数字骨科与导航模板在寰枢椎椎弓根钉个性化置钉的临床应用

目的探讨数字骨科与导航模板在寰枢椎椎弓根钉个性化置钉的临床效果及安全性。方法回顾分析自2015年1月至2018年7月在我院行寰枢椎椎弓根钉内固定12例患者,男7例,女5例;年龄38~67岁,平均49.7岁,本组所有患者均有枕颈部疼痛,颈部活动受限,或伴有四肢感觉运动功能障碍。术前VAS评分3~7分,平均4.3分,术前JOA评分5~14分,平均8.4分。所有患者均行颈椎薄层CT(层厚1 mm)检查,颈椎MR检查,颈椎开口位,颈椎正侧位及颈椎动力位检查。获得的CT数据以DICOM格式导入三维重建软件Mimics软件,进行三维图像重建,获得寰枢椎原始模型,生成STL格式文件,在Med CAD模块中制作导航模板,3D打印机打印模型及导航模板。术中按照导航模板置入椎弓根钉,记录术前、术后3天、1个月、术后3个月、术后6个月、末次随访时的颈部疼痛视觉模拟量表(VAS)评分,JOA评分。记录手术时间、出血量、术后引流量。术后行上颈椎CT扫描,按照Kawaguchi等提出的方法对置钉准确度进行分析。结果 12例患者顺利完成手术,手术时间约120~180 min,平均(148±35)min,术中失血约100~300 mL,平均(208±45)mL,术后拔管时引流总量120~260 mL,平均(160±60)ml。术中未见椎动脉损伤、脊髓及神经损伤、脑脊液漏等并发症。所有患者均获得随访,平均(24.5±9.8)个月。VAS评分同术前对比,术后3天无统计学意义(P0.05),术后1个月、术后3个月、术后6个月、末次随访均有统计学意义(P0.05),疼痛明显减轻;JOA评分同术前比较,术后3天无统计学意义(P0.05),术后1个月、术后3个月、术后6个月、末次随访均有统计学意义(P0.05),功能改善。重复测量方差分析结果显示,12例患者在VAS评分及JOA评分在不同时间点之间差异具有统计学意义(P0.001)。结论术前数字骨科导航模板辅助寰枢椎椎弓根螺钉置钉是一种置钉准确性高,安全、有效、可靠的方法。

Clinical efficacy of digital orthopaedic technique and navigation template assisted atlantoaxial personalized pedicle screw placement

［Abstract］ Objective To investigate the clinical efficacy and safety of digital orthopaedics and navigation template assisted atlantoaxial personalized pedicle screw. Methods From Jan 2015 to Jul 2018， 12 cases of atlantoaxial dislocation and instability， including 7 males and 5 females， aged 38 to 67 years， with an average of 49.7 years， were analyzed retrospectively. All patients had occipital and neck pain， limited neck movement or sensory and motor dysfunction of extremities. The preoperative VAS score was 3 to 7， with an average of 4.3， and the preoperative JOA score was 5 to14， with an average of 8.4. All patients were examined by thin slice CT （slice thickness 1 mm）. The obtained CT data are imported into the 3D reconstruction software Mimics software in DICOM format， and the original model of atlantoaxial vertebrae is obtained， the STL format file is generated， and the navigation template， 3D printer printing model and navigation template were made in Med CAD module. The pedicle screw was inserted according to the navigation template during the operation. The （VAS） score and JOA score were recorded preoperatively， at 3rd days postoperative， 1st month postoperative， 3rd month postoperative and the final follow-up. The operation time， bleeding volume and postoperative drainage were recorded. CT scan of upper cervical vertebrae was performed after operation， and the accuracy of pedical screw placement was analyzed according to the method proposed by Kawaguchi. Results Twelve patients successfully completed the operation， the operation time was about 120 min~180 min， the average intraoperative blood loss was （148±35） min， the average blood loss was about 100 to 300 ml， and the average drainage volume ranged from 120 to 260 ml， with an average of （160±60） ml. There were no complications such as vertebral artery injury， spinal cord and nerve injury， cerebrospinal fluid leakage and so on. All patients were followed up with an average of （24.5±9.8） months. There was no significant difference in VAS score at 3rd days postoperative （P>0.05）. There was significant difference in VAS score at 1st month postoperative， 3rd month postoperative and the final follow-up （P<0.05）. There was no significant difference in JOA score at 3rd days postoperative （P>0.05）， There was significant difference in JOA score at 1st month postoperative， 3rd month postoperative and the final follow-up （P<0.05）. The results of repeated measurements of ANOVA showed that 12 patients had statistically significant differences between VAS and JOA scores at different time points （P<0.001）. Conclusion Preoperative digital orthopaedic navigation template assisted atlantoaxial pedicle screw placement is a safe， effective and reliable method for clinical application of atlantoaxial pedicle screw placement.