黄轩;李凤宁;张帆;王琨;陈智;阳青松;党瑞山;苏佳灿;沈洪兴;李明;

• 1:第二军医大学长海医院骨科
• 2:第二军医大学长海医院影像科
• 3:第二军医大学解剖学教研室

摘要(Abstract)：

[目的]探讨一种基于三维打印成型技术制备个体化下颈椎椎弓根螺钉导航模板的可行性,并对该方法辅助置钉的准确性进行评估。[方法]选取10具成人尸体的颈椎标本,行CT扫描后将原始数据导入Mimics软件,对C3~7节段行选择性重建,设计与其椎板和棘突相贴合的阴模,利用三维打印技术成型。基于目标椎体三维模型,直视下徒手将阴模制成具有双侧椎弓根螺钉钉道的导航模板,并在其辅助下于各椎体标本置入双侧椎弓根螺钉。术后再次行CT扫描评估螺钉位置。[结果]剔除骨性结构不完整的标本后,共制作62个下颈椎导航模板,辅助置入椎弓根螺钉124枚。CT扫描轴位图像显示121枚螺钉完全位于椎弓根内,3枚部分穿破椎弓根壁;矢状位图像提示除1枚螺钉误入椎间孔外,余钉位准确。[结论]本研究结果表明,基于CT图像,使用Mimics软件能够精确重建下颈椎各节段椎体及其附属结构,并建立其对应阴模。利用三维打印模型所设计的个体化导航模板,辅助置钉准确性高、操作简单,为下颈椎椎弓根螺钉的精确置入提供了一种可供选择的新方法。

关键词(KeyWords)： 三维打印;椎弓根螺钉;个体化导航模板;熔融沉积快速成型;聚乳酸

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目(编号:81372012,31271031);; 长海医院“1255”学科建设计划项目(编号:CH125540200,CH125520900)

作者(Author): 黄轩;李凤宁;张帆;王琨;陈智;阳青松;党瑞山;苏佳灿;沈洪兴;李明;

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DOI:

参考文献(References)：

• [1]Cho W,Cho SK,Wu C.The biomechanics of pedicle screw-based instrumentation[J].J Bone Joint Surg Br,2010,92:1061-1065.
• [2]Mason A,Paulsen R,Babuska JM,et al.The accuracy of pedicle screw placement using intraoperative image guidance systems[J].J Neurosurg Spine,2013:120.
• [3]Park JH,Jeon SR,Roh SW,et al.The safety and accuracy of freehand pedicle screw placement in the subaxial cervical spine:a series of 45consecutive patients[J].Spine(Phila Pa 1976),2014,4:280-285.
• [4]Luther N,Iorgulescu JB,Geannette C,et al.Comparison of navigated versus non-navigated pedicle screw placement in 260 patients and 1434 screws:screw accuracy,screw size,and the complexity of surgery[J].J Spinal Disord Tech,2013.Epub ahead of print.
• [5]Tian W,Liu Y,Zheng S,et al.Accuracy of lower cervical pedicle screw placement with assistance of distinct navigation systems:a human cadaveric study[J].Eur Spine J,2013,22:148-155.
• [6]Mulconrey DS.Fluoroscopic radiation exposure in spinal surgery:in vivo evaluation for operating room personnel[J].J Spinal Disord Tech,2013.Epub ahead of print.
• [7]Sun J,Zhang FQ.The application of rapid prototyping in prosthodontics[J].J Prosthodont,2012,21:641-644.
• [8]Lonstein JE,Denis F,Perra JH,et al.Complications associated with pedicle screws[J].J Bone Joint Surg Am,1999,81:1519-1528.
• [9]Abumi K,Shono Y,Taneichi H,et al.Correction of cervical kyphosis using pedicle screw fixation systems[J].Spine(Phila Pa 1976),1999,24:2389-2396.
• [10]Yoshihara H,Passias PG,Errico TJ.Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws:a systematic review[J].J Neurosurg Spine,2013,19:614-623.
• [11]Abumi K,Ito M,Sudo H.Reconstruction of the subaxial cervical spine using pedicle screw instrumentation[J].Spine(Phila Pa1976),2012,37:E349-356.
• [12]Lu S,Xu YQ,Lu WW,et al.A novel patient-specific navigational template for cervical pedicle screw placement[J].Spine(Phila Pa1976),2009,34:959-966.
• [13]Lu S,Xu YQ,Chen GP,et al.Efficacy and accuracy of a novel rapid prototyping drill template for cervical pedicle screw placement[J].Comput Aided Surg,2011,16:240-248.
• [14]Hu Y,Yuan ZS,Spiker WR,et al.Deviation analysis of C2 translaminar screw placement assisted by a novel rapid prototyping drill template:a cadaveric study[J].Eur Spine J,2013,22:2770-2776.