标杆型3D打印导板在寰枢椎脱位治疗中的应用疗效及准确性研究

背景:寰枢椎解剖结构复杂,寰枢椎后方毗邻生命中枢延髓,徒手进行寰枢椎椎弓根置钉有较大难度,一旦出现置钉偏差即有可能造成椎动脉、脊髓、静脉丛及神经根的损伤。目的:探讨标杆型3D打印导板在寰枢椎脱位治疗中的应用疗效及准确性。方法:回顾性分析2017年1月至2019年3月收治的44例寰枢椎脱位患者的临床资料,根据治疗方式不同分为徒手置钉的对照组20例,标杆型3D打印导板辅助置钉的研究组24例。观察两组的手术时间、出血量、透视次数;术后复查CT判断置钉准确率;术前和术后6个月随访时采用日本骨科协会(JOA)颈椎神经功能评分评估患者的颈部神经功能,采用视觉模拟评分法(visual analogue scale,VAS)评估患者的枕颈部疼痛情况。结果:两组术中出血量及手术时间比较,差异无统计学意义(P>0.05),但研究组术中透视次数相比对照组少(P<0.05);研究组术后6个月的颈部神经功能及VAS评分明显优于对照组(P<0.05);研究组置钉准确率更高(P<0.05)。结论:借助标杆型3D打印导板可有效减少寰枢椎脱位治疗中的透视次数,提高椎弓根螺钉的置钉准确率,促进术后颈部神经功能恢复,降低枕颈部疼痛程度,值得临床推广。

The efficacy and accuracy of the standard 3D printed guide plate in the treatment of atlantoaxial dislocation

Background:The anatomical structure of atlantoaxial vertebra is complex.Atlantoaxial vertebra is adjacent to vi?tal center medulla oblongata,so it is difficult for surgeons to set vertebral screw with bare hands.Once the vertebra pedicle set inappropriately,the injury of vertebral artery,spinal cord,venous plexus and nerve root would occur.Objective:To explore the efficacy and accuracy of the standard 3D printed guide plate in the treatment of atlantoaxial dislocation.Methods:A retro?spective analysis was performed on 44 patients with atlantoaxial dislocation who were admitted to our hospital from January 2017 to March 2019.According to their treatment methods,they were divided into 2 groups as control groups with 20 patients traditionally hand-studded and study group with 24 patients set by standard 3D printed guide plate.The clinical indexes such as operation time,blood loss and number of fluoroscopy were observed;the accuracy of pedicle screw setting was checked by CT after the operation;the cervical nerve function was evaluated by JOA before the operation and 6 months after the operation;visual analogue scale was taken for evaluation of pain of occipitocervical region.Results:There was no significant difference in intraoperative blood loss and operation time between the two groups(P>0.05),but the number of fluoroscopy in the study group was lower than that in the control group(P<0.05).The cervical nerve function and VAS score were better in the study group than in the control group 6 months after operation(P<0.05).The accuracy of pedicle screw placement in the study group was higher than that in the control group(P<0.05).Conclusions:With the help of the standard 3D printed guide plate,the number of fluoroscopy in the treatment of atlantoaxial fractures can be effectively reduced,the accuracy of pedicle screw place?ment can be improved,the recovery of cervical nerve function can be promoted,and the degree of pain in the occipitocervical region can be reduced.The standard 3D printed guide plate is worth being promoted in clinic.