3D打印技术辅助后路临时 C1-2 椎弓根钉固定治疗Ⅱ型齿状突骨折

3D printing navigational template-assisted posterior temporary C1-2 pedicle screw fixation for the treatment of type II odontoid fractures

摘要:

[目的]探讨3D打印技术辅助后路临时 C1-2 椎弓根钉固定治疗Ⅱ型齿状突骨折的可行性及临床疗效，评估临时植入物取出后颈椎旋转活动度的恢复程度。[方法]这是一项回顾性研究。研究共纳入 14名患者（10 名男性和 4 名女性）。他们的年龄从 23 岁到 56 岁不等（平均年龄 41.64 岁）。患者均被诊断为Ⅱ型齿状突骨折，行3D打印技术辅助后路临时 C1-2 椎弓根钉固定手术。患者在大约术后3、6、9 、12个月以及取出内固定装置后7天接受一系列术后临床检查。采用颈部残疾指数（NDI）、视觉模拟评分 (VAS)和颈部旋转活动度评价患者术后临床疗效。在每次随访时测量颈椎旋转活动范围。所有患者均在术后行X 片和颈椎CT检查以评估螺钉位置、骨折愈合情况。[结果]14例患者手术顺利完成，未出现椎动脉损伤、神经损伤或刀口感染。手术时间为 98.18 ± 8.45 分钟，手术出血量为 133.64 ±39.31 毫升，随访时间为 18.91±3.56 个月（范围 16～22 个月）。寰枢椎内固定术前及术后6个月随访VAS 评分分别为 6.91±1.14、2.45±1.04，术后VAS评分较术前明显改善，差异有显著统计学意义（P<0.05）。拆除内固定装置前、拆除内固定装置后7天以及末次随访的颈椎旋转活动度分别为 60.59±5.51°、93.36±6.10°、112.32± 8.97°差异有显著统计学意义（P<0.01）。术前、术后6个月以及拆除内固定前NDI评分分别为48.18±7.35、26.73±5.68、17.09±2.88差异有显著统计学意义（P<0.01）。内固定装置拆除后7天NDI为7.45±2.30，优于内固定装置拆除前（P <0.01）。在该研究中，所有患者在手术后6到12个月之间实现了骨折愈合。

Abstract:

[Objective]:?To discuss the feasibility and clinical efficacy of 3 D printing navigational template-assisted posterior temporary C1-2 pedicle screw fixation for the treatment of type II odontoid fracture. To evaluate the recovery of cervical rotation after temporary implant removal. Methods:?This is a retrospective study. A total of 14 patients were included in the study (10 males and 4 female). Their age ranged from 23 to 56 years (mean age of 41.64 years). The patients were diagnosed with type II odontoid fractures and underwent3 D printing navigational template-assisted posterior temporary C1-2 pedicle screw fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 ,12months, and 7 days after removal of the internal fixation device. The neck disability index (NDI)、visual analogue scale (VAS) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. The range of rotary motion was evaluated at each visit. All patients underwent X-ray and cervical CT scans to evaluate the screw position and fracture healing.Results:?All patients successfully completed the operation without vertebral artery injury, nerve injury or infection.The average operation time and blood loss were 98.18 ± 8.45?min and 133.64 ±39.31?ml, respectively. The mean follow-up was 18.91±3.56 months (range 16 to 22 months). The VAS score improved from preoperative 6.91±1.14 to 2.45±1.04 postoperative 6 months(P＜0.05).The neck rotary motion before removal, 7-days after removal, and the last follow-up were 60.59±5.51°、93.36±6.10°、112.32± 8.97°（P < 0.01）. The NDI scores before and after the operation were48.18±7.35、26.73±5.68、17.09±2.88（P <0.01）, and the NDI score 7 days after the internal fixation was removed was 7.45±2.30, which was better than immediately after the operation (P?< 0.01).Conclusions:3 D printing navigational template-assisted posterior temporary C1-2 pedicle screw fixation is a good surgical treatment for type II odontoid fractures.