3D打印导向器与导航下引导骶髂螺钉置入的对比研究

A Comparative Study of Sacroiliac Screw Placement Guided By 3D Printing Screw Guide and Navigation

目的 比较3D打印螺钉导向器与导航下引导骶髂螺钉置入在骶髂关节损伤治疗中的临床疗效。方法 分析2018年6月至2021年6月收治的骶髂关节损伤32例患者资料,按照螺钉引导方式不同分为3D打印螺钉导向器组(17例)和导航组(15例),其中导向器组男13例,女4例;年龄23~56岁,平均(37.81±9.73)岁;Tile分型,B型10例,C型7例。导航组男12例,女3例;年龄23~58岁,平均(36.23±9.35)岁;Tile分型,B型9例,C型6例。比较两组术中透视次数、置钉时间、术中出血量、术后并发症等,采用Majeed评分在术后1年对骨盆功能进行评价,采用Matta评分对骨折复位质量进行评价。结果 两组患者术后均无伤口感染和神经损伤并发症出现。患者均获随访,随访时间12~32个月,平均(19.82±0.25)个月。两组患者透视次数方面比较差异无统计学意义(P>0.05)。导向器组出血量稍多,与导航组比较差异有统计学意义(P<0.05)。导向器组置钉时间要少于导航组,两组比较差异有统计学意义(P<0.05)。按照Matta评分标准:导向器组优12例,良4例,可1例;导航组优11例,良3例,可1例(P>0.05)。术后1年随防时,按照Majeed评分标准:导向器组评分67~93分,平均(85.76±6.86)分;导航组评分68~92分,平均(86.47±7.37)分(P>0.05)。结论 采用3D打印螺钉导向器引导置入骶髂螺钉治疗骶髂关节损伤,具有术中置钉时间少、置钉准确等优点,且不需要导航等高科技设备,在基层临床工作中可以推广应用。

Objective This study aimed to compare the clinical effectiveness of 3D printing screw guides with navigation in assisting surgery for sacroiliac screw placement.Methods We retrospectively analyzed clinical data from 32 patients who underwent surgical treatment for sacroiliac joint injuries using sacroiliac screws between June 2018 and June 2021.Patients were divided into two groups:The 3D printing screw guide group(17 cases)and the navigation group(15 cases).In the 3D printing screw guide group,13 males and 4 females with a mean age of(37.81±9.73)years old(range:23~56 years old)were included,with 10 cases of Tile type B and 7 cases of type C.The navigation group comprised 12 males and 3 females with a mean age of(36.23±9.35)years old(range:23~58 years old),including 9 cases of Tile type B and 6 cases of type C.We compared intraoperative fluoroscopy frequency,screw placement time,intraoperative blood loss,and postoperative complications between the two groups.Pelvic function was evaluated one year postoperatively using the Majeed score,and fracture reduction was assessed using Matta criteria Results There were no wound infection or nerve injury complications in either group.All patients were followed up for an average of(19.82±0.25)months(range:12~32 months).Comparisons between the two groups revealed no significant difference in intraoperative fluoroscopy frequency(P>0.05).However,intraoperative blood loss was higher in the 3D printing screw guide group than in the navigation group(P<0.05).Conversely,screw placement time was shorter in the 3D printing screw guide group compared to the navigation group(P<0.05).According to Matta criteria,the 3D printing screw guide group had 12 excellent,4 good,and 1 fair cases,while the navigation group had 11 excellent,3 good,and 1 fair cases(P>0.05).According to Majeed score at one year after operation,ranged from 67 to 93,mean(85.76±6.86)in 3D printing screw guide group,and ranged from 68 to 92,mean(86.47±7.37)in the navigation group(P>0.05).Conclusion The use of 3D printing screw guides in assisting sacroiliac screw placement surgery offers advantages such as reduced screw placement time,accurate nail placement,and does not require high-tech equipment.This approach could be promoted in clinical practice.