改良3D打印导板辅助颈椎椎弓根螺钉置钉的准确性研究

Study on the accuracy of cervical pedicle screw placement assisted with improved 3D-printed drill guiding template

中文关键词:  3D打印  改良导板  颈椎椎弓根置钉

英文关键词:3D printing  Improved drill guiding template  Cervical pedicle screw placement

中文摘要:

  【摘要】 目的：探讨改良3D打印导板辅助颈椎椎弓根螺钉置钉的准确性。方法：回顾性分析2016年1月~2023年1月在我院行颈椎后路椎弓根螺钉内固定手术的60例患者的临床资料，其中男30例，女30例，年龄58.7±13.8岁（17~84岁）；根据颈椎后路手术是否使用导板辅助置钉分为导板组及徒手置钉组。导板组（30例）采用改良3D打印导板辅助颈椎椎弓根置钉，徒手置钉组（30例）采用角度尺辅助颈椎弓根置钉，两组患者年龄、性别、术前诊断无统计学差异（P＞0.05）。所有患者术后1周行颈椎CT扫描，按照Kaneyama标准判断椎弓根置钉准确性：0级，螺钉完全处于椎弓根中，没有穿破骨皮质；1级，螺钉穿破皮质<螺钉直径的50％；2级，螺钉穿破皮质≥螺钉直径的50％但没完全穿出；3级，完全穿出骨皮质。记录椎弓根置钉准确率（0级+1级螺钉占比）及因螺钉误置导致的血管神经损伤、切口感染、脑脊液漏、螺钉松动断裂等并发症。结果：导板组共置入椎弓根螺钉152枚，其中0级74枚，1级68枚，2级10枚，3级0枚，置钉准确率93.4%；徒手置钉组共置入椎弓根螺钉136枚，其中0级53枚，1级61枚，2级18枚，3级4枚，置钉准确率83.8%，导板组置钉准确率高于徒手置钉组（P＜0.05）。所有患者均未出现因椎弓根螺钉误置导致的血管神经损伤、切口感染及脑脊液漏等相关并发症。所有患者随访5～29个月（14.2±7.7个月），无内固定松动、断裂等并发症。结论：改良3D打印导板辅助颈椎椎弓根置钉可提高置钉精准度。

英文摘要:

  【Abstract】 Objectives: To explore the accuracy of pedicle screw placement assisted with improved 3D-printed drill guiding template in cervical spine. Methods: The clinical data of 60 patients undergone posterior cervical pedicle screw placement in our hospital between January 2016 and January 2023 were analyzed retrospectively, including 30 males and 30 females with an average age of 17-84 years(58.7±13.8 years). The patients were divided into guiding template group and free-hand group based on whether the guiding template was used to assist the placement of screws or not. The improved 3D-printed guiding template was used to assist cervical pedicle screw placement in the guiding template group(n=30), and the self-made angular-ruler was used in the free-hand group(n=30). There was no significant difference in age, gender ratio, and preoperative diagnosis between the two groups(P>0.05). Cervical CT scan was performed at one week after surgery, and the accuracy of pedicle screw placement was evaluated according to the Kaneyama standard: Grade 0, the screw was completely in the pedicle; Grade 1, the size of screw penetrating the cortex ＜50% of the screw diameter; Grade 2, the size of screw penetrating the cortex ≥50% of the screw diameter but not completely out; Grade 3, the screw was completely on the outside of the pedicle. The accuracy of pedicle screw placement(ratio of grades 0 and 1) and complications such as vascular and nerve injury, incision infection, cerebrospinal fluid leakage, screw loosening and breakage caused by screw misplacement were recorded. Results: A total of 152 pedicle screws were placed in the guiding template group, including 74 screws of grade 0, 68 of grade 1, 10 of grade 2 and 0 of grade 3, with an accuracy of screw placement of 93.4%. A total of 136 pedicle screws were placed in free-hand group, including 53 screws of grade 0, 61 of grade 1, 18 of grade 2 and 4 of grade 3, with an accuracy of screw placement of 83.8%. The accuracy of screw placement in the guiding template group was significantly higher than that in the free-hand group(P<0.05). There were no related complications such as vascular and nerve injury, incision infection and cerebrospinal fluid leakage caused by misplacement of pedicle screws. The patients were followed up for 5-29 months(14.2±7.7months), and there were no complications such as screw loosening or breakage. Conclusions: Improved 3D-printed drill guiding template can improve the accuracy of pedicle screw placement in cervical spine.