3D打印导向模板辅助寰枢椎后路椎弓根螺钉固定治疗寰枢椎不稳症疗效分析
摘要
目的探讨3D打印导向模板辅助下寰枢椎后路椎弓根螺钉固定治疗寰枢椎不稳症的临床疗效。方法收集寰枢椎不稳症患者32例,均采用3D打印导向模板辅助寰枢椎后路椎弓根螺钉固定治疗。观察螺钉在CT横断面和矢状面的位置,记录术前和术后3个月颈部视觉模拟疼痛评分(VAS),随访观察临床疗效、骨折复位、稳定性及手术并发症等情况。结果所有患者均行寰枢椎后路椎弓根螺钉固定,共置入螺钉128枚螺钉。寰枢椎椎弓根螺钉最佳安全钉道和实际钉道的进针点、钉道方向的偏差较小。术后均无脊髓损伤、硬膜破裂及椎动脉损伤等并发症。随访12~32个月,平均16.5个月。术后3个月枕颈部疼痛缓解,颈部活动范围基本接近伤前水平;术后6个月复查骨折断端达到骨性融合;随访期间颈椎序列良好,未见内固定松动、断裂,无寰枢关节失稳。结论个性化3D打印导向模板辅助寰枢椎椎弓根螺钉置钉技术能够有效提高置钉的准确性及安全性,减少神经血管等严重并发症。
引文
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[15]Kaneyama S,Sugawara T,Sumi M,et al.A novel screw guiding method with a screw guide template system for posterior C-2 fixation:clinical article[J].J Neurosurg Spine,2014,21(2):231-238.
[2]Gebauer M,Barvencik F,Briem D,et al.Evaluation of anatomic landmarks and safe zones for screw placement in the atlas via the posterior arch[J].European Spine Journal,2010,19(1):85-90.
[3]Resnick DK,Benzel EC.C1-C2 pedicle screw fixation with rigid cantilever beam construct:case report and technical note[J].Neurosurgery,2002,50(2):426-428.
[4]Resnick DK,Lapsiwala S,Trost GR.Anatomic suitability of the C1-C2 complex for pedicle screw fixation[J].Spine,2002,27(14):1494-1498.
[5]Tan M,Wang H,Wang Y,et al.Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass[J].Spine,2003,28(9):888-895.
[6]Sciubba DM,Noggle JC,Vellimana AK,et al.Radiographic and clinical evaluation of free-hand placement of C-2 pedicle screws[J].J Neurosurgery:Spine,2009,11(1):15-22.
[7]Guo X,Xie N,Lu X,et al.One-step reduction and fixation applying transposterior arch lateral mass screw of C1 combined with pedicle screw of C2 and rod system for pediatric acute atlantoaxial rotatory subluxation with injury of trans verse ligament[J].Spine(Phila Pa 1976),2015,40(5):E272-E278.
[8]Wang L,Liu C,Zhao Q,et al.Posterior pedicle screw fixation for complex atlantoaxial fractures with atlanto-dental interval of≥5 mm or C2-C3 angulation of≥11°[J].J Orthop Surg Res,2014,9:104..
[9]Hu Y,Yuan ZS,Kepler CK,et al.Deviation analysis of atlantoaxial pedicle screws assisted by a drill template[J].Orthopedics,2014,37(5):e420-e427.
[10]胡勇,袁振山,董伟鑫,等.个性化3D打印“定点-定向”双导板辅助寰枢椎后路椎弓根螺钉置钉技术的安全性和准确性[J].中华创伤杂志,2016,32(1):27-34.
[11]胡勇,袁振山,谢辉,等.快速成型导向模板辅助下寰枢椎椎弓根螺钉置钉的偏差因素分析[J].中华医学杂志,2013,93(33):2659-2663.
[12]Uehara M,Takahashi J,Hirabayashi H,et al.Computer-assisted C1-C2 transarticular screw fixation“Magerl Technique”for atlantoaxial instability[J].Asian Spine J,2012,6(3):168-177.
[13]Hu Y,Yuan ZS,Spiker WR,et al.A comparative study on the accuracy of pedicle screw placement assisted by personalized rapid prototyping template between preand post-operation in patients with relatively normal mid-upper thoracic spine[J].Eur Spine J,2016,25(6):1706-1715.
[14]胡勇,袁振山,谢辉,等.快速成型导向模板技术在枢椎椎板交叉螺钉置钉中的应用[J].中华骨科杂志,2013,33(6):640-648.
[15]Kaneyama S,Sugawara T,Sumi M,et al.A novel screw guiding method with a screw guide template system for posterior C-2 fixation:clinical article[J].J Neurosurg Spine,2014,21(2):231-238.