摘要
[目的]介绍3D打印导板辅助后路寰枢椎螺钉固定治疗齿状突骨折的手术技术与初步临床效果。[方法]2017年1月—2019年12月收治的31例Ⅱ型齿状突骨折患者均行后路寰枢椎置钉内固定治疗。术前行薄层CT扫描,将数据导入Mimics软件中重建三维模型,使用STL格式导入Geomagic Studio软件中,对三维参考平面进行定位,设计相应椎弓根钉的导板,3D打印机打印出导板实物。术前先行颅骨牵引7~10 d,定期摄床旁DR直至骨折复位。行后正中切口显露C_(1)和C_(2),放置3D打印导板,分别于寰椎椎弓根、枢椎椎弓根各置入合适椎弓根螺钉,安装连接棒固定。[结果]31例患者均顺利完成手术,无严重并发症。共置入椎弓根螺钉124枚,手术时间(102.90±4.21)min,术中出血量(123.23±11.91)ml。术后CT显示124枚椎弓根钉均为Neo评级0级。[结论]3D打印导板技术可显著提升齿状突骨折后路寰枢椎螺钉固定置钉精准度。
[Objective]To introduce the surgical technique and preliminary clinical results of 3D printed guider assisted posterior atlantoaxial screw fixation for the treatment of odontoid fractures.[Methods]A total of 31 patients underwent posterior atlantoaxial screw fixation for typeⅡodontoid fractures from January 2017 to December 2019.After preoperative thin-slice CT scanning,the data was imported into Mimics software to reconstruct the 3D model,and then transferred into Geomagic Studio software by using the STL format to locate the3D reference plane,design the guiders for the screw,finally print the actual guider by 3D printer.Skull traction was applied continuously for 7-10 days before surgery,and bedside radiographs were taken regularly until the fracture was reduced.In the real surgical procedure,a midline incision was made to reveal C_(1)and C_(2).As the 3D printed guider were placed properly,suitable screws were inserted bilaterally into the atlas and axial pedicles respectively,and then connecting rods was installed to fix them.[Results]All the 31 patients were successfully operated on without serious complications.A total of 124 screws were inserted with operation time of(102.90±4.21)min,and the intraoperative blood loss of(123.23±11.91)ml.The postoperative CT showed that all 124 pedicle screws were placed correctly as Neo grade 0.[Conclusion]This 3D printed guider does significantly improve the accuracy of posterior atlantoaxial screw placement for odontoid fractures.
作者
李佳佳
姜泽威
吴瑞
刘彬
姚树强
张廷伟
杨凯
杨永军
周纪平
谭明生
LI Jia-jia;JIANG Ze-wei;WU Rui;LIU Bin;YAO Shu-qiang;ZHANG Ting-wei;YANG Kai;YANG Yong-jun;ZHOU Ji-ping;TAN Ming-sheng(Shandong Wendeng 0rthopaeidc Hospital,Wendeng 264400,China;China-Japan Friendship Hospital,Beijing 10000,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2022年第14期1311-1313,1317,共4页
Orthopedic Journal of China
关键词
齿状突骨折
3D导板
颈后路手术
椎弓螺钉
odontoid fracture
3D printed guider
posterior cervical surgery
pedicle screw
