枚螺钉)和传统经验置钉组(24枚螺钉),3D打印导航模板组借助改良3D打印导航模板辅助置钉;传统经验置钉组术前虚拟设计理想钉道,不打印导航模板,术中经验性置钉。术后两组所有患者复查颈椎CT,分析两组在置钉等级、置钉内倾角误差值、头倾角误差值上的差异,明确置钉精准性与安全性。结果改良3D打印导航模板组置钉准确率达95%,传统置钉准确率70.8%,差异有统计学意义(P<0.05);术前、术后CT影像学分析,改良3D打印导航模板组置钉内倾角误差值为(4.47±3.86)°,头倾角误差值为(4.41±5.90)°,传统经验组置钉内倾角误差值为(9.98±7.91)°,头倾角误差值为(8.65±7.33)°,两组在置钉内倾角、头倾角误差值,差异有统计学意义(P<0.05)。结论借助改良3D打印导航模板辅助颈椎椎弓根置钉技术具较高的准确性,置钉角度误差小,值得临床推广应用。

Objective To explore the accuracy of the novel 3D-printed navigation template and the actual nail placement angle error in placement of the posterior cervical transpedicular screw,so as to clarify its advantages and disadvantages in clinical application.Methods The prospective research method was used.12 patients with cervical pedicle fixation who were treated from January 2021 to February 2022 were divided into the improved 3D printing navigation template group(20 screws)and the traditional experience screw placement group(24 screws).In the novel 3D-printed navigation template group,the template were used to assist transpedicular screw placement during operation.In the traditional experience group,the ideal screw path was designed virtually before operation,the navigation template was not printed,and the operation relied on empirical nail placement.After the operation,all the patients in the two groups underwent three-dimensional CT examination of cervical spine.The statistical significance of the two groups in nail placement grade,nail placement internal inclination error value and head inclination error value was analyzed to clarify the accuracy and safety of transpedicular screw placement.Results The accuracy of nail placement in the novel 3D-printed navigation template group was 95%,and the accuracy of traditional nail placement was 70.8%,which was statistically significant(P<0.05).According to the statistical analysis of CT imaging,the error value of nail placement internal inclination in the novel 3D-printed navigation template group was(4.47±3.86)°,the error value of head inclination was(4.41±5.90)°,the error value of nail placement internal inclination in the traditional experience group was(9.98±7.91)°,and the error value of head inclination was(8.65±7.33)°.The two groups had statistical significance in nail internal placement inclination error value and head inclination error value respectively(P<0.05).Conclusion The placement of posterior cervical transpedicular screw with novel 3D-printed navigation template has very high accuracy,small screw placement angle error and more advantages,which is worthy of clinical application.