3D打印模板导航经皮椎弓根螺钉置钉在经椎间孔腰椎椎间融合术治疗腰椎椎管狭窄症中的初步应用

目的探讨3D打印模板导航经皮椎弓根螺钉置钉在经椎间孔腰椎椎间融合术(TLIF)治疗腰椎椎管狭窄症中应用的可行性、准确性和安全性。方法回顾性分析2016年1月—2017年3月本院采用TILF治疗的单节段腰椎椎管狭窄症患者的临床资料,选取10例应用3D打印模板导航置钉的患者作为试验组,选取一般情况相似的10例作为对照组。试验组下肢无临床表现侧在3D打印模板导航下置入螺钉(模板侧),下肢有临床表现侧切开后经Wiltse入路顺导针置入螺钉(穿刺侧);对照组采用传统徒手法置入椎弓根螺钉。记录患者手术时间、出血量、透视时间及次数、螺钉置入的准确性及脊髓、神经损伤并发症发生情况。结果试验组手术时间、出血量少于对照组,差异有统计学意义(P0.05)。试验组模板侧透视时间及次数少于穿刺侧及对照组,差异有统计学意义(P0.05);而穿刺侧与对照组相比差异无统计学意义(P0.05)。试验组无2级螺钉,对照组2级螺钉有4枚。0级螺钉比例,试验组两侧均优于对照组,差异有统计学意义(P0.05);试验组两侧差异无统计学意义(P0.05)。所有患者均无脊髓、神经损伤等并发症发生。结论 3D打印模板导航经皮椎弓根螺钉置钉应用于TLIF治疗腰椎椎管狭窄症是可行的。虽然应用过程中需要注意避免皮肤移动、体位变化对置钉准确性的影响,但仍是一种新的、可选择的微创置钉技术。

Preliminary application of percutaneous pedicle screws placement assisted by navigation with 3D printing template in transforaminal lumbar interbody fusion for lumbar spinal stenosis

Objective To investigate the feasibility, accuracy and safety of percutaneous pedicle screws placement assisted by navigation with 3D printing template in transforaminal lumbar interbody fusion(TLIF) for lumbar spinal stenosis. Methods From January 2016 to March 2017, the clinical data of single segment lumbar spinal stenosis patients treated with TILF were retrospectively analyzed. Screws placement of 10 patients assisted by 3D printing template navigation were selected as the experimental group, and 10 cases with similar general conditions were selected as the control group. In the experimental group, screws placement on the side with no clinical manifestation assisted by navigation with 3D printing template(template side), and on the other side through Wiltse approach(puncture side). In the control group, pedicle screws were placed by traditional bare-handed method. The operation time, blood loss, fluoroscopy time and frequency, accuracy of pedicle screw implantation and complications of spinal cord and nerve injuries were recorded. Results The operation time and blood loss in the experimental group were less than those in the control group, and the differences were statistically significant(P<0.05). The fluoroscopy time and frequency in template side were less than those in puncture side and the control group, and the differences were statistically significant(P<0.05); while there was no significant difference between the puncture side and the control group(P>0.05). There were no grade 2 screws in the experimental group. There were 4 grade 2 screws in the control group. The percentage of grade 0 pedicle screw, 2 sides of the experimental group were higher than that of the control group, and the differences were statistically significant(P<0.05); while there was no significant difference between the 2 sides of the experimental group (P>0.05). There was no such complications as spinal cord and nerve injuries in 2 groups. Conclusion Percutaneous pedicle screw placement assisted by navigation with 3D printing template in TLIF for lumbar spinal stenosis is feasible. Although it is necessary to avoid the influence of skin movements and postural changes on accuracy of implant nails, it can be regarded as a new and optional technique for minimally invasive nailing.