改良3D打印导板辅助颈椎椎弓根螺钉置钉的准确性研究
Study on the accuracy of cervical pedicle screw placement assisted with improved 3D-printed drill guiding template
张宝锋 1马军 1倪双洋 1张群虎 1陈聪 1江永亮1
作者信息
- 1. 徐州医科大学宿迁临床学院脊柱外科 223800 宿迁市
- 折叠
摘要
目的:探讨改良 3D打印导板辅助颈椎椎弓根螺钉置钉的准确性.方法:回顾性分析 2016 年 1 月～2023年 1 月在我院行颈椎后路椎弓根螺钉内固定手术的 60 例患者的临床资料,其中男 30 例,女 30 例,年龄 58.7±13.8 岁(17～84 岁);根据颈椎后路手术是否使用导板辅助置钉分为导板组及徒手置钉组.导板组(30 例)采用改良 3D打印导板辅助颈椎椎弓根置钉,徒手置钉组(30 例)采用角度尺辅助颈椎弓根置钉,两组患者年龄、性别、术前诊断无统计学差异(P＞0.05).所有患者术后 1 周行颈椎CT扫描,按照Kaneyama标准判断椎弓根置钉准确性:0 级,螺钉完全处于椎弓根中,没有穿破骨皮质;1 级,螺钉穿破皮质＜螺钉直径的 50%;2 级,螺钉穿破皮质≥螺钉直径的 50%但没完全穿出;3 级,完全穿出骨皮质.记录椎弓根置钉准确率(0 级+1 级螺钉占比)及因螺钉误置导致的血管神经损伤、切口感染、脑脊液漏、螺钉松动断裂等并发症.结果:导板组共置入椎弓根螺钉 152 枚,其中 0 级 74 枚,1 级 68 枚,2 级 10 枚,3 级 0 枚,置钉准确率 93.4%;徒手置钉组共置入椎弓根螺钉136 枚,其中 0 级 53 枚,1 级 61 枚,2 级 18 枚,3 级 4 枚,置钉准确率 83.8%,导板组置钉准确率高于徒手置钉组(P＜0.05).所有患者均未出现因椎弓根螺钉误置导致的血管神经损伤、切口感染及脑脊液漏等相关并发症.所有患者随访 5～29 个月(14.2±7.7 个月),无内固定松动、断裂等并发症.结论:改良 3D打印导板辅助颈椎椎弓根置钉可提高置钉精准度.
Abstract
Objectives:To explore the accuracy of pedicle screw placement assisted with improved 3D-print-ed drill guiding template in cervical spine.Methods:The clinical data of 60 patients undergone posterior cervical pedicle screw placement in our hospital between January 2016 and January 2023 were analyzed retro-spectively,including 30 males and 30 females with an average age of 17-84 years(58.7±13.8 years).The pa-tients were divided into guiding template group and free-hand group based on whether the guiding template was used to assist the placement of screws or not.The improved 3D-printed guiding template was used to assist cervical pedicle screw placement in the guiding template group(n=30),and the self-made angular-ruler was used in the free-hand group(n=30).There was no significant difference in age,gender ratio,and preoper-ative diagnosis between the two groups(P＞0.05).Cervical CT scan was performed at one week after surgery,and the accuracy of pedicle screw placement was evaluated according to the Kaneyama standard:Grade 0,the screw was completely in the pedicle;Grade 1,the size of screw penetrating the cortex＜50%of the screw diameter;Grade 2,the size of screw penetrating the cortex≥50%of the screw diameter but not com pletely out;Grade 3,the screw was completely on the outside of the pedicle.The accuracy of pedicle screw placement(ratio of grades 0 and 1)and complications such as vascular and nerve injury,incision infection,cerebrospinal fluid leakage,screw loosening and breakage caused by screw misplacement were recorded.Re-sults:A total of 152 pedicle screws were placed in the guiding template group,including 74 screws of grade 0,68 of grade 1,10 of grade 2 and 0 of grade 3,with an accuracy of screw placement of 93.4%.A total of 136 pedicle screws were placed in free-hand group,including 53 screws of grade 0,61 of grade 1,18 of grade 2 and 4 of grade 3,with an accuracy of screw placement of 83.8%.The accuracy of screw placement in the guiding template group was significantly higher than that in the free-hand group(P＜0.05).There were no related complications such as vascular and nerve injury,incision infection and cerebrospinal fluid leakage caused by misplacement of pedicle screws.The patients were followed up for 5-29 months(14.2±7.7months),and there were no complications such as screw loosening or breakage.Conclusions:Improved 3D-printed drill guiding template can improve the accuracy of pedicle screw placement in cervical spine.
关键词
3D打印/改良导板/颈椎椎弓根置钉Key words
3D printing/Improved drill guiding template/Cervical pedicle screw placement引用本文复制引用
基金项目
宿迁市重点研发计划-社会发展项目(S202115)
徐州医科大学附属医院发展基金资助项目-重点项目(XYFZ202201)
出版年
2024
NETL
NSTL
万方数据