摘要
目的探讨3D打印和术中导航等数字骨科技术在寰枢椎脱位术中的应用，评价其临床可行性和有效性。方法回顾性分析2009年6月至2014年6月期间收治的39例寰枢椎脱位患者资料。其中18例患者采取常规后路寰枢椎复位、寰枢椎椎弓根螺钉内固定、植骨融合手术（常规组），男11例，女7例；平均年龄为（52．7±12．3）岁。21例患者联合3D打印模型和术中即时导航系统进行后路手术（3D组），男12例，女9例；平均年龄为（51．1±11．4）岁。通过比较两组患者的手术时间、出血量、疼痛视觉模拟评分（VAS）、颈椎日本骨科学会评分（JOA）、JOA改善率、颈椎功能障碍指数（NDI）、椎弓根螺钉位置准确性等指标，评价数字骨科技术的可行性和临床疗效。两组患者术前一般资料比较差异无统计学意义（P〉0．05），具有可比性。结果常规组与3D组患者术后分别获平均（43．7±5．4）、（21．3±3．2）个月随访，手术时间平均分别为（100．2±9．4）、（84．8±8．2）min，术中出血量平均分别为（94．2±9．6）、（85．6±8．0）mL，置钉总准确率分别为97．2％（70／72）和100％（84／84），以上项目两组间比较差异均有统计学意义（P〈0．05）。两组患者术后1年VAS评分比较差异有统计学意义（P〈0．05），而JOA评分、JOA改善率、NDI两组间比较差异无统计学意义（P〉0．05）。同一组内术前与术后1年VAS评分、JOA、NDI两组组内比较差异均有统计学意义（P〈0．05）。两组患者寰枢椎均获骨性融合，未见内固定物松动、移位、断裂等并发症。结论采用3D打印和术中导航等数字骨科技术辅助外科治疗寰枢椎脱位，椎弓根螺钉置入准确性高、术中风险明显降低、手术安全性高、临床疗效满意，是一种有效、可行、值得推广的新技术。
Objective To evaluate the clinical feasibility and effectiveness of digital orthopedic technology （3D printing and intraoperative navigation） in the surgery of posterior atlantoaxial dislocation. Methods We reviewed the clinical data of 39 cases of atlantoaxial dislocation which had been treated from June 2009 to June 2014. Eighteen patients were treated by conventional posterior atlantoaxial reduction, atlantoaxial pedicle screw fixation, and fusion surgery （conventional group）, including 11 males and 7 females, aged from 34 to 71 years （mean, 52.7 ± 12.3 years）. Twenty-one patients received posterior surgery aided by 3D printing models and real-time intraoperative navigation system （3D Group）, including 12 males and 9 females, aged from 30 to 71 years （mean, 51.1 ±11.4 years）. The feasibility and clinical efficacy of digital orthopedic technology were evaluated by comparing the 2 groups in terms of operation time, blood loss, visual analogue scale （VAS） score, cervical Japanese Orthopaedic Association （JOA） score, neck disability index （NDI）, and accuracy of pedicle screwing. No significant difference was found in preoperative general data between the 2 groups （ P 〉 0.05） . Results The conventional and 3D groups were followed up for re- spectively 43.7±5.4 months and 21.3 ±3.2 months. There were statistically significant differences between the 2 groups in terms of operation time （100. 2 ± 9.4 minutes versus 84.8 ± 8.2 minutes）, blood loss （94.2 ±9.6 mL versus 85.6 ± 8.0 mL） and accuracy of pedicle screwing [98.6% （71/72） versus 100% （84/84） ] （ P 〈 0.05）. The difference in VAS score between the 2 groups was also statistically significant at one year post-surgery （ P 〈 0.05）, but the differences in JOA score and ND1 between the 2 groups were not statistically significant （ P 〉 0.05 ） . There were significant differences in VAS score, JOA score, and NDI between pre-surgery and one year post-surgery （ P 〈 0.05） in both groups. All the patients in both groups finally obtained bony fusion, with no complications like loosening, displacement and breakage of internal fixation. Conclusions Application of digital orthopedic technology （3D printing and intraoperative navigation） in the surgical treatment of reductive atlantoaxial dislocation can increase accuracy of screwing, reduce surgical risk and improve surgical safety and outcomes. This new technology is effective, feasible and worthy of spreading.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第1期29-34,共6页
Chinese Journal of Orthopaedic Trauma
关键词
寰椎
枢椎
脱位
计算机模拟
3D打印
导航模板
Atlas
Axis
Dislocation
Computer simulation
3D printing
Navigation template
