3D打印导航模块设计及对腰椎椎弓根置钉准确率的影响研究-现代医学

3D打印导航模块设计及对腰椎椎弓根置钉准确率的影响研究

单位：广东省肇庆市第一人民医院骨科, 广东肇庆 526060

关键词：腰椎椎弓根螺钉腰椎椎弓根手术 3D打印技术导航模块模拟手术腰椎功能治疗效果置钉准确率

分类号：R681.5

出版年·卷·期（页码）：2017·36·第十二期（1791-1797）

摘要：

目的：探讨3D打印导航模块设计及对腰椎椎弓根钉置钉准确率的影响，为提高手术成功率提供依据。方法：取2013年12月至2016年10月医院收治创伤性腰椎骨折患者50例作为研究对象，随机数字法分为对照组（n=25）和3D打印导航模块组（n=25）。2组均采用微创腰椎椎间固定融合术治疗，对照组根据医生经验、X线等方法辅助置钉，3D打印导航模块组术前采集CT资料，利用3D打印导航模块设计，术中辅助置钉治疗，术后均采用CT、X线等评估置钉准确性，术后对2组患者进行6个月随访，比较2组治疗效果。结果：（1）3D打印导航模块组共置入68枚螺钉，对照组共置入71枚螺钉。3D打印导航模块组置钉准确率为95.59%，对照组为87.32%，2组置钉准确率比较差异有统计学意义（P<0.05）；（2）2组治疗前JOA下腰痛评分比较差异无统计学意义（P>0.05）；3D打印导航模块组治疗后JOA下腰痛评分，高于对照组（P<0.05）；（3）2组治疗前Oswestry功能障碍指数问卷表评分比较差异无统计学意义（P>0.05）；3D打印导航模块组治疗后Oswestry功能障碍指数问卷表评分，低于对照组（P<0.05）。结论：腰椎椎弓根手术术前设计3D打印导航模块能进行模拟手术，制定精确的术前计划，有助于提高置钉准确率。

Objective: To study the design of 3D navigation module and the effect on the accuracy of pedicle screw fixation,so as to provide the basis for improving the success rate of the operation.Methods: A total of 50 patients with traumatic lumbar spine fractures in our hospital from December 2013 to -2016 were selected as the research objects. The patients were randomly divided into control group(n=25) and 3D navigation module group(n=25). The two groups were treated with minimally invasive lumbar interbody fusion treatment,the control group were given screw placement according to the doctor's experience,X-ray and other methods,the 3D printing navigation module group were given CT data acquisition before surgery, with the use of 3D printing navigation module design,intraoperative screw placement assisted treatment,postoperative X-ray and CT were used to evaluate the accuracy of pedicle screw,the two groups of patients were followed-up for 6 months, the curative effects of the two groups were compared.Results: (1) A total of 68 screws were implanted into the 3D navigation module group,and the control group was treated with a total of 71 screws. The insertion accuracy of the D printing navigation module group was 95.59%,the control group was 87.32%,the difference of pedicle screw accuracy between the two groups was statistically significant(P<0.05);(2) The difference of JOA score before the treatment between the two groups was not statistically significant(P>0.05); The JOA score after treatment of the 3D printing navigation module group was higher than that ofthe control group(P<0.05);(3) The difference of Oswestry Disability Index questionnaire score before the treatment between the twogroups was notstatistically significant(P>0.05); The Oswestry Disability Index questionnaire score after the treatment of the 3D printing navigation module group was lower than that of the control group(P<0.05).Conclusion: The design of 3D navigation module can be used to simulate the operation of lumbar pedicle surgery,and to make accurate preoperative planning,which is helpful to improve the accuracy of screw placement.

