3D打印滑动钛板固定不稳定性寰椎骨折△

3D printed sliding titanium plate for internal fixation of unstable atlas fractures

摘要:

[目的]介绍 3D 打印滑动钛板固定不稳定型寰椎骨折的手术技术和初步临床效果。[方法]2018 年 4 月—2021 年 4 月，对 9 例不稳定型寰椎骨折患者采用 3D 打印个性化滑动钛板行内固定术。术前行上颈椎薄层 CT 扫描，采用 Mimics 软件中重建三维模型，导入 Geomagic Studio 软件捕获所得三维扫描数据，设计个性化 C1后侧滑动钛板，3D 打印实体。全麻下行颈椎后侧切口，显露 C1后弓，建立椎弓钉道，放置 3D 打印滑动钛板，置入椎弓钉固定，调整滑动钛板，达到骨折复位和加压固定。[结果]所有患者均顺利完成手术，无严重并发症，手术时间平均(66.5±7.3)min；术中失血量平均(92.5±27.3)ml。患者均获 12~18 个月随访，与术前相比，末次随访时 VAS 评分 [(7.1±1.6) vs (1.8±1.0), P＜0.05]、JOA 评分 [(8.7±6.0) vs (16.3±4.7), P＜ 0.05] 均显著改善。影像方面，所有患者螺钉置入位置准确，螺钉均未突破骨皮质，Neo 评级标均为 0 级，骨折复位满意。至末次随访，所有患者骨折均骨性愈合，未见内固定无松动、断裂。[结论] 3D 打印滑动钛板内固定不稳定型寰椎骨折技术可行， 安全高效。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcomes of 3D printed sliding titanium plate for fixation of unstable atlas fracture. [Methods] From April 2018 to April 2021, 9 patients received open reduction and internal fixation with 3D printed personalized sliding titanium plate for unstable atlas fractures. As thin-layer CT scan of the upper cervical vertebra was per- formed before surgery, the 3D model of upper cervical spine was reconstructed using the Mimics software, and then the data captured by the Geomagic Studio software to design the C1 posterior sliding titanium plate, finally the real personalized sliding plate was made by the 3D printer. The posterior cervical incision was made under general anesthesia to expose the posterior arch of C1, establish the vertebral arch screw path. The 3D printed sliding titanium plate was placed to fit the posterior arch, and then insert the screw in proper length. As adjust- ing the plate sliding, the fracture reduction and compressive fixation were finished. [Results] All patients were successfully operated on without serious complications, whereas with operation time of (66.5±7.3)min and intraoperative blood loss of (92.5±27.3)ml, and followed up for 12~18 months. Compared with those preoperatively, the VAS scores [(7.1±1.6), (1.8±1.0), P＜0.05], JOA score [(8.7±6.0), (16.3±4.7), P＜0.05] improved significantly at the latest follow-up. Radiographically, all patients had screw placed properly on images, without screw broken through the bone cortex, while with satisfactory fracture reduction. Up to the last follow-up, all patients got fractures healing without loosening or fracture of the implants. [Conclusion] The 3D printed titanium sliding plate for internal fixation of unstable atlas fracture is feasible, safe and efficient.