CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值评估

目的:探讨CT三维重建配合3D打印技术在辅助寰枢椎椎弓根螺钉置入的应用价值。方法:通过CT三维重建的多种后处理技术明确寰枢椎病变13例作为观察组，再将CT三维重建、逆向工程原理及快速成形技术相结合，设计出一种新型的导航模板，辅助椎弓根螺钉置入，并与13例之前已通过X线透视置钉法的病例（对照组）进行置钉效果比较。结果:对照组13例共置椎弓根螺钉41枚，其中Ⅰ类置钉9枚，Ⅱ类置钉18枚，Ⅲ类置钉14枚，成功率65.9%；观察组共打印颈椎模型13例，设计导向模板21个，5例由于先前通过X线透视仅在枢椎两侧的椎弓根内置钉，只制作出枢椎的导航模板；模拟手术同样置钉41枚，其中Ⅰ类置钉15枚，Ⅱ类置钉21枚，Ⅲ类置钉5枚，成功率87.8%。结论:CT三维重建的各种后处理技术不仅能够准确的判断寰枢椎病变，并能配合3D打印技术，制作出个体化的导航模板，使上颈椎椎弓根螺钉的置入变得既安全又省时，并能在术后准确评估置钉效果。

The application value of CT three-dimensional reconstruction combined with 3 D printing technology in atlantoaxial pedicle screw placement operation

Objective:To investigate the application value of CT three-dimensional reconstruction combined with 3D printing technology in atlantoaxial pedicle screw placement operation.Methods:Thirteen atlantoaxial? lesions patients diagnosed by post-processing methods of CT three-dimensional reconstruction were set as the observation group.A kind of new navigation template guiding the atlantoaxial pedicle screw placement operation was designed through CT three-dimensional reconstruction,principle of reverse engineering and rapid prototyping technology.Thirteen patients treated with pedicle screw fixation by X-ray fluoroscopy were set as the control group.The treatment effect between two groups was compared.Results:Forty-one pedicle screws in control group were implanted,which included 9 cases of level-I,18 cases of level-Ⅱ and 14 cases of level-Ⅲ pedicle screws,and the success rate of which was 65.9%.Twenty-one guiding templates were designed in observation group,and 5 cases were treated with X-ray fluoroscopy for the internal fixation of pedicle screws.Forty-one pedicle screws in simulated operation were implanted,which included 11 cases of level-Ⅰ,21 cases of level-Ⅱ and 5 cases of level-Ⅲ pedicle screws,and the success rate of which was 87.8%.Conclusions:The post-processing methods of CT three-dimensional reconstruction can accurately diagnose the atlantoaxial vertebral lesions,which combining with 3D printing technology in cervical pedicle screw placement operation is safe and short time,and can accurately evaluate the effect of pedicle screw insertion after surgery.