| 新型枢椎椎板钉导向器的应用研究 |
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投稿时间：2020-11-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 孙玛骥 |
SUN Ma-ji |
南京医科大学, 江苏 南京 211166 |
Nanjing Medical University, Nanjing 211166, Jiangsu, China |
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| 王秋安 |
WANG Qiu-an |
徐州医科大学附属医院骨科, 江苏 徐州 221006 |
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| 张星晨 |
ZHANG Xing-chen |
徐州医科大学附属医院骨科, 江苏 徐州 221006 |
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| 袁峰 |
YUAN Feng |
徐州医科大学附属医院骨科, 江苏 徐州 221006 |
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| 郭开今 |
GUO Kai-jin |
南京医科大学, 江苏 南京 211166 |
Nanjing Medical University, Nanjing 211166, Jiangsu, China |
301810212309@stu.xzhmu.edu.cn |
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| 期刊信息：《中国骨伤》2021年，第34卷，第9期，第834-839页 |
| DOI：10.12200/j.issn.1003-0034.2021.09.009 |
| 基金项目: |
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中文摘要:
目的：通过体外试验探讨新型枢椎椎板钉导向器的安全性及准确性。
方法：选取2018年1月至2018年6月行颈椎三维CT的患者40例，男21例，女19例；身高165~180（172.9±9.5） cm，年龄38~55（51.1±12.8）岁，排除枢椎椎板缺损及发育不全患者。每例患者的颈椎三维CT数据制作两套3D打印标本，共80个颈椎标本，均用于体外置钉试验。根据置钉方式的不同，体外试验部分分为导向器置钉组40个和徒手置钉组40个。同时，在计算机上重建出该40例患者的颈椎三维模型，通过计算机模拟置钉，得到理想出针点数据与理想内倾角度，此为3D模拟置钉组（理想钉道），40例。在体外试验中，分别测量导向器置钉组、徒手置钉组置入螺钉的位置危险等级、出针点位置及内倾角度。并以出针点精确性及钉道内倾角度为基准，将导向器置钉组、徒手置钉组与3D模拟置钉组数据对比，并将各组数据行统计学分析以确定准确性。
结果：导向组螺钉位置可接受的为75例，位置危险的为5例，可接受率为94%，双皮质率为93%。徒手组螺钉位置可接受为62例，位置危险为18例，可接受率为78%，双皮质率33%，两组比较差异有统计学意义（P<0.05）。导向器置钉组与3D模拟置钉组的出针点精确性及钉道内倾角度比较，差异无统计学意义（P>0.05），徒手置钉组与3D模拟置钉组出针点精确性及钉道内倾角度比较，差异有统计学意义（P<0.05）。
结论：本导向器为通用型，结构稳定，导向精确，操作简便，可同时置入双侧椎板钉，缩短置钉时间，同时可有效避免双向交叉螺钉的碰撞，增加双皮质率，有效提高枢椎椎板钉置钉的效率和安全性。 |
| 【关键词】枢椎,颈椎 打印,三维 计算机模拟 |
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| Study on the application of a new type of vertebral plate nail guide |
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ABSTRACT
Objective: To explore safety and accuracy of novel C2 laminar staple guide through in vitro experiments.
Methods: From January 2018 to June 2018,40 patients who underwent three-dimensional CT of cervical spine were selected,including 21 males and 19 females,heighted from 165 to 180 cm with an average of (172.9±9.5) cm,aged from 38 to 55 years old(51.1±12.8) years old,excluding patients with axis lamina defect and hypoplasia. Two sets of 3D printed specimens were made from the three-dimensional CT data of cervical spine of each patient,and both of than were used for the in vitro nailing experiment. According to different nail placement methods,in vitro experimental part of this experiment was divided into guide nail placement group and hand nail placement group,40 pieces in each group. At the same time,the three-dimensional model of cervical spine of 40 patients was reconstructed on computer,and the ideal needle point data and inclination angle were obtained by computer simulation of the nail placement. This is 3D simulation nail placement group,40 pieces. With vitro experiment,the risk level of screw placement,the position of needle exit point and inclination angle were measured in guide nail group and hand nail group. Based on the accuracy of needle point and inclination angle of nail path,the data of guide nail group,the hand nail group and 3D simulation nail group were compared,and the data of each group were statistically analyzed to determine the accuracy.
Results: In guide nail group,75 screws were acceptable and 5 were dangerous. The acceptable rate was 94%,and the double cortical rate was 93%. There were 62 position-acceptable screws in hand nail group,and 18 positions were dangerous,with an acceptable rate of 78% and a double cortical rate of 33%. The difference between two groups was statistically significant (P<0.05). There was no significant difference in accuracy of needle exit point and inclination angle of nail path between guide nail group and 3D simulation nail group(P>0.05),but there was significant difference in the accuracy of needle exit point and inclination angle of nail path between hand nail group and 3D simulation nail group(P<0.05).
Conclusion: The guide is universal,with stable structure,accurate guidance,and easy operation. It could be placed with bilateral lamina screws at the same time,shortening the time of nail placement,avoiding collision of two-way cross screws,increase the rate of double cortex. Ultimately,efficiency and security can be improved. |
| KEY WORDS Asix,cervical vertebra Printing,three-dimensional Computer simulation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孙玛骥,王秋安,张星晨,袁峰,郭开今.新型枢椎椎板钉导向器的应用研究[J].中国骨伤,2021,34(9):834~839 |
| 英文格式: | SUN Ma-ji,WANG Qiu-an,ZHANG Xing-chen,YUAN Feng,GUO Kai-jin.Study on the application of a new type of vertebral plate nail guide[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(9):834~839 |
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