3D打印导航模板在下颈椎骨折并脱位手术中的应用
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摘要
目的探讨3D打印导航模板应用于下颈椎骨折并脱位手术中椎弓根螺钉置入的准确性和安全性。方法将24例下颈椎骨折并脱位患者的C_(3～7)节段CT连续扫描的影像数据导入三维重建软件Mimics 10. 01中建立三维模型,以STL格式导出。在UG Imageware 12. 0平台打开三维重建模型。在逆向工程中将模板与椎弓根钉道拟合。术后根据颈椎X线片和CT扫描评估椎弓根螺钉位置。结果用3D打印导航模板为24例患者共置入螺钉122枚,术中导航模板与暴露的后部结构能够紧密贴合,稳定性好。所有椎弓根螺钉置入顺利,术中和术后未出现血管和神经并发症。结论 3D打印导航模板辅助下手术治疗下颈椎骨折并脱位,椎弓根螺钉置钉准确性高,操作简单,手术安全。
Objective To investigate the accuracy and safety of the low cervical fracture and dislocation of pedicle screw placement in the help of the 3D printing navigation template. Methods 3D reconstruction image model of 24 C_(3 ～ 7) patients suffered from traumatic fracture and dislocation were established and exported out with the STL format by software Mimics 10. 01. Opened the 3D reconstruction model in the platform of UG Imageware 12. 0 to fit the templates and peicle screw trajectory in reverse engineering software geomagic. After surgery,according to the cervical X-ray and CT film,the pedicle screws position were assessed. Results There were 122 pedicle screws placed in 24 patients with the help of 3D printing navigation template. Navigation template and exposed back structure could fit closely with good stability and all pedicle screws were inserted smoothly in all cases. Neither blood complication nor nerves complication were found in all cases through or after surgery. Conclusions With the help of 3D printing navigation template,the accuracy of pedicle screws placement in the operations of low cervical fracture and dislocation can be improved,which make the operations simpler and safer.
Objective To investigate the accuracy and safety of the low cervical fracture and dislocation of pedicle screw placement in the help of the 3D printing navigation template. Methods 3D reconstruction image model of 24 C_(3 ～ 7) patients suffered from traumatic fracture and dislocation were established and exported out with the STL format by software Mimics 10. 01. Opened the 3D reconstruction model in the platform of UG Imageware 12. 0 to fit the templates and peicle screw trajectory in reverse engineering software geomagic. After surgery,according to the cervical X-ray and CT film,the pedicle screws position were assessed. Results There were 122 pedicle screws placed in 24 patients with the help of 3D printing navigation template. Navigation template and exposed back structure could fit closely with good stability and all pedicle screws were inserted smoothly in all cases. Neither blood complication nor nerves complication were found in all cases through or after surgery. Conclusions With the help of 3D printing navigation template,the accuracy of pedicle screws placement in the operations of low cervical fracture and dislocation can be improved,which make the operations simpler and safer.
引文
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[14] Ryken T C,Owen B D,Christensen G E,et al. Image-based drill templates for cervical pedicle screw placement[J]. J Neurosurg Spine,2009,10(1):21-26.
[15] Lu S,Xu Y Q,Chen G P,et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement[J]. Comput Aided Surg,2011,16(5):240-248.
[16] Lu S,Xu Y Q,Lu W W,et al. A novel patient-specific navigational template for cervical pedicle screw placement[J]. Spine,2009,34(26):E959-966.
[17] Lu S,Xu Y Q,Zhang Y Z,et al. A novel computer-assisted drill guide template for placement of C2laminar screws[J]. Eur Spine J,2009,18(9):1379-1385.
[18] Kawaguchi Y,Nakano M,Yasuda T,et al. Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide[J]. Spine,2012,37(23):1983-1988.
[19] Kaneyama S,Sugawara T,Sumi M,et al. A novel screw guiding method with a screw guide template system for posterior C2fixation:clinical article[J]. J Neurosurg Spine,2014,21(2):231-238.
[2] Kouyoumdjian P,Guerin P,Schaelderle C,et al. Fracture of the lower cervical spine in patients with ankylosing spondylitis:Retrospective study of 19 cases[J]. Orthop Traumatol Surg Res,2012,98(5):543-551.
[3] Hoyek N,Collet C,Di Rienzo F,et al. Effectiveness of three-dimensional digital animation in teaching human anatomy in an authentic classroom context[J]. Anat Sci Educ,2014,7(6):430-437.
[4] Sugawara T,Higashiyama N,Kaneyama S,et al. Accurate and simple screw insertion procedure with patient-specific screw guide templates for posterior C1-C2fixation[J]. Spine,2017,42(6):E340-E346.
[5] Nachef N,Bariatinsky V,Sulimovic S,et al. Predictors of radial nerve palsy recovery in humeral shaft fractures:A retrospective review of 17 patients[J]. Orthop Traumatol Surg Res,2017,103(2):177-182.
[6] Oteir A O,Smith K,Stoelwinder J U,et al. Should suspected cervical spinal cord injury be immobilised:a systematic review[J]. Injury,2015,46(4):528-535.
[7] Odate S,Shikata J,Soeda T,et al. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament[J]. J Neurosurg Spine,2017,26(4):466-473.
[8] Klingler J H,Sircar R,Scheiwe C,et al. Comparative study of Carms for intraoperative 3-Dimensional imaging and navigation in minimally invasive spine surgery partⅠ:applicability and image quality[J]. Clin Spine Surg,2017,30(6):276-284.
[9] Guo F,Dai J,Zhang J,et al. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine[J].PLo S One,2017,12(2):e0171509.
[10] Shimokawa N,Takami T. Surgical safety of cervical pedicle screw placement with computer navigation system[J]. Neurosurg Rev,2017,40(2):251-258.
[11] Chen C,Ruan D,Wu C,et al. CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae[J].PLo S One,2013,8(12):e81159.
[12] Ma T,Xu Y Q,Cheng Y B,et al. A novel computer-assisted drill guide template for thoracic pedicle screw placement:a cadaveric study[J]. Arch Orthop Trauma Surg,2012,132(1):65-72.
[13] Ryken T C,Kim J,Owen B D,et al. Engineering patient-specific drill templates and bioabsorbable posterior cervical plates:a feasibility study[J]. J Neurosurg Spine,2009,10(2):129-132.
[14] Ryken T C,Owen B D,Christensen G E,et al. Image-based drill templates for cervical pedicle screw placement[J]. J Neurosurg Spine,2009,10(1):21-26.
[15] Lu S,Xu Y Q,Chen G P,et al. Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement[J]. Comput Aided Surg,2011,16(5):240-248.
[16] Lu S,Xu Y Q,Lu W W,et al. A novel patient-specific navigational template for cervical pedicle screw placement[J]. Spine,2009,34(26):E959-966.
[17] Lu S,Xu Y Q,Zhang Y Z,et al. A novel computer-assisted drill guide template for placement of C2laminar screws[J]. Eur Spine J,2009,18(9):1379-1385.
[18] Kawaguchi Y,Nakano M,Yasuda T,et al. Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide[J]. Spine,2012,37(23):1983-1988.
[19] Kaneyama S,Sugawara T,Sumi M,et al. A novel screw guiding method with a screw guide template system for posterior C2fixation:clinical article[J]. J Neurosurg Spine,2014,21(2):231-238.