| 姜良海,谭明生,董亮,杨峰,移平,唐向盛,韦竑宇,王威.标杆型3D打印导板辅助寰枢椎椎弓根置钉准确度分析[J].脊柱外科杂志,2016,14(4):205-210. |
标杆型3D打印导板辅助寰枢椎椎弓根置钉准确度分析  点此下载全文 (Fulltext) |
| 姜良海1 2 谭明生1 2 董亮3 杨峰1 移平1 唐向盛1 韦竑宇1 王威1 |
1. 中日友好医院脊柱外科, 北京 100029;
2. 北京协和医学院研究生院, 北京 100730;
3. 西安红十字会医院脊柱外科, 陕西 710054 |
| 基金项目：北京市科委首都临床特色课题（Z141107002514058） |
| DOI：10.3969/j.issn.1672-2957.2016.04.005 |
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| 全文下载次数: 151 |
| 摘要： |
| 目的 探讨标杆型3D打印导板辅助寰枢椎椎弓根置钉的可行性，并进行置钉准确度分析。方法 2014年6月-2015年8月，本院收治寰枢椎脱位患者21例，男12例，女9例；年龄12～54岁，平均42.6岁。术前使用Mimics 17.0软件和3-matic 9.0软件为每例患者制作标杆型3D打印导板，术中使用标杆型3D打印导板辅助寰枢椎椎弓根置钉，术后患者行颈椎CT平扫。在Mimics 17.0软件中，将手术前后的寰枢椎模型及螺钉配对拟合，调整空间坐标轴，测量并比较术前预设钉道与术后实际钉道的内倾角、头倾角、进钉点坐标。结果 21例患者手术顺利，手术时间（193±51） min，术中出血量（384±127） mL。共置入寰椎椎弓根螺钉30枚，枢椎椎弓根螺钉42枚。除2枚寰椎椎弓根螺钉侵入椎管≤2 mm外，其他螺钉均位于椎弓根骨皮质内。寰椎左右侧预设最佳钉道内倾角度分别为9.4°±1.8°、9.8°±1.6°，实际钉道内倾角度分别为8.7°±1.6°、10.6°±2.2°；左右侧预设最佳钉道头倾角度分别为8.9°±2.5°、8.8°±2.3°，实际钉道头倾角度分别为9.3°±2.9°、9.4°±3.5°。枢椎左右侧预设最佳钉道内倾角度分别为21.9°±6.6°、22.4°±6.9°，左右侧实际钉道内倾角度分别为24.1°±6.3°、20.8°±6.4°；左右侧预设最佳钉道头倾角度分别为23.7°±7.3°、24.2°±7.2°，左右侧实际钉道头倾角度分别为22.1°±7.9°、22.3°±7.6°。寰枢椎术后实际钉道与术前预设最佳钉道的内倾角、头倾角、进钉点坐标差异均无统计学意义（P>0.05）。结论 标杆型3D打印导板辅助寰枢椎椎弓根置钉方向可调整性好，置钉准确度较高，为临床寰枢椎置钉提供了一种新的方法。 |
| 关键词：寰椎 枢椎 脱位 骨螺丝 计算机模拟 计算机辅助设计 成像,三维 |
| Accuracy assessment of a 3D printed navigational guiding template for atlantoaxial pedicle screw placement Fulltext |
| JIANG Liang-hai1 2 TAN Ming-sheng1 2 DONG Liang3 YANG Feng1 YI Ping1 TANG Xiang-sheng1 WEI Hong-yu1 WANG Wei1 |
1. Department of Spine Surgery, China-Japan Friendship Hospital, Beijing 100029, China;
2. Graduate School, Union Medical College, Beijing 100730, China;
3. Department of Spine Surgery, Xian Red Cross Hospital, Xi'an 710054, Shaanxi, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the feasibility of establishing a 3D printed navigational template for atlantoaxial pedicle screw placement,and assess the accuracy of pedicle screw placement. Methods From June 2014 to August 2015, clinical data of 21 cases with atlantoaxial dislocation were analyzed. There were 12 males and 9 females with a mean age of 42.6(range,12-54) years old. Preoperatively,3D printed navigational template with 2 guide rods was designed for every patient using the Mimics 17.0 and 3-Matic 9.0 software. The 3D printed navigational template with 2 guide rods was used for atlantoaxial pedicle screw placement during operation. Postoperatively,all the patients took CT scan of cervical vertebrae. In the Mimics 17.0 software,pre- and post-operative trajactories and entry points of pedicle screws were measured after matching the positions of preoperative and postoperative 3D atlantoaxial models in a redefining coordinate. Results All the 21 patients underwent the surgeries successfully,with operation time of (193±51) min and blood loss of (384±127) mL. In total,30 pedicle screws were placed for the atlas,and 42 for axis. There were 2 screws for atlas protruded into the spinal canal within 2 mm. Transverse angle of ideal screw trajectories for atlantal pedicle screws measured 9.4°±1.8° on the left and 9.8°±1.6° on the right,and actual screw trajectories measured 8.7°±1.6° and 10.6°±2.2°,respectively. Sagittal angle of ideal screw trajectories for atlantal pedicle screws measured 8.9°±2.5° on the left and 8.8°±2.3° on the right,and actual screw trajectories measured 9.3°±2.9° and 9.4°±3.5°,respectively. Transverse angle of ideal screw trajectories for axial pedicle screws measured 21.9°±6.6° on the left and 22.4°±6.9° on the right,and actual screw trajectories measured 24.1°±6.3° and 20.8°±6.4°,respectively. Sagittal angle of ideal screw trajectories for axial pedicle screws measured 23.7°±7.3° on the left and 24.2°±7.2° on the right,and actual screw trajectories measured 22.1°±7.9° and 22.3°±7.6°,respectively. There were no statistically significant differences in the deviation of either screw orientation or entry point location between ideal and actual screw trajectories(P>0.05). Conclusion Using this 3D printed navigational template for atlantoaxial pedicle screw placement,surgeons could change screw direction based on the template,and provide a high accuracy of screw placement. |
| Keywords:Atlas Axis Dislocations Bone screws Computer simulation Computer-aided design Imaging,three-dimensional |
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