| 快速成形3D导板辅助下置入下颈椎前路椎弓根螺钉与徒手置钉的对比研究 |
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投稿时间：2019-12-14
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| 作者 | Author | 单位 | Address | E-Mail |
| 李杰 |
LI Jie |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 赵刘军 |
ZHAO Liu-jun |
宁波市第六医院脊柱外科, 浙江 宁波 315000 |
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| 郑敏哲 |
ZHENG Min-zhe |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 干开丰 |
GAN Kai-feng |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 陈意磊 |
CHEN Yi-lei |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016
浙江省骨骼肌肉退变与再生修复转化研究重点实验室, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 冯宗贤 |
FENG Zong-xian |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 潘凌霄 |
PAN Ling-xiao |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 徐君翔 |
XU Jun-xiang |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 范腾迪 |
FAN Teng-di |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 陈景阳 |
CHEN Jing-yang |
宁波市医疗中心李惠利医院骨科, 浙江 宁波 315000 |
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| 赵凤东 |
and ZHAO Feng-dong |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016
浙江省骨骼肌肉退变与再生修复转化研究重点实验室, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
zhaofengdong@zju.edu.cn |
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| 期刊信息：《中国骨伤》2021年，第34卷，第1期，第45-50页 |
| DOI：10.12200/j.issn.1003-0034.2021.01.009 |
| 基金项目:浙江省医药卫生科技项目（编号：2018KY725） |
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中文摘要:目的：比较快速成形3D导板辅助下和徒手置入下颈椎前路椎弓根螺钉的位置差异，评价两种置钉方法的安全性。
方法：8具甲醛浸泡后的成人下颈椎尸体标本，男4具，女4具；年龄32~65（40.3±5.6）岁，行X线片检查排除骨质破坏和畸形后，随机选取其中4具（3D导板组）行CT扫描后获得DICOM格式数据，导入Mimics软件建模，设计颈椎前路椎弓根螺钉（anterior cervical transpedicular screw，ATPS）理想进钉点和钉道，获得钉道的个性化导板后以STL数据导出，通过快速成形和3D打印技术打印个体化导板，依次在3D导板辅助下在之前选取的4具下颈椎尸体标本上一对一的个性化置入ATPS螺钉，另外4具（徒手组）下颈椎尸体标本采用徒手技术置入ATPS螺钉。术后对所有标本行CT薄层扫描加三维重建，采用Tomasino法分别在CT横断位和矢状位图像上评价螺钉的安全性，以明确是否有椎弓根下缘、内缘皮质穿破。根据CT评级结果Ⅰ级和Ⅱ级是安全，Ⅲ-Ⅴ级为危险，记录并统计分析两组ATPS螺钉的准确性评级情况。
结果：8具尸体分别在C3-C7节段，每节置入2枚螺钉。共计置入螺钉80枚，3D导板组40枚，徒手组40枚。根据Tomasino螺钉评级法进行螺钉的安全性评级，3D导板组Ⅰ级21枚，Ⅱ级14枚，Ⅲ级3枚，Ⅳ级1枚，Ⅴ级2枚；徒手组Ⅰ级14枚，Ⅱ级8枚，Ⅲ级8枚，Ⅳ级6枚，Ⅴ级2枚；螺钉的安全率3D导板组为87.5%，徒手组为55.0%（X2=8.7，P=0.003）。
结论：3D打印快速成形导板辅助下置入下颈椎前路椎弓根螺钉，可明显提高置钉的准确性和安全性，为后期临床应用提供理论依据。 |
| 【关键词】颈椎 前路椎弓根螺钉 快速成形 3D导板 |
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| Comparative study between 3D guide plate assisted and free-hand insertion of anterior cervical transpedicular screw |
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ABSTRACT Objective: To compare accuracy of anterior cervical pedicle screws between assist of rapid prototyping 3D guide plate and free-hand insertion,and evaluate the safety of two methods.
Methods: Eight adult cervical cadaver specimens after formaldehyde immersion,including 4 males and 4 females,aged 32 to 65(40.3±5.6) years old. After X-ray examination to exclude bone damage and deformity,4 of them (3D guide plate group) randomly selected were for CT scan to obtain DICOM format data,and the data was imported into Mimics software for model,designed the ideal entry point and nail path for anterior cervical transpedicular screw(ATPS). After obtaining the personalized guide plate of the nail channel,it was exported as STL data,and the individual guide plate was printed by rapid prototyping and 3D printing technology. In turn,with the assistance of 3D guide plates,one-to-one personalized ATPS screws were placed on the four lower cervical cadaver specimens. Another 4 (free-hand group) lower cervical cadaver specimens were implanted with ATPS screws using free-hand technique. All specimens were performed CT thin-layer scanning and three-dimensional reconstruction after operation. The Tomasino method was used to evaluate the safety of the screws on the CT cross-sectional and sagittal images,to determine whether there was a cortical puncture of the lower and inner edges of the pedicle. According to the CT rating results,gradeⅠandⅡwere safe,and grade Ⅲ-Ⅴ were dangerous.And the accuracy of screws was recorded and analyzed between two groups.
Results: Two screws were in serted in each segment from C3 to C7 in 8 adult cadavers. A total of 80 screws were inserted,40 in the 3D guide plate group,and 40 in the free-hand group. The Tomasino screw rating method was used to evaluate the safety of screw,21 screws were gradeⅠ,14 screws were gradeⅡ,3 screws were grade Ⅲ,1 screw was grade Ⅳ,2 screws were grade Ⅴ in 3D guide plate group,while 14 screws were gradeⅠ,8 screws were gradeⅡ,8 screws were grade Ⅲ,6 screws were grade Ⅳ,2 screws were grade Ⅴ in free-hand group. The safety rate of 3D guide plate group was 87.5%,and 55.0% of the free-hand group(χ2=8.7,P=0.003).
Conclusion: The 3D printing rapid prototyping guide plate assisted insertion of the anterior cervical pedicle screw can significantly improve the accuracy and safety,and provide a theoretical basis for further clinical application. |
| KEY WORDS Cervical spine Anterior cervical transpedicular screw Rapid prototyping 3D guide plate |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李杰,赵刘军,郑敏哲,干开丰,陈意磊,冯宗贤,潘凌霄,徐君翔,范腾迪,陈景阳,赵凤东.快速成形3D导板辅助下置入下颈椎前路椎弓根螺钉与徒手置钉的对比研究[J].中国骨伤,2021,34(1):45~50 |
| 英文格式: | LI Jie,ZHAO Liu-jun,ZHENG Min-zhe,GAN Kai-feng,CHEN Yi-lei,FENG Zong-xian,PAN Ling-xiao,XU Jun-xiang,FAN Teng-di,CHEN Jing-yang,and ZHAO Feng-dong.Comparative study between 3D guide plate assisted and free-hand insertion of anterior cervical transpedicular screw[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(1):45~50 |
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