3D打印导板辅助后路寰枢椎螺钉固定治疗齿状突骨折

3D printed guider assisted posterior atlantoaxial screw fixation for odontoid fractures

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 C₁和 C₂，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。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of 3D printed guider assisted posterior at- lantoaxial screw fixation for the treatment of odontoid fractures. [Methods] A total of 31 patients underwent posterior atlantoaxial screw fixa- tion for type Ⅱ odontoid 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 the 3D 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 C₁ and C₂. 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 intraopera- tive 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.