摘要
目的比较3D打印导航模板辅助与徒手颈后路置钉内固定治疗寰枢椎骨折的疗效。方法采用回顾性队列研究分析2018年9月至2020年12月华中科技大学同济医学院附属同济医院收治的22例寰枢椎骨折患者的临床资料,其中男13例,女9例;年龄26~68岁[(50.7±11.9)岁]。患者均行后路寰枢椎椎弓根螺钉内固定融合术。2019年11月至2020年12月入院的11例采用3D打印导航模板辅助置入椎弓根螺钉(导板辅助置钉组),2018年9月至2019年10月入院的11例采用徒手方式置入椎弓根螺钉(徒手置钉组)。两组共置入椎弓根螺钉88枚,其中导板辅助置钉组和徒手置钉组各置入44枚。比较两组手术时间、术中出血量、术中透视次数;在术前,术后3 d、3个月、6个月及末次随访时比较视觉模拟评分(VAS)和日本骨科学会(JOA)评分。根据Kawaguchi分级比较两组椎弓根螺钉置钉准确率。观察并发症发生情况。结果患者均获随访24~30个月[(26.4±1.8)个月]。导板辅助置钉组手术时间和术中透视次数分别为(87.3±19.5)min、(6.4±1.4)次,短于或少于徒手置钉组的(115.5±23.0)min、(10.3±1.7)次(P均<0.01)。两组术中出血量差异无统计学意义(P>0.05)。两组术前,术后3 d、3个月、6个月及末次随访时VAS和JOA评分比较,差异无统计学意义(P均>0.05)。导板辅助置钉组椎弓根螺钉置钉准确率为95.5%(42/44),徒手置钉组为79.5%(35/44)(P<0.05)。两组术中均未出现螺钉偏离所导致的椎动脉损伤、脊髓损伤、脑脊液漏,术后均未出现内固定物松动、断裂、骨折不愈合。结论与徒手颈后路置钉相比,3D打印导航模板辅助颈后路椎弓根螺钉内固定治疗寰枢椎骨折,能够缩短手术时间、减少术中透视次数、提高置钉准确率。
Objective To compare the efficacies of 3D‑printed navigation template assisted and freehand posterior cervical screw fixation of atlantoaxial fractures.Methods A retrospective cohort study was used to analyze the clinical data of 22 patients with atlantoaxial fractures admitted to Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from September 2018 to December 2020.There were 13 males and 9 females,with age range of 26‑68 years[(50.7±11.9)years].All the patients underwent posterior atlantoaxial pedicle screw internal fixation and fusion,among whom 11 patients admitted from November 2019 to December 2020 were assisted with 3D printed navigation templates for the placement of pedicle screws(assisted group)and 11 patients admitted from September 2018 to October 2019 used the traditional way of placing pedicle screws(freehand group).A total of 88 pedicle screws were implanted,with 44 pedicle screws in each group.The operation time,intraoperative blood loss,and intraoperative fluoroscopy frequency were compared between the two groups.The visual analogue score(VAS)and Japanese Orthopedic Society(JOA)score were also compared before operation,at 3 days,3 months,6 months postoperatively and at the last follow‑up.The accuracy of pedicle screw placement was evaluated according to the Kawaguchi classification,and complications were observed.Results All the patients were followed up for 24‑30 months[(26.4±1.8)months].The assisted group showed the operation time of(87.3±19.5)minutes and the intraoperative fluoroscopy frequency of(6.4±1.4)times,decreased compared with the freehand group[(115.5±23.0)minutes,(10.3±1.7)times](all P<0.01).However,no significant difference was observed in the intraoperative blood loss between the two groups(P>0.05).Both groups demonstrated comparable VAS and JOA score before operation,at 3 days,3 months,6 months postoperatively and at the last follow‑up(all P>0.05).Furthermore,the assisted group exhibited a significantly higher accuracy of pedicle screw placement[95.5%(42/44)]compared with the freehand group[79.5%(35/44)](P<0.05).Notably,there were no intraoperative vertebral artery injury,spinal cord injury,or cerebrospinal fluid leakage in either group,or internal fixation loosening,fracture,nonunion in either group after operation.Conclusion Compared with freehand posterior cervical screw placement,3D‑printed navigation template‑assisted posterior cervical pedicle screw fixation of atlantoaxial fracture can shorten the operation time,reduce the intraoperative fluoroscopy frequency,and improve the accuracy of screw placement.
作者
陈光子
方忠
李锋
熊伟
马天
刘朝旭
Chen Guangzi;Fang Zhong;Li Feng;Xiong Wei;Ma Tian;Liu Chaoxu(Department of Orthopedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第9期816-822,共7页
Chinese Journal of Trauma
关键词
脊柱骨折
寰枢关节
椎弓根钉
3D打印
Spinal fractures
Atlanto‑axial joint
Pedicle screws
Three‑dimensional printing
