3D打印辅助C1/2椎弓根钉固定治疗II型齿状突骨折△

3D printing assisted C1/2 pedicle screw fixation of type II odontoid fracture

摘要:

[目的]介绍 3D 打印辅助 C_1/2 椎弓根钉固定治疗Ⅱ型齿状突骨折的手术技术和初步临床效果。[方法]对 14 例被诊断为Ⅱ型齿状突骨折的患者，术前定制 3D 模型及导航模板，完成术前手术模拟，确定内固定物尺寸、进钉点和深度。行后正中切口，单极和双极电凝显露椎板、棘突后，将 3D 模型与相应椎板、小关节、棘突相匹配，术者用细钻头磨钻沿导板导航方向钻探，探查无误后置入椎弓根螺钉，连接钛棒固定。在确认骨折愈合 3 个月以后移除置入物。[结果]14 例患者手术顺利完成，未出现椎动脉损伤、神经损伤或切口感染。与术前相比，术后 6 个月 VAS 评分 [(7.3±0.8), (2.9±0.6), P＜0.001] 和 NDI 评分 [(61.8±4.9), (32.1±3.0), P＜0.001] 显著降低。所有患者在术后 9~12 个月实现了骨折愈合，术后 12 个月左右拆除内固定物。与拆除内固定装置前相比，拆除内固定装置后 7 d 的颈椎旋转活动度 [(55.8±7.0)°, (85.1±11.9)°, P＜0.001] 和 NDI 评分 [(25.2±4.9), (10.3±2.7), P＜0.001] 均显著改善。[结论]3D 打印辅助 C_1/2椎弓根钉固定Ⅱ型齿状突骨折是一种有效的治疗方式，内固定取出后能显著恢复颈椎活动度。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of 3D printing assisted C_1/2 pedicle screw fixation of type II odontoid fracture. [Methods] A total of 14 patients diagnosed with type II odontoid fracture were simulated operation on the customized 3D model and guide before real surgery to determine the size, insertion point and depth of internal fixators. In the real surgery, a posterior median incision was made, lamina and spinous process were exposed after unipolar or bipolar electrocautery. The 3D model was matched with the corresponding real lamina, facet joints and spinous process, screw path was individually drilled along the guide with a fine drill bit. After no error was found, the pedicle screw was inserted and fixed with a titanium rod to finish the fixation. The implant was removed 3 months after the fracture healed firmly. [Results] All the 14 patients got operation performed smoothly without vertebral artery injury, nerve injury or incision infection. Compared with those preoperatively, the VAS score [(7.3±0.8), (2.9±0.6), P＜0.001] and NDI score [(61.8±4.9), (32.1±3.0), P＜0.001] significantly reduced 6 months postoperatively. Fracture union was achieved in all patients between 9 and 12 months after surgery, and internal fixation was removed around 12 months after surgery. Compared with those before removing internal fixation devices, cervical rotational range of motion (ROM) [(55.8±7.0) °, (85.1±11.9) °, P＜0.001] and NDI scores [(25.2±4.9), (10.3± 2.7), P＜0.001] significantly improved 7 days after the implant removed. [Conclusion] 3D printing assisted C_1/2 pedicle screw fixation of type II odontoid fracture is an effective treatment method, which can significantly restore cervical motion after internal fixation removed.