3D打印导航模板与计算机导航辅助置入C<sub>2</sub>椎弓根和侧块螺钉的对比研究

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摘要目的比较3D打印导航模板辅助C₂椎弓根和侧块螺钉置钉与计算机导航辅助置钉准确性和安全性的差异，探讨3D打印导板在C₂螺钉置钉中的应用价值。方法纳入我院采用C₂椎弓根螺钉和C₂侧块螺钉后路内固定患者64例，根据辅助螺钉置入方法的不同分为3D打印导航模板置钉组(A组)和计算机导航置钉组(B组)，其中A组又分A1(导板置入C₂椎弓根螺钉)、A2(导板置入C₂侧块螺钉)两个亚组；B组又分B1(导航置入C₂椎弓根螺钉)、B2(导航置入C₂侧块螺钉)两个亚组。A组：纳入我院2015年6月至2018年9月采用3D打印导板置钉患者32例，其中男21例，女11例；年龄27~64岁，平均(47.2±11.1)岁。B组：纳入我院2014年1月至2018年9月采用计算机导航置钉患者32例，其中男19例，女13例；年龄25~60岁，平均(45.6±10.4)岁。所有患者术前均行颈椎X线、CT、MRI及CTA。记录并比较两组患者疾病类型、置钉时间、术中出血量、术中透视次数、术前、术后3 d、术后6个月的VAS评分及JOA评分。所有患者术后均行颈椎CT平扫，按照Hlubek等提出的新的C₂螺钉分级标准、根据CT结果分别记录并比较两组的置钉准确率及相关并发症的发生率。结果两组中A组置钉时间、术中透视次数均优于B组，差异有统计学意义(P＜0.05)，术中出血量比较差异无统计学意义(P＞0.05)。两组术前视觉模拟评分(visual analogue scale，VAS)和日本矫形外科协会(Japanese orthopedic association，JOA)评分差异无统计学意义(P＞0.05)，术后3 d及术后6个月两组的VAS评分和JOA评分较术前均明显改善，差异有统计学意义(P＜0.05)，组间比较差异无统计学意义(P＞0.05)。两组中A组共置入C₂螺钉64枚，A级置钉精确率为95.31%，其中A1组共置入52枚，A级置钉精确率为96.15%；A2组共置入12枚，A级置钉精确率为91.67%。B组共置入C₂螺钉64枚，A级置钉精确率为84.38%，其中B1组共置入50枚，A级置钉精确率为84.00%；B2组共置入14枚，A级置钉精确率为85.71%。A组与B组置钉准确率差异有统计学意义(P＝0.041)，A1组与B1组置钉精确率差异有统计学意义(P＝0.039)；A2组与B2组置钉精确率差异无统计学意义(P＝0.636)。两组均无置钉相关的血管、神经并发症发生。结论虽然3D打印导航模板与计算机导航辅助置入C₂椎弓根、侧块螺钉均能提供较高的准确性、安全性和临床疗效，但导板技术在C₂椎弓根螺钉置入准确率方面更优于导航技术。

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	田野 1
	2
	张嘉男 2
	樊勇 2
	郝定均2*

关键词 ： 3D打印导航模板, 计算机导航, C₂椎弓根螺钉, C₂侧块螺钉, 置钉准确率

Abstract：Objective To compare the accuracy and safety of 3D printing navigation template and computer navigation-assisted C₂ pedicle and pars screws placement and explore the advantages of the 3D printing template based C₂ screws placement.Methods 64 patients who underwentthe C₂ pedicle screws and C₂ pars screws insertion in our hospital were included.According to the different methods of screw placement，they were divided into the 3D printing navigation template group (group A) and the computer navigation group (group B).Group A was divided into two subgroups：A1 (C₂ pedicle screw) and A2 (C₂ parsscrew)；Group B was divided into B1 (C₂ pedicle screw) and B2 (C₂ parsscrew).Group A consisted of 32 patients，including 21 males and 11 females with a mean age of 47.2±11.1 years(27~64 years).All patients were treated with 3D printing navigation template between June 2015 and September 2018.Group B consisted of 32 patients，including 19 males and 13 females with a mean age of 45.6±10.4 years(25~60 years).All patients were treated with the computer navigation between January 2014 and September 2018.All patients underwent cervical X-ray，CT，MRI and CTA before surgery.The disease types，nail placement time，intraoperative blood loss，intraoperative fluoroscopy frequency were compared between the two groups.Besides，the VAS score and JOA score were compared before operation，3 days after operation，and 6 months after operation.All patients undertook cervical CT scan after surgery，and the accuracy of screw placement and the incidence of related complications in the two groups were compared according to Hlubek's new C₂ screw grading standard and CT results.Results In the two groups，the time of screw placement and intraoperative fluoroscopy in group A were better than that in group B，and the difference was statistically significant (P＜0.05).The difference of intraoperative blood loss was not statistically significant (P＞0.05).There was no significant difference in preoperative VAS score and JOA score between the two groups (P＞0.05)，and VAS and JOA scores were significantly improved 3 days after surgery and 6 months after surgery，with statistically significant differences (P＜0.05).There was no significant difference between the two groups (P＞0.05).64 C₂ screws were implanted in group A，and the accuracy rate of grade A was 95.31%，among which 52 screws were implanted in group A1，and the accuracy rate of grade A was 96.15%.12 screws were implanted in group A2，and the accuracy rate of grade A was 91.67%.64 C₂ screws were implanted in group B，and the accuracy rate of grade A was 84.38%，among which 50 screws were implanted in group B1，and the accuracy rate of grade A was 84.00%.14 screws were implanted in group B2，and the accuracy rate of grade A was 85.71%.The accuracy of screw placement between group A and group B was statistically significant (P＝0.041)，and the accuracy of screw placement between group A1 and group B1 was statistically significant (P＝0.039).There was no significant difference between group A2 and group B2 (P＝0.636).There were no complications of blood vessel and nerve related to nail placement in both groups.Conclusion Although the placement of C₂ pedicle screws and C₂ pars screws by 3D printing navigation template and computer navigation implantation can provide higher accuracy，safety and clinical efficacy.The guide template technology is better than the navigation technology in the accuracy of C₂ pedicle screw implantation.

Key words： 3D printing navigation template computer navigation C₂ pedicle screws C₂ pars screws acuracyrate

基金资助:国家自然科学基金(81772357)

通讯作者: 郝定均

作者简介: 田野(1993－ )，男，研究生在读，西安交通大学附属红会医院脊柱外科，710054。

引用本文:

田野 1，2，张嘉男 2，樊勇 2，郝定均2*. 3D打印导航模板与计算机导航辅助置入C₂椎弓根和侧块螺钉的对比研究[J]. 实用骨科杂志, 2019, 25(7): 581-587.
TianYe 1，2，Zhang Jianan 2，Fan Yong 2，et al. A Comparative Study of 3D Printing Navigation Template and Computer Navigation-assisted C₂ Pedicle and Pars Screws Placement. sygkzz, 2019, 25(7): 581-587.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I7/581

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