CAJ | 학술논문

目的研究个体化3D打印模型辅助后路内固定治疗颅颈交界区畸形的方法和效果.方法对贵州省人民医院神经外科MRI及CT确诊的31例颅颈交界区畸形患者进行回顾性分析.采用3D打印技术建立颅颈交界区个体化3D打印模型,在模型上进行模拟置钉及内固定手术,获得个体化置钉数据,再进一步术中辅助真实手术,采取一期后路减压及内固定治疗.结果 25例建立了个体化3D打印模型辅助术中置钉进行内固定手术,全部置钉成功.术前CT判断,有2例可直接行枢椎椎弓根置钉,但通过3D模型测量以及术中辅助发现不能置钉;术前有3例评估不适合椎弓根置钉的病例,经过3D模型分析,最后仍能行椎弓根峡部置钉.术后随访时间3～ 28个月,平均13.9个月.术后JOA评分显著提高,差异有统计学意义(P=0.000).术后复查MRI及CT,寰枢椎脱位行撑开复位的24例中,完全复位19例,不完全者5例.术后寰椎齿突间隙(ADI)明显缩小,延髓颈髓角(CMA)明显增大,延髓腹侧受压明显减轻或消失,差异有统计学意义(P=0.000).无手术死亡,2例出现呼吸困难.结论个体化3D打印模型辅助后路螺钉内固定可提高置钉成功率,有效保护椎动脉,提高安全性,值得初学内固定者借鉴和推广;采取螺钉间撑开复位技术治疗寰枢椎脱位短期疗效好.
목적 연구개체화3D타인모형보조후로내고정치료로경교계구기형적방법화효과.방법 대귀주성인민의원신경외과MRI급CT학진적31례로경교계구기형환자진행회고성분석.채용3D타인기술건립로경교계구개체화3D타인모형,재모형상진행모의치정급내고정수술,획득개체화치정수거,재진일보술중보조진실수술,채취일기후로감압급내고정치료.결과 25례건립료개체화3D타인모형보조술중치정진행내고정수술,전부치정성공.술전CT판단,유2례가직접행추추추궁근치정,단통과3D모형측량이급술중보조발현불능치정;술전유3례평고불괄합추궁근치정적병례,경과3D모형분석,최후잉능행추궁근협부치정.술후수방시간3～ 28개월,평균13.9개월.술후JOA평분현저제고,차이유통계학의의(P=0.000).술후복사MRI급CT,환추추탈위행탱개복위적24례중,완전복위19례,불완전자5례.술후환추치돌간극(ADI)명현축소,연수경수각(CMA)명현증대,연수복측수압명현감경혹소실,차이유통계학의의(P=0.000).무수술사망,2례출현호흡곤난.결론 개체화3D타인모형보조후로라정내고정가제고치정성공솔,유효보호추동맥,제고안전성,치득초학내고정자차감화추엄;채취라정간탱개복위기술치료환추추탈위단기료효호.
Objective To study the method and effect of individualized 3 D printing model-assisted posterior screw fixation for the treatment of craniovertebral junction abnormality.Methods 31 patients with craniovertebral junction abnormalities diagnosed by CT and MRI were retrospectively analyzed in neurosurgical department of Guizhou Provincial People's Hospital.First,made a 3D printing model of craniovertebral junction by 31 printing technology,then simulated screw insertion and fixation operation on the model to obtain the individual screw insertion data to assist the real operation,at last implemented one-stage posterior decompression operation combined with internal fixation.Results 25 of 31 patients with craniovertebral junction abnormalities successfully underwent the posterior screw fixation operation assisted by individual 3D printing models.Preoperative CT evaluation suggested that the operations of axial pedicle screw placement were planned for 2 cases,but 3D printing models revealed the operations could not be implemented; and 3 cases were unsuitable for axial pedicle screw placement,but 3D printing models revealed the operation could be accomplished by an isthmus part screw insertion of axial pedicle.Postoperative follow-up time was 3-28 months,with an average of 13.9 months.Postoperative JOA scores of the patients underwent posterior screw fixation treatment were significantly increased,with significant differences (P =0.000).Postoperative MRI and CT scanning of 24 cases with craniovertebral junction abnormalities combined with atlantoaxial dislocation revealed that the dislocations were completely reduced in 19 cases and incompletely reduced in 5 cases.Postoperative ADI was significantly reduced,CMA was significantly increased,medullary ventral compression obviously alleviated or disappeared and there was a significant statistical difference (P =0.000).There were no deaths during operation,but dyspnea