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

doi:10.3969/j.issn.2095-4344.1125

Abstract

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 L₃screws, 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

CLC Number:

R445

Wang Xiji, Zhang Yongyuan, Yang Ruize, Hao Dingjun, Sun Honghui. Accuracy and clinical efficacy of three-dimensional printing and navigation technology assisted lumbar cortical bone trajectory screw placement[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(12): 1864-1869.

Figures/Tables 7

References

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