摘要目的 探讨3D打印辅助寰枢椎置钉的临床效果。 方法 回顾性分析2014年3月到2022年9月安徽医科大学第二附属医院收治的33例寰枢椎后路钉棒固定融合术患者的临床资料，其中3D打印组15例，男11例，女4例；年龄20~80岁，平均年龄(52.87±16.97)岁；对照组18例，男13例，女5例；年龄19~68岁，平均年龄(43.39±13.59)岁。3D打印组进行3D打印模型的制作、模型研读、模型模拟制作钉道、预制好理想钉道的模型术中参考置钉；对照组根据术者经验常规徒手置钉。比较两组手术时间、术中出血量、透视次数、术后住院天数、置钉准确性Kawaguchi分级、不同时间点疼痛视觉模拟评分(visual analogue scale，VAS)、颈椎功能障碍指数(neck disability index，NDI)。 结果 两组患者均获随访，随访时间12~36个月，平均(32.88±7.15)个月。3D打印组手术时间(131.07±28.65)min，短于对照组的(168.11±61.75)min，差异有统计学意义( P ＜0.05)。3D打印组透视次数(9.80±2.21)次，少于对照组的(14.00±3.36)次，差异有统计学意义( P ＜0.05)。3D打印组术后3 d VAS评分(2.84±1.04)分，较对照组的(3.37±1.26)分更低，差异有统计学意义( P ＜0.05)。3D打印组置钉60枚，Kawaguchi分级0级56枚，优良率93.33%；对照组置钉72枚，Kawaguchi分级0级57枚，优良率79.17%；3D打印组置钉准确性优于对照组，差异有统计学意义( P ＜0.05)。其他相关指标组间比较，差异无统计学意义( P ＞0.05)。 结论 3D打印辅助寰枢椎置钉技术可缩短手术时间，提高螺钉的置入精度，减少潜在的神经血管损伤风险，疗效满意。
Objective To investigate the clinical effect of 3D printing assisted atlantoaxial screw placement. Methods The clinical data of 33 patients who had posterior atlantoaxial screw fixation and fusion in The Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed.Among them，15 patients were included in the 3D printing group (11 males and 4 females).The age ranged from 20 to 80 years，with an average age of (52.87±16.97) years.The control group consisted of 18 patients (13 males and 5 females).The age ranged from 19 to 68 years，with an average age of (43.39±13.59) years.In the 3D printing group，we made models using 3D printing，studied the mdoels，made ideal screw path on the models，and used the models with the ideal screw path as an intraoperative reference.In the control group，freehand screw placement based on surgeon’s experience.Operative time，intraoperative blood loss，fluoroscopy times，postoperative hospitalization days，Kawaguchi grade of screw placement accuracy，visual analogue scale (VAS)，and neck disability index (NDI) at various time points were among the indicators that were compared. Results Patients in both groups were followed up for 12 to 36 months，with an average of (32.88±7.15) months.The operation time of the 3D printing group was (131.07±28.65) min，which was shorter than that of the control group (168.11±61.75) min ( P ＜0.05).The fluoroscopy times of the 3D printing group (9.80±2.21) were less than that of the control group (14.00±3.36) ( P ＜0.05).The VAS score of 3D printing group (2.84±1.04) was lower than that of control group (3.37±1.26) 3 days after surgery ( P ＜0.05).There were 56 screws of Kawaguchi grade 0 in all 60 screws in the 3D printing group，with an excellent rate of 93.33%.There were 57 crews of Kawaguchi grade 0 in in 72 in the control group，with an excellent rate of 79.17%，the difference was statistically significant ( P ＜0.05).There were no significant differences in other relevant indicators among groups ( P ＞0.05). Conclusion The use of 3D printing technology in atlantoaxial screw placement can reduce operation time，improve the accuracy of screw placement，and lower the potential risk of neurovascular injury.Overall，it has a satisfactory effect.
［1］ Chen Q，Brahimaj BC，Khanna R， et al .Posterior atlantoaxial fusion：A comprehensive review of surgical techniques and relevant vascular anomalies［J］.J Spine Surg，2020，6(1)：164-180.
［2］ Zhai MY，Wang CP，Liu F， et al .The efficacy of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation［J］.Arch Orthop Trauma Surg，2015，135(9)：1193-1199.
［3］ Buchmann N，Schweizer C，Kirschke JS， et al .C1~C2 posterior screw fixation in atlantoaxial fractures revisited：Technical update based on 127 cases［J］.Eur Spine J，2020，29(5)：1036-1042.
［4］ Tian W，Liu YJ，Liu B， et al .Guideline for posterior atlantoaxial internal fixation assisted by orthopaedic surgical robot［J］.Orthop Surg，2019，11(2)：160-166.
