个性化寰枢椎椎弓根螺钉导向器的研制及早期疗效观察
Development and clinical application of individualized 3D printed drilling guide for implantation of atlantoaxial pedicle screws
目的 基于三维打印技术,研制个性化C1/2椎弓根螺钉置入导向器,并应用于临床寰枢椎骨折的治疗并观察其早期疗效. 方法 2014年1月至2016年6月共收治17例寰枢椎骨折脱位患者,将患者的颈椎CT数据导入数字骨科工作站,三维重建、数据建模,3D打印制作个性化寰枢椎导向模板;术中在导向模板辅助下置入C1、C2椎弓根螺钉,行骨折复位短节段融合固定;术后进行临床和影像学随访. 结果 所有患者术中未发生椎弓根螺钉损伤脊髓及椎动脉等严重并发症;手术时间为136 ~ 222 min,平均168.0 min;术中出血量为260 ~ 556 mL,平均356.0 mL.17例患者术后获6~-36个月(平均13.5个月)随访;患者在术后4~6个月(平均4.8个月)均获得骨性融合.末次随访时患者临床疗效按国际脊髓损伤神经分类标准(ASIA92)感觉评分由术前的(7.4±3.2)分提高至(13.1±5.9)分;运动评分由术前的(5.3±3.1)分提高至(11.7±5.1)分,差异均有统计学意义(P<0.05).术后无一例患者发生感染、内固定物松动、断裂、退出等并发症. 结论 3D制定个性化寰枢椎椎弓根螺钉导向器,可使复杂、高风险的寰枢椎螺钉置入手术变得准确、安全、操作简便,大幅度提高手术精确性并降低手术风险.
更多Objective To evaluate the individualized 3D) printed drilling guide we developed and used for placement of C1/2 pedicle screws in the clinical treatment of fracture and dislocation of the atlantoaxial joint.Methods From January 2014 to June 2016,we treated a total of 17 patients with fracture and dislocation of the atlantoaxial joint.All the cervical CT data of the patients were imported into the digital orthopaedic workstation for 3D reconstruction,data modeling and 3D printing to design and manufacture individualized atlantoaxial vertebral guide templates.Intraoperatively,C1 and C2 pedicle screws were placed under the guide of individualized 3D printed drilling template.Cervical short-segment fixation and fusion were conducted for the patients.Postoperatively,regular clinical and radiographic follow-ups were carried out.Results No serious complications like injury to spinal cord and vertebral artery happened due to failed placement of C1/2 pedicle screws.The operation time ranged from 136 to 222 min (average,168.0 rmin);the intraoperative blood loss ranged from 260 to 556 mL (average,356.0 mL).The 17 patients were followed up for 6 to 36 months (average,13.5 months).The patients obtained bony union after 4 to 6 months (average,4.8 months).At the final follow-up,according to ASIA92 scoring system,the average sensory score was improved significantly from preoperative 7.4 + 3.2 to postoperative 13.1 + 5.9,and the average motor score was improved significantly from preoperative 5.3 + 3.1 to postoperative 11.7 + 5.1 (P < 0.05).No such complications as infection or implant failure occurred after operation.Conclusion Individualized 3D printed drilling guide for implantation of atlantoaxial pedicle screws can make the complicate and risky placement become accurate,safe and simple.
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