中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (12): 1864-1869.doi: 10.3969/j.issn.2095-4344.1125

• 数字化骨科 digital orthopedics • 上一篇    下一篇

3D打印及导航技术辅助腰椎皮质骨轨迹螺钉置入的准确性及疗效分析

王希骥1，张永远2，杨瑞泽2，郝定均2，孙宏慧1   

  1. 1西安空军军医大学唐都医院骨科，陕西省西安市 710038；2西安交通大学附属红会医院脊柱外科，陕西省西安市 710054
  • 出版日期:2019-04-28 发布日期:2019-04-28
  • 通讯作者: 孙宏慧 ，博士，主任医师，西安空军军医大学唐都医院骨科，陕西省西安市 710038
  • 作者简介:王希骥，男，1990年生，陕西省西安市人，汉族，西安空军军医大学唐都医院在读硕士，医师，主要从事脊柱外科方面的研究。
  • 基金资助:

    陕西省重点研发计划项目(2017ZDXM-SF-054)，项目负责人：郝定均

Accuracy and clinical efficacy of three-dimensional printing and navigation technology assisted lumbar cortical bone trajectory screw placement

Wang Xiji1, Zhang Yongyuan2, Yang Ruize2, Hao Dingjun2, Sun Honghui1   

  1. 1Department of Orthopedics, Tangdu Hospital, the Military Medical University of Air Forces, Xi’an 710038, Shaanxi Province, China; 2Department of Spinal Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Online:2019-04-28 Published:2019-04-28
  • Contact: Sun Honghui, MD, Chief physician, Department of Orthopedics, Tangdu Hospital, the Military Medical University of Air Forces, Xi’an 710038, Shaanxi Province, China
  • About author:Wang Xiji, Master candidate, Physician, Department of Orthopedics, Tangdu Hospital, the Military Medical University of Air Forces, Xi’an 710038, Shaanxi Province, China
  • Supported by:

    the Major Research and Development Program of Shaanxi Province, No. 2017ZDXM-SF-054 (to HDJ)

PDF

102

摘要：

文章快速阅读：

 

文题释义：
3D打印及术中CT导航技术：2项技术已凭借其精准化、便捷化、个体化等优势在脊柱外科领域得到越来越广泛的应用。尤其是在上颈椎、脊柱侧弯、脊柱肿瘤等复杂手术中优势明显，帮助医师了解最佳进钉位置、选择合适的进钉通道，掌握螺钉的长度、直径等基本信息，为手术的顺利进行提供保障。
腰椎皮质骨轨迹螺钉：对比传统椎弓根螺钉具有更多优势，提供更大的把持力；手术创伤更小；术中出血少，减少围术期疼痛。尤其适合骨质疏松及肥胖患者，但该技术也有一些缺陷：皮质骨轨迹螺钉置钉点邻近峡部外侧，置钉时可能致峡部外侧骨折，导致椎弓根劈裂等，而且置钉点在神经根上方，可能损伤神经根，徒手置钉的风险大，学习曲线长，不易掌握。
 
摘要
背景：腰椎皮质骨螺钉轨迹螺钉技术适用于骨质疏松患者及肥胖患者，但凭借经验徒手置钉失败率高，风险大，学习曲线长，不易掌握。
目的：对比3D打印及术中导航技术辅助腰椎皮质骨轨迹螺钉置钉与徒手置钉的准确性，探讨3D打印技术及术中导航技术在腰椎手术中应用的优势。
方法：纳入西安空军军医大学唐都医院2017年1月至2018年1月采用腰椎皮质骨轨迹螺钉内固定治疗伴有骨质疏松的腰椎退行性变患者32例，随机分为3组。3D打印组10例术中利用术前打印的置钉导板置入腰椎皮质骨轨迹螺钉；术中导航组12例术中在导航辅助下置入腰椎皮质骨轨迹螺钉；徒手置钉组10例术前完善常规检查，术中采用徒手置钉。所有患者术后均行CT平扫，根据螺钉穿破皮质的程度将置钉精确性分为4级，评估置钉的准确性并对3组患者围术期情况进行统计学分析。
结果与结论：①3D打印组共置入皮质骨轨迹螺钉44枚(L3 2枚，L4 18枚，L5 24枚)，其中0级38枚，1级6枚，无2级或3级不良置钉；术中导航组共置入皮质骨轨迹螺钉52枚(L3 6枚，L4 20枚，L5 26枚)，其中0级47枚，1级5枚，无2级或3级不良置钉；徒手置钉组共置入皮质骨轨迹螺钉40枚(L3 4枚，L4 16枚，L5 20枚)，其中0级27枚，1级8枚，2级3枚，3级2枚；②3组间置钉精确性分级差异有显著性意义(P=0.010)；3D打印组和导航组组间差异无显著性意义(P=0.540)，2组均优于徒手置钉组(P=0.034；P=0.005)；③3组患者相比，术中导航组平均住院日少于3D打印组和徒手置钉组(P=0.001；P=0.009)，3D打印组术中出血量少于徒手置钉组(P=0.005)，术中导航组的手术时间长于其他2组(P=0.004；P=0.026)；④徒手置钉组1例患者出现脑脊液漏，其余患者均未出现置钉相关的血管、神经并发症；3组所有患者术后随访均未出现螺钉松动移位及断裂情况；⑤提示利用3D打印及术中导航技术辅助皮质骨轨迹螺钉治疗伴骨质疏松腰椎退行性变，螺钉置入准确性高，可有效降低不良置钉率，防止置钉相关并发症；且3D打印技术在减少术中出血量方面、导航技术在缩短平均住院日方面有一定的优势。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0001-6514-8442(孙宏慧)

