| 个体化3D打印导向模板辅助胸腰椎椎弓根螺钉置入在强直性脊柱炎中的应用研究 |
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投稿时间：2020-02-10
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| 作者 | Author | 单位 | Address | E-Mail |
| 李超 |
LI Chao |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
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| 牛国旗 |
NIU Guo-qi |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
ssngq@163.com |
| 蒋维利 |
JIANG Wei-li |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
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| 陈辉 |
CHEN Hui |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
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| 刘路坦 |
LIU Lu-tan |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
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| 周乾坤 |
ZHOU Qian-kun |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
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| 程嘉伟 |
CHENG Jia-wei |
蚌埠医学院第二附属医院骨科, 安徽 蚌埠 233000 |
Department of Orthopaedics, the Second Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第7期，第649-654页 |
| DOI：10.12200/j.issn.1003-0034.2020.07.011 |
| 基金项目:安徽省科技攻关项目（编号：1804h08020247）；蚌埠医学院研究生科研创新计划项目（编号：Byycx1970） |
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中文摘要:
目的： 评价个体化设计定制3D打印椎弓根螺钉导向模板辅助强直性脊柱炎（ankylosing spondylitis，AS）患者胸腰椎椎弓根螺钉置入的准确性与安全性。
方法： 纳入2016年1月至2019年9月收治的8例AS患者的胸腰椎三维CT检查数据，利用Mimics 17.0、ideaMaker等计算机软件设计AS胸腰椎椎弓根螺钉导向模板，并利用3D打印机打印制作全部病例的实体模型（T10-L2），每例2份，分为导板辅助螺钉置入组（实验组）和徒手置钉组（对照组）。两组胸腰椎椎弓根螺钉均由同一名脊柱外科医师负责置入。根据术后CT影像结果评估两组椎弓根螺钉置入的准确性，并对螺钉置入情况进行分级：0级和1级螺钉为可接受置钉，2级和3级为不可接受置钉。同时比较术前3D打印软件虚拟设计的椎弓根螺钉的直径、长度、进钉点与后正中线的距离等指标与术中实际使用情况。
结果： 导板辅助螺钉置入组设计并打印出AS胸腰椎3D打印椎弓根螺钉导向模板23块，辅助置入螺钉46枚，可接受螺钉为44枚；置入单枚螺钉平均时间为（4.20±1.15）min，X线机透视次数为（5.00±1.25）次，置钉过程中螺钉和克氏针平均调整次数为（1.76±1.32）次。徒手置钉组使用传统影像学透视徒手方法置钉46枚，可接受螺钉30枚；置入单枚螺钉平均时间为（14.67±2.23）min，X线机透视次数为（14.46±2.21）次，螺钉和克氏针平均调整次数为（4.76±3.39）次。导板辅助螺钉置入组与徒手置钉组螺钉置入成功率分别为95.65%（44/46）和56.22%（30/46），差异有统计学意义（χ2=13.538，P<0.05）；术前3D打印软件虚拟设计的椎弓根螺钉的直径、长度、进钉点与后正中线的距离，与术中实际使用情况差异无统计学意义（P>0.05）；导板辅助螺钉置入组置入单枚螺钉的时间、X线机透视次数及置钉过程中螺钉和克氏针平均调整次数均明显少于徒手置钉组（P<0.01）。
结论： 3D打印技术定制个体化椎弓根螺钉导向模板显著提高了置钉的安全性、准确性及手术效率，尤其适用于AS合并骨折脱位等须行后路椎弓根螺钉固定的胸腰椎椎体。 |
| 【关键词】打印,三维 脊柱炎,强直性 个体化医学 |
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| Experimental study of individualized 3D printing-guided template combined with thoracolumbar pedicle screw placement for the treatment of ankylosing spondylitis |
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ABSTRACT
Objective: To evaluate accuracy and safety of individualized 3D printing-guided template for thoracolumbar pedicle screw placement in patients with ankylosing spondylitis.
Methods: From January 2016 to September 2019,thoracolumbar spine three-dimensional CT data of 8 patients with ankylosing spondylitis were included,Mimics 17.0 and ideaMaker computer software were applied to design thoracolumbar pedicle screw guided template of patients with AS,physical model of all patients(T10-L2)were printed by 3D printer,2 parts in each patient,and divided into guide-plate-assisted screw group (experimental group) and free-hand nail group(control group). Thoracolumbar pedicle screws of both groups were placed by the same spinal surgeon. The accuracy of pedicle screw placement between two groups were evaluated according to results of postoperative CT,the accuracy of the fixation of thoracolumbar pedicle screw was divided into 4 grades,grade 0 and 1 screws were acceptable nails,grade 2 and 3 screws were unacceptable nails. The diameter and length of pedicle screws,the distance between entry point and posterior median line designed by preoperative 3D printing were compared with actual use in operation.
Results: Twenty-three blocks of thoracolumbar 3D printing screw of ankylosing spondylitis guided templates were designed and printed in guide-plate-assisted screw group,46 screws were inserted and 44 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was (4.20±1.15) min,the frequency of X-ray was (5.00±1.25) times and the average adjustment times of screw and Kirschner needle during screw placement was(1.76±1.32) times. In the control group,46 nails were placed by traditional surgical method and 30 screws were accepted. The time of implanting a screw into thoracolumbar pedicle was(14.67±2.23) min,the frequency of X-ray fluoroscopy was(14.46±2.21) times and the average times of Kirschner needle adjustment was (4.76±3.39) times. The success rates between experimental group and control group were 95.65%(44/46) and 56.22%(30/46) respectively,and had statistical difference (χ2=13.538,P<0.05). There was no significant difference in diameter,length of pedicle screws and the distance of posterior median line between virtual designed by 3D printing before operation and actual situation in opertaion(P>0.05). The operation time of inserting a single screw,the times of X-ray fluoroscopy,and the average times of adjustment screw and Kirschner needle in experimental group were significant less than those in control group(P<0.01).
Conclusion: The personalized guide template assisted the thoracolumbar fixation designed by 3D printing could significantly improve safety,accuracy and efficiency of surgery,especially suitable for thoracolumbar vertebral bodies requiring posterior pedicle screw fixation for fracture or dislocation with AS. |
| KEY WORDS Printing,three-dimensional Spondylitis,ankylosing Individualized medicine |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李超,牛国旗,蒋维利,陈辉,刘路坦,周乾坤,程嘉伟.个体化3D打印导向模板辅助胸腰椎椎弓根螺钉置入在强直性脊柱炎中的应用研究[J].中国骨伤,2020,33(7):649~654 |
| 英文格式: | LI Chao,NIU Guo-qi,JIANG Wei-li,CHEN Hui,LIU Lu-tan,ZHOU Qian-kun,CHENG Jia-wei.Experimental study of individualized 3D printing-guided template combined with thoracolumbar pedicle screw placement for the treatment of ankylosing spondylitis[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(7):649~654 |
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