虚拟手术计划和3D打印导板辅助寰椎侧块结合枢椎椎弓根螺钉治疗寰枢椎失稳的疗效与安全性

Efficacy and Safety of Virtual Surgery Plan and 3D Printing Guide Plate Assisted Atlas Lateral Mass Combined with Axis Pedicle Screw in the Treatment of Atlantoaxial Instability

目的探讨虚拟手术计划和3D打印导板辅助寰椎侧块结合枢椎椎弓根螺钉置入治疗寰枢椎脱位的临床疗效与安全性。方法回顾分析2019年1月-2022年5月济宁市第一人民医院收治的19例接受寰椎侧块结合枢椎椎弓根螺钉置入内固定治疗的寰枢椎失稳患者,其中9例患者采用虚拟手术计划和3D打印导板辅助植钉(3D打印组),10例患者采用传统手术方式植钉(传统组),比较两组患者的围手术期指标、植钉准确性及临床疗效指标。结果3D打印组在手术时间、术中出血量、术中透视次数、置钉优良率低于传统组,差异有统计学意义(P<0.05)。两组患者术后7天VAS评分及JOA评分比较,差异有统计学意义(P<0.05);术后并发症及术后1年JOA评分改善率比较,差异无统计学意义(P>0.05)。结论虚拟手术计划和3D打印导板辅助与传统手术方式下寰椎侧块结合枢椎椎弓根螺钉置入内固定治疗寰枢椎失稳均疗效确切,但3D打印导航模板辅助下植钉优良率更高,手术时间更短,术中出血量和透视次数都更少,因此具有一定优势。

Objective To investigate the clinical efficacy and safety of virtual surgery plan and 3D printing guide plate assisted atlas lateral mass combined with axis pedicle screw placement in the treatment of atlantoaxial dislocation.Methods A retrospective analysis was performed on 19 patients with atlantoaxial instability who underwent atlantoaxial lateral mass combined with axial pedicle screw placement and internal fixation in Jining First People's Hospital from January 2019 to December 2022.Among them,9 patients were treated with virtual surgery plan and 3D printing guide plate-assisted screw placement(3D printing group),and 10 patients were treated with traditional surgical screw placement(traditional group).The perioperative indicators,screw placement accuracy and clinical efficacy indicators were compared between the two groups.Results The operation time,intraoperative blood loss,intraoperative fluoroscopy times and excellent and good rate of screw placement in the 3D printing group were lower than those in the traditional group,and the differences were statistically significant(P<0.05).There were significant differences in VAS score and JOA score between the two groups at 7 days after operation(P<0.05).There was no significant difference in postoperative complications and JOA score improvement rate at 1 year after operation(P>0.05).Conclusion Virtual surgery plan and 3D printing guide plate assisted and traditional surgical methods of atlas lateral mass combined with axis pedicle screw placement and internal fixation are effective in the treatment of atlantoaxial instability,but 3D printing navigation template assisted screw placement has higher excellent and good rate,shorter operation time,less intraoperative blood loss and fewer fluoroscopy times,so it has certain advantages.