关键词: 腰椎退行性变, 骨质疏松, 皮质骨轨迹螺钉, 3D打印导板, 导航技术, 皮质骨轨迹

Abstract:

BACKGROUND: Lumbar cortical bone trajectory screw is available for the osteoporotic and obese patients, but un-armed placement exhibits high failure rate and risk, long learning duration and difficulty in grasping.   

OBJECTIVE: To compare the accuracy of three-dimensional printing and intraoperative navigation technology assisted lumbar cortical bone trajectory screw placement and unarmed placement, and to explore the advantages of three-dimensional printing technology and intraoperative navigation technology in lumbar surgery.   
METHODS: Thirty-two patients with lumbar degenerative diseases and osteoporosis who treated with lumbar cortical bone trajectory screw fixation at Tangdu Hospital, The Military Medical University of Air Forces from January 2017 to January 2018 were enrolled and randomized into three groups. The patients in the three-dimensional printing group (n=10) were placed the lumbar cortical bone trajectory screws by intraoperative pre-printed nail guide. The patients in the navigation group (n=12) were placed the lumbar cortical bone trajectory screws under the aid of navigation. The patients in the unarmed group (n=10) completed the routine examination before surgery and the nails were placed by experience. All patients undertook postoperative CT scans. The accuracy of the nails was divided into four grades according to the degree of screw penetration to assess the accuracy of placement. The perioperative status of the patients in each group was statistically analyzed.   
RESULTS AND CONCLUSION: (1) The three-dimensional printing group had 44 cortical bone trajectory screws being inserted (2 L3 screws, 18 L4 screws and 24 L5 screws), 38 of them were classified as grade 0, 6 were grade 1, and no grade 2 or grade 3 was identified. A total of 52 cortical bone trajectory screws were placed in the navigation group (6 L3 screws, 20 L4 screws and 26 L5 screws), 47 of them were classified as grade 0, 5 as grade 1, and no grade 2 or grade 3 was identified. The unarmed group had 40 cortical bone trajectory screws being inserted (4 L3 screws, 16 L4 screws and 20 L5 screws), 27 of them were classified as grade 0, 8 as grade 1, 3 as grade 2, and 2 as grade 3. (2) There were significant differences in the accuracy of nail placement among groups (P=0.010). There was no significant difference between three-dimensional printing and navigation groups (P=0.540), and both groups were better than the unarmed group (P=0.034; P=0.005). (3) The average hospitalization time in the navigation group was less than that in the three-dimensional printing and unarmed groups (P=0.001; P=0.009). The three-dimensional printing group had less intraoperative blood loss than that in the unarmed group (P=0.005), while the operation time was longer than that in the other two groups (P=0.004; P=0.026). (4) One patient in the unarmed group occurred with cerebrospinal fluid leakage, and the other patients had no vascular or neurological complications associated with nail placement. All patients in the three groups did not have displacement loosening or fracture after operation. (5) Our findings suggest that using three-dimensional printing technology and intraoperative navigation can help lumbar cortical bone trajectory screw placement in the treatment of lumbar degenerative disease with osteoporosis. The accuracy of screw placement is high, which can effectively reduce the rate of poor nail placement and prevent postoperative complications. Three-dimensional printing technology can reduce the amount of intraoperative blood loss, and the navigation technology has the advantage in shortening average hospitalization time.

Key words: Lumbar Vertebrae, Osteoporosis, Bone Nails, Therapy, Computer-Assisted, Tissue Engineering

中图分类号: