摘要
目的初步探讨3D打印导航模板辅助枢椎椎弓根拉力螺钉置钉治疗不典型Hangman(AHF)骨折的疗效。方法回顾性研究2015年5月至2017年1月四川省自贡市第四人民医院骨科采用3D打印导航模板辅助下枢椎椎弓根拉力螺钉内固定手术治疗的12例AHF患者资料,男8例,女4例;年龄27~53岁,平均45.6岁;按Levine-Edwards分型:Ⅰ型7例;Ⅱ型4例、ⅡA型1例;按美国脊髓损伤协会(ASIA)分级:D级2例,E级12例。比较患者手术前、后颈部疼痛视觉模拟评分(VAS)和患者颈部活动度。通过比较术后螺钉进钉点和螺钉在椎弓根内相对于术前的偏移量、螺钉内倾角、螺钉头倾角、最大骨折位移评估术后螺钉的安全性。结果本研究共设计并打印导板12个,共置入拉力螺钉24枚,所有患者均顺利完成手术。随访时间12~20个月,平均14.7个月。术后2例ASIA分级D级的患者末次随访恢复至E级。所有患者颈部疼痛明显好转,术前VAS评分为(8.3±1.9)分,术后5d为(5.9±2.0)分,末次随访时为(1.7±0.9)分,术后5dVAS评分与术前比较,末次随访时VAS评分与术后5d比较,差异均有统计学意义(P<0.05)。术后6个月颈椎活动度较术后3个月改善,差异有统计学意义(P<0.05);末次随访时颈椎活动度基本恢复正常,与6个月比较差异均无统计学意义(P>0.05)。术后X线片及CT提示脱位均纠正,骨折移位末次随访未见椎体明显不稳,无螺钉断裂松动等。术后CT示24枚螺钉完全位于椎弓根皮质内(0级),置钉准确率为100%;螺钉进钉点偏移量(0.70±0.78)mm、螺钉椎弓根内偏移量(1.30±0.82)mm、螺钉术后内倾角度8.26°±0.88°、术后头倾角度22.62°±0.86°与术前设计比较差异均无统计学意义(P>0.05);术后骨折断端最大移位[(2.21±0.39)mm]小于术前[(3.94±0.38)mm],差异有统计学意义(P<0.05)。结论通过3D打印技术辅助拉力螺钉置入治疗AHF,置钉安全,可获得较好的复位固定效果,并且能与术前设计的钉道较精确的匹配,为此类骨折的手术治疗提供了一种新的方法。
Objectives To evaluate the 3D printed navigation template used to assist axis pedicle lag-screw placement in the treatment of atypical Hangman’s fracture (AHF). Methods From May 2015 to January 2017, 12 patients with AHF were treated at Department of Orthopedics, The Fourth People’s Hospital of Zigong.In their operation, the axis pedicle lag-screw placement was assisted by a 3D printed navigation template.They were 8 men and 4 women, aged from 27 to 53 years (average, 45.6 years).There were 7 cases of type Ⅰ, 4 cases type Ⅱ and one case of type ⅡA according to the Levine-Edwards classifi-cation.There were 2 cases of grade D and 12 cases of grade E according to the assessment of America Spinal Injury Association (ASIA).Their preoperative and postoperative neck pain was evaluated by visual analogue scale (VAS);their preoperative and postoperative ranges of cervical motion were recorded and compared.To evaluate the postoperative safety of screws, the insertion point, position within the pedicle, axial angle and sagittal angle of the screws and maximum fracture displacement were compared between actual operation and simulative operation. Results A total of 12 guide plates were designed and printed;a total of 24 lag-screws were placed.All patients underwent surgery uneventfully.They were followed up for 12 to 20 months, with an average of 14.7 months.Two patients with ASIA grade D recovered to ASIA grade E at the last follow-up.All patients showed a significant improvement in neck pain.Their VAS score at 5 days after surgery (5.86±2.02) was significantly lower than their preoperative score (8.29±1.88)(P<0.05) and their VAS score at the last follow-up (1.73±0.87) was also significantly lower than that at 5 days after surgery (P<0.05).Their range of cervical motion at 6 months after surgery was significantly larger than that at 3 months after surgery (P<0.05);their range of cervical motion returned to normal roughly at the last follow-up, showing no significant difference from that at 6 months (P>0.05).Their postoperative X-ray and CT images showed that the dislocation was all corrected.The last follow-up showed no obvious vertebral in-stability, screw breakage or loosening.Postoperative CT showed that the 24 screws had been located com-pletely in the pedicle (grade 0), indicating that the screw placement was 100% accurate.The postoperative deviation at insertion point (0.70±0.78 mm), deviation within the pedicle (1.3±0.82 mm), axial angle (8.26°±0.88°) and sagittal angle (22.62°±0.86°) of the screws showed no significant differences from the preoperative simulative data (P>0.05).There was a significant difference in the maximum fracture dis-placement between the preoperative data (3.94±0.38 mm) and the postoperative data (2.21±0.39 mm)(P<0.05). Conclusion The 3D printed navigation template can be used to better assist axis pedicle lag-screw placement in the treatment of AHF, because it ensures safe screw placement, leading to good re-duction and fixation and precise match with the preoperative plan.
作者
吴超门
邓佳燕
谭伦
胡海刚
袁德超
Wu Chao;Deng Jiayan;Tan Lun;Hu Haigang;Yuan Dechao(Department of Orthopaedics, The Fourth People’s Hospital of Zigong, Zigong 643000, Sichuan, China;Digital Medicine Center, The Fourth People’s Hospital of Zigong, Zigong 643000, Sichuan, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第4期338-344,共7页
Chinese Journal of Orthopaedic Trauma
基金
四川省重点科技计划项目(2016JY0108)
四川省卫计委科研课题(17PJ144)
四川省医学会科研课题(2015GK016)。
关键词
枢椎
骨折
骨折固定术
内
骨钉
3D打印技术
Axis
Fracture
Fractures fixation, internal
Bone screw
3D printing tech-nology