参考文献：

[1] MASON A,PAULSEN R,BABUSKA J M,et al.The accuracy of pedicle screw placement using intraoperative image guidance systems[J].J Neurosurg Spine.2014,20(2):196-203.
[2] TIAN N F,HUANG Q S,ZHOU P,et al.Pedicle screw insertion accuracy with different assisted methods:a systematic review and meta-analysis of comparative studies[J].Eur Spine J.2011,20(6):846-859.
[3] 余正希,陈宣煌,张国栋,等.3D打印模块辅助腰椎弓根微创置钉:自身对照、开放性、2年随访临床试验方案[J].中国组织工程研究,2016,20(53):7973-7978.
[4] MERC M,DRSTVENSEK I,VOGRIN M,et al.Error rate of multi-level rapid prototyping trajectories for pedicle screw placement in lumbar and sacral spine[J].Chin J Traumatol.2014,17(5):261-266.
[5] 陈宣煌,许卫红,黄文华,等.基于3D打印的腰椎椎弓根螺钉数字化置入及临床应用[J].中国组织工程研究,2015,19(17):2752-2757.
[6] HU Y,YUAN Z S,SPIKER W R,et al.Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template:a cadaveric study[J].Eur Spine J.2013,22(12):2770-2776.
[7] MERC M,DRSTVENSEK I,VOGRIN M,et al.A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine[J].Arch Orthop Trauma Surg.2013,133(7):893-899.
[8] 张少杰,王星,史君,等.数字化导航模板辅助儿童胸椎椎弓根螺钉置钉的准确性[J].中国组织工程研究,2014,18(35):5660-5665.
[9] 高方友,王曲,刘窗溪,等.个体化3D打印模型辅助后路螺钉内固定治疗颅颈交界区畸形[J].中华神经外科杂志,2013,29(9):896-901.
[10] TOQUART A,GRAILLON T,MANSOURI N,et al.Management of spinal metastasis by minimal invasive surgery technique:surgical principles,indications:a literature review[J].Neurochirurgie.2016,62(10):157-164.
[11] YANG S H,ZHANG X,YU Y F,et al.Clinical application of 3d printing rapid prototyping assisted posterior reduction and pedicle screw-rod fixafion in the treatment of thoracolumbar vertebral fracture with ankylosing spondylitis[J].Zhongguo Shuzi Yixue.2016,11(2):77-80.
[12] MERC M,DRSTVENSEK I,VOGRIN M.A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine[J].Arch Orthop Trauma Surg.2013,133(44):893-899.
[13] RUCKER C,KIRCH H,PULLIG O,et al.Strategies and first advances in the development of prevascularized bone implants[J].Curr Mol Biol Rep.2016,2(10):149-157.
[14] TARAFDER S,BALLA V K,DAVIES N M.3D printed tricaleium phosphate scaffolds for bone tissue engineering[J].Zuzhi Gongcheng He Zaisheng Yixue.2013,7(6):631-641.
[15] FAN G,GUAN X,ZHANG H,et al.Significant improvement of puncture accuracy and fluoroscopy reduction in percutaneous transforaminal endoscopic discectomy with novel lumbar location system:preliminary report of prospective hello study[J].Medicine.2015,94(36):e2189.
[16] 杨长征,裴晓东,柴红生,等.基于3D打印的腰椎椎弓根螺钉治疗腰椎退变性疾病的临床应用[J].临床医学研究与实践,2016,1(24):1-3.
[17] 林海滨,张国栋,陈宣煌,等.3D打印导航模块辅助腰椎弓根螺钉数字化置入的实验精度[J].解剖学杂志,2016,39(4):459-464.
[18] 严斌,张国栋,吴章林,等.3D打印导航模块辅助腰椎椎弓根螺钉精确植入的实验研究[J].中国临床解剖学杂志,2014,32(3):252-255.
[19] 邹伟民,冯学烽,庞祖才,等.3D打印技术在胸腰椎骨折椎弓根螺钉置入术中的应用[J].广东医学,2016,37(14):2130-2132.
[20] HE B,YAN L,GUO H,et al.The difference in superior adjacent segment pathology after lumbar posterolateral fusion by using 2 different pedicle screw insertion techniques in 9-year minimum followup[J].spine(Phila Pa 1976),2014,39(14):1093-1098.
[21] AMIR A,SEAN V,MUNDIS G M,et al.Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4-5 spondylolisthesis:clinical outcomes[J].J Neurosurg Spine,2013,19(3):314-320.
[22] MASON A,PAULSEN R,BABUSKA J M,et al.The accuracy of pedicle screw placement using intraoperative image guidance systems[J].J Neurosurg Spine,2014,20(2):196-203.
[23] 许世兵,单乐天,金红婷,等.3D打印技术在骨科的应用进展[J].中华创伤杂志,2015,31(1):10-14.
[24] 于海龙,刘军,陈语,等.腰椎骨折伤椎置钉中椎弓根螺钉可视化技术的应用[J].中国组织工程研究,2014,18(4):547-552.
[25] 宁金沛,吴卫东,覃求,等.3D打印个体化导航模板在胸椎和颈椎椎弓根螺钉植入的临床应用[J].实用骨科杂志,2015,21(5):385-389.
[26] 李鑫,张强,赵昌松,等.椎弓根置钉导板导航治疗严重脊柱侧凸手术八例临床观察[J].中华医学杂志,2014,94(11):840-843.
[27] 李健伟,佘黎平,周世梅,等.3D打印技术在踝关节骨折手术中的应用[J].中国骨科临床与基础研究杂志,2014,6(6):333-338.
[28] 高方友,王曲,刘窗溪,等.个体化3D打印模型辅助后路螺钉内固定治疗颅颈交界区畸形[J].中华神经外科杂志,2013,29(9):896-901.
[29] 盛晓磊,袁峰,李智多,等.3D打印组合式导板辅助下颈椎前路椎弓根螺钉置入与徒手置钉的准确性对比[J].中国组织工程研究,2017,21(3):406-411.
[30] 陈旭,余正希,陈宣煌,等.3D打印数字化导航模块辅助股骨颈中空拉力螺钉的精准置入[J].中国组织工程研究,2016,20(53):7979-7984.

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