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| 3D打印导板辅助上颈椎椎弓根置钉与徒手置钉的比较 |
| Comparion of upper cervical pedicle screw placement assisted by 3D printing guide plate and freehand screw placement |
| 投稿时间：2022-11-07 |
| DOI：10.3969/j.issn.1000-0399.2023.05.004 |
| 中文关键词: 高危颈椎 椎弓根螺钉 徒手置钉 3D 打印 导向模板 |
| 英文关键词: High-risk cervical vertebra Pedicle screw Freehand screw placement 3D printing Guiding template |
| 基金项目:安徽省科技攻关项目（编号：1804h08020247），蚌埠医学院自然科学基金（编号：2021byzd199），蚌埠医学院科研创新团队项目（编号：BYKC201911） |
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| 中文摘要: |
| 目的 比较个体化 3D 打印导板辅助上颈椎椎弓根置钉与徒手置钉的精准性。方法 选择 2019 年 6 月至 2022 年 6 月在蚌埠医学院第二附属医院就诊的上颈椎疾患患者 20 例,获取每位患者颈椎三维 CT 数据,根据置钉方式不同分为导板组和对照组,分别制作 20 例等比例 3D 打印上颈椎模型,导板组使用 3D 打印导板辅助上颈椎模型椎弓根螺钉置入,对照组在透视辅助下徒手置钉。根据椎体是否存在骨折,将导板组内 20 例模型分为钉道损伤组 10 例(寰椎骨折与枢椎骨折病例)和钉道完整组 10 例(畸形与关节脱位病例)。比较导板组和对照组螺钉可接受率、单枚螺钉置入时间差异;比较导板组术前理想钉道与术后实际钉道内倾角差异,对比钉道损伤组和钉道完整组置钉结果差异。结果 导板组螺钉可接受率为 93.55%,高于对照组的 79.03%(P<0.05);导板组单枚螺钉置入时间短于对照组(P<0.05);导板组术前理想螺钉内倾角与术后实际螺钉内倾角之间差异无统计学意义(P>0.05);钉道损伤组螺钉突破椎弓根率 26.7% 高于钉道完整组 3.1%(P<0.05)。结论 个体化 3D 打印导板辅助上颈椎椎弓根置钉在置钉精准度、安全性和置钉效率方面优于徒手置钉技术。 |
| 英文摘要: |
| Objective To compare the accuracy of pedicle screw placement assisted by individualized 3D printing guide plate with that by hand. Methods A total of 20 patients with upper cervical spine diseases who were treated in the Second Affiliated Hospital of Bengbu Medical College from June 2019 to June 2022 were selected. Cervical spine 3D CT data of each patient were obtained. Cervical spine models of equal scale were made for 20 patients in the guide group and the control group, respectively. The control group was treated with fluoroscopy. According to the presence or absence of vertebral fractures, the 20 models in the guide plate group were divided into the nail path injury group (10 cases of atlas fracture and axial fracture) and the nail path integrity group (10 cases of deformity and dislocation). The time and accuracy of single screw placement were compared between the two groups. The difference in the internal inclination of the ideal nail path before surgery and the actual nail path after surgery in the guide group was compared, and the difference in the results of nail placement in fracture cases and non-fracture cases in the guide group was compared. Results The acceptable rate of screw in guide group was 93.55% higher than that in control group (79.03%) (P< 0.05). The single screw placement time of the guide plate group was lower than that of the control group (P< 0.05). There was no significant difference between the ideal screw inclination angle before surgery and the actual screw inclination angle after surgery in the guide group (P > 0.05). The rate of screw breakthrough through pedicle in the screw route injury group was 26.7%,which was higher than that in the screw route intact group (3.1%) (P< 0.05). Conclusions Individualized 3D printing guide plate assisted pedicle screw placement is superior to freehand technique in terms of screw placement accuracy, safety and screw placement efficiency. |
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