计算机辅助设计3D打印在骶神经调控术中的应用

目的 探讨利用计算机断层扫描三维重建与计算机辅助设计的3D打印技术在骶神经调控术中的应用价值和效果。方法 本研究为随机、对照、前瞻性研究。纳入2017年3月至2018年3月入住我院行骶神经调控术治疗的患者15例，随机分为两组：传统穿刺组（n=10），采用传统X线透视下十字定位法；3D打印导航模板穿刺组（n=5），采用3D打印技术制造个性化穿刺导航模板定位法。评估两组患者的临床疗效，术中评估指标为穿刺时间、穿刺进针次数、术中调控测试时间，术后并发症评估指标为伤口出血，伤口感染，伤口裂开，电极断裂、移位或脱出等。结果 两组患者的性别、年龄、骶神经孔大小、骶尾椎畸形、疾病类型差异均无统计学意义（P均>0.05），具有可比性。3D打印导航模板穿刺组术中穿刺时间短于传统穿刺组（9.10±2.73）min vs（26.20±5.67）min]，穿刺进针次数少于传统穿刺组（3.20±0.84 vs 5.30±1.30），术中调控测试时间也短于传统穿刺组（20.80±3.27）min vs（27.60±4.63）min]，差异均有统计学意义（t=6.301、3.255、2.916，P均<0.05）。两组患者术后均无切口或穿刺点感染及出血，切口裂开，电极断裂、移位或脱出，刺激器部位疼痛等并发症发生。结论 与传统方法相比，利用计算机辅助设计的3D打印技术应用于骶神经调控术中的骶神经孔穿刺安全性好，并可减少穿刺进针次数、缩短穿刺时间，提高术中调控测试的效率。

Application of computer-assisted 3D printing techniques in electrode placement during sacral neuromodulation

Objective To explore the application and efficacy of 3D printing technology of computed tomography 3D reconstruction and computer-assisted design in sacral neuromodulation. Methods This is a randomized, controlled, prospective study. From March 2017 to March 2018, 15 candidates for sacral neuromodulation were randomized into traditional puncture group (n=10) and 3D printing group (n=5). X-ray guided electrode placement was used in the traditional puncture group, and 3D printing navigation template puncture was applied in the 3D printing group. The clinical efficacy of the two groups was evaluated. Puncture time, needle insertion times, intraoperative adjustment and testing time, and postoperative complications (such as wound bleeding, wound infection, wound dehiscence, electrode breakage, displacement or prolapse) were assessed. Results There were no significant differences in gender, age, sacral neural foramen size, sacrococcygeal deformity, or disease type between the two groups (all P>0.05). Compared with those in the traditional puncture group, the puncture time, needle insertion times, intraoperative adjustment and testing time were significantly decreased in the 3D printing group (9.10±2.73] min vs26.20±5.67] min, 3.20±0.84 vs 5.30±1.30,20.80±3.27] min vs27.60±4.63] min; t=6.301, 3.255, 2.916; all P<0.05). Complications such as wound infection, wound bleeding, wound dehiscence, electrode breakage, displacement or prolapse, or pain of stimulator, were not found after operation. Conclusion Compared with traditional method, computer-assisted 3D printing technology is safe in sacral neuromodulation. It can reduce the needle insertion times, shorten the puncture time, and improve the efficiency of intraoperative adjustment and testing.