数字化骨科理念辅助椎弓根置钉在寰枢椎不稳中的临床应用

目的:探讨3D打印辅助置钉技术用于寰枢椎不稳椎弓根置钉的安全性及准确性。方法:收集2013年1月到2015年1月西安交通大学第一附属医院收治的寰枢椎不稳病例,术前采用3D打印技术构建个体化3D打印模型,在模型上模拟置钉,获取最佳置钉点、置钉角度等个体化置钉数据,并于术中辅助椎弓根螺钉置入。通过CT扫描评价置钉准确性,测量术前、术后患者寰齿间隙判断寰枢椎复位情况,测量颈延角评价脊髓压迫改善情况,并采用日本骨科学会(JOA)评分判断患者脊髓功能改善情况。术后定期随访观察固定效果、稳定性、神经损伤等手术并发症的发生情况。结果:13例患者均采用3D打印辅助置钉技术进行内固定治疗,手术顺利,术中及术后无血管、神经损伤等并发症,复位及内固定效果满意。共置入椎弓根螺钉31枚,其中29枚完全在椎弓根内,置钉准确率为93.5%。寰枢椎较术前明显复位,术后寰齿间隙、颈延角和JOA评分较术前明显改善,差异具有统计学意义(P0.05)。结论:3D打印技术辅助上颈椎椎弓根置钉的准确性及安全性均较高。

Clinical Application of 3D Printing-assisted Posterior Screw Fixation for Pedicle Screw Fixation in the treatment of Atlantoaxial Instability

ABSTRACT Objective: To evaluate the safety and accuracy of 3D printing-assisted posterior screw fixation for pedicle screw fixation in the treatment of atlantoaxial instability. Methods: 13 patients diagnosed with atlantoaxial instability from Jan 2013 to Jan 2015 in the First Affiliated Hospital of Xi''an Jiaotong University were analyzed. Before the surgery, 3D printing models were established by 3D printing technology. Screw insertion was simulated on the 3D printing models and personalized data was acquired for assisting actual operations. The accuracy of pedicle screw insertion was assessed by CT scans. The anterior atlas-dens interval was measured to evaluate the reduction of atlantoaxial dislocation. The cervical extension angle was measured to evaluate the improvement of compression on the medulla. The JOA score was used to evaluate the improvement of spinal function. The clinical efficiency, stability of internal fixation, complications were observed after operation. Results: All of the 13 patients were treated with 3D printing-assisted posterior pedicle screw fixation. All the surgeries were successful without complications including neural and vascular injury. 31 transpedicular screws were implanted into cervical pedicle and 29 out of 31 were fully located within the vertebral pedicle. The placement accurate rate was 93.5%. Atlantoaxial reduction was recovered. After the operation, anterior atlas-dens interval, cervical extension angle and JOA score were all significantly improved(P<0.05). Conclusion: 3D printing-assisted screw fixation has high safety and accuracy for pedicle screw fixation in the upper cervical spine.