［5］ Hur JW，Kim JS，Ryu KS， et al .Accuracy and safety in screw placement in the high cervical spine：Retrospective analysis of o-arm-based navigation-assisted C1 lateral mass and C2 pedicle screws［J］.Clin Spine Surg，2019，32(4)：E193-E199.
［6］ Lin GX，Chen CM，Rui G，Hu BS.Research relating to three-dimensional(3D) printing in spine surgery：A bibliometric analysis［J］.Eur Spine J，2023，32(2)：395-407.
［7］ 刘正蓬，王雅辉，褚立，等.3D打印技术辅助椎弓根螺钉置入治疗胸腰椎骨折的临床分析［J］.实用骨科杂志，2018，24(11)：970-974.
［8］ Maruo K，Arizumi F，Kishima K， et al .Patient-specific guide systems decrease the major perforation rate of pedicle screw placement in comparison to the freehand technique for adolescent idiopathic scoliosis［J］.Eur Spine J，2023，32(9)：3105-3112.
［9］ 李超，牛国旗，刘香平，等.3D打印辅助与徒手上颈椎椎弓钉置入比较［J］.中国矫形外科杂志，2023，31(14)：1338-1340；1344.
［10］ Li Y，Lin J，Wang Y， et al .Comparative study of 3D printed navigation template-assisted atlantoaxial pedicle screws versus free-hand screws for type Ⅱ odontoid fractures［J］.Eur Spine J，2021，30(2)：498-506.
［11］ 李佳佳，姜泽威，吴瑞，等.3D打印导板辅助后路寰枢椎螺钉固定治疗齿状突骨折［J］.中国矫形外科杂志，2022，30 (14)：1311-1313；1317.
［12］ Yang M，Zhang N，Shi H， et al .Three-dimensional printed model-assisted screw installation in treating posterior atlantoaxial internal fixation［J］.Sci Rep，2018，8(1)：11026.
［13］ 谭明生，张光铂，李子荣，等.寰椎测量及其经后弓侧块螺钉固定通道的研究［J］.中国脊柱脊髓杂志，2002，12 (1)：5-8.
［14］ Goel A，Desai KI，Muzumdar DP.Atlantoaxial fixation using plate and screw method：A report of 160 treated patients［J］.Neurosurgery，2002，51(6)：1351-1356.
［15］ Kawaguchi Y，Nakano M，Yasuda T， et al .Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide［J］.Spine (Phila Pa 1976)，2012，37(23)：1983-1988.
［16］ Lam KY，Mark C，Yee SY.Office 3D-printing in paediatric orthopaedics：The orthopaedic surgeon’s guide［J］.Transl Pediatr，2021，10(3)：474-484.
［17］ Zhang YH，Zhou FC，Zhang J， et al .Efficacy and safety of atlantoaxial fluoroscopy-guided pedicle screw fixation in patients younger than 12 years：A radiographic and clinical assessment［J］.Spine (Phila Pa 1976)，2019，44(20)：1412-1417.
［18］ Brouwers L，Teutelink A，van Tilborg F， et al .Validation study of 3D-printed anatomical models using 2 PLA printers for preoperative planning in trauma surgery：A human cadaver study［J］.Eur J Trauma Emerg Surg，2019，45(6)：1013-1020.
［19］ Galvez M，Asahi T，Baar A， et al .Use of three-dimensional printing in orthopaedic surgical planning［J］.J Am Acad Orthop Surg Glob Res Rev，2018，2(5)：e071.
［20］ Yang M，Li C，Li Y， et al .Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients［J］.Medicine (Abingdon)，2015，94(8)：e582.
［21］ Wada K，Tamaki R，Inoue T， et al .Comparison of atlantoaxial fusion with transarticular screws and C1 lateral mass-C2 screws using intraoperative O-arm navigation［J］.World Neurosurg，2020(141)：e1005-e1009.
［22］ Lang Z，Han X，Fan M， et al .Posterior atlantoaxial internal fixation using Harms technique assisted by 3D-based navigation robot for treatment of atlantoaxial instability［J］.BMC Surgery，2022，22(1)：378.
［23］ Zhan J，Xu W，Lin J， et al .Accuracy and safety of robot-assisted versus fluoroscopy-guided posterior C1 lateral mass and C2 pedicle screw internal fixation for atlantoaxial dislocation：A preliminary study［J］.Biomed Res Int，2022(2022)：8508113.
［24］ Smith JD，Jack MM，Harn NR， et al .Screw placement accuracy and outcomes following O-arm-navigated atlantoaxial fusion：A feasibility study［J］.Global Spine J，2016，6(4)：344-349.
［25］ 徐辉，岳保荣，尉可道，等.我国X射线摄影程序受检者入射体表剂量调查结果与分析［J］.中华放射医学与防护杂志，2019，39(1)：68-72.
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