实用医学杂志 ›› 2021, Vol. 37 ›› Issue (18): 2380-2385.doi: 10.3969/j.issn.1006⁃5725.2021.18.015

• 临床研究 • 上一篇    下一篇

个体化3D打印导航模板辅助寰枢椎骨折置钉中的准确性研究

程嘉伟, 牛国旗, 李超, 刘路坦, 周乾坤, 朱军, 刘涛, 蒋维利, 陈辉   

  1. 蚌埠医学院第二附属医院骨科(安徽蚌埠 233000)

  • 出版日期:2021-09-25 发布日期:2021-09-25
  • 通讯作者: 牛国旗 E⁃mail:ssngq@163.com
  • 基金资助:

    安徽省科技攻关项目(编号:1804h08020247)


     

Study on the accuracy of individualized 3D printing navigation template in atlantoaxial fracture screw

CHENG Jiawei,NIU Guoqi,LI Chao,LIU Lutan,ZHOU Qiankun,ZHU Jun,LIU Tao,JIANG Weili,CHEN Hui.   

  1. Department of Orthopaedics,the Second Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China

  • Online:2021-09-25 Published:2021-09-25
  • Contact: NIU Guoqi E⁃mail:ssngq@163.com

摘要:

目的 探讨个体化 3D 打印导向模板辅助寰枢椎骨折椎弓根螺钉置入的准确性和安全性。 方法 选取 2017 9 月至 2019 6 月在蚌埠医学院第二附属医院收治的寰枢椎骨折患者 11 例,收集患者的颈椎三维 CT 数据,利用计算机 Mimics 软件重建颈椎的三维骨骼模型,获取寰枢椎椎弓根、棘突、椎板和侧块的解剖特征,模拟椎弓根螺钉的最佳轨迹,根据理想的椎弓根通道设计反向模板,并用 3D 打印机制 作出患者颈椎实体模型和相对应的寰枢椎导航模板。由同一名脊柱外科医生利用导板于颈椎模型上置钉,共置入 44 枚寰枢椎椎弓根螺钉。螺钉置入后,进行 CT 薄层扫描和 Mimics 重建,根据螺钉有无穿破椎弓根皮质及螺钉的头倾角和内倾角,评价置钉准确性。结果 11 例颈椎模型共置入 44 枚寰枢椎椎弓根 螺钉。术后 CT 扫描显示,没有螺钉穿破椎弓根皮质,理想螺钉轨迹和实际螺钉轨迹的头倾角和内倾角差 异无统计学意义(P > 0.05)。结论 个体化 3D 打印导航模板在辅助寰枢椎骨折置钉中具有较高的准确 性、安全性,值得临床进一步的研究和推广使用。

关键词:

寰枢椎, 椎弓根螺钉, 导航模板, 3D 打印

Abstract:

Objective To investigate the accuracy and safety of the individualized 3D print ⁃guided tem⁃ plate in the placement of atlantoaxial fracture pedicle screws. The navigation template suitable for the placement of atlantoaxial pedicle screw was designed and made by using 3D printing technology,the accuracy of the template was verified,and the deviation of screw trajectory was quantitatively analyzed. Methods Eleven patients with atlantoaxial fracture were treated in the second affiliated Hospital of Bengbu Medical College from September 2017 to June 2019. The three⁃dimensional CT data of cervical vertebrae were collected,and the three⁃dimensional bone model of cervical vertebra was reconstructed by computer Mimics software. The anatomical characteristics of atlanto⁃ axial pedicle,spinous process,lamina and lateral mass were obtained,the best trajectory of pedicle screw was sim⁃ ulated,and the reverse template was designed according to the ideal pedicle channel. The 3D printing mechanism was used to make the patient′s cervical solid model and the corresponding atlantoaxial navigation template. A total of 44 atlantoaxial pedicle screws were implanted by the same spinal surgeon using the cervical model guide plate to assist in the simulated operation. After screw placement,thin slice CT scan and Mimics reconstruction were per⁃ formed again. The accuracy of screw placement was evaluated according to the measurement of whether the screw had penetrated the pedicle cortex and the screw,and compared the head inclination angle and internal inclination angle of the actual screw track with that of the ideal screw track. Results A total of 44 atlantoaxial pedicle screws were placed in 11 cervical models. Postoperative CT scan showed that no atlantoaxial screw penetrated the pedicle cortex,and there was no significant difference in head inclination and introversion angle between ideal screw track and actual screw track(P > 0.05). Conclusion The individualized 3D printing individualized navigation template had high accuracy and safety in auxiliary atlantoaxial fracture nail placement,which was worthy of further clinical research and application.

Key words:

atlantoaxial, pedicle screw, navigation template, 3D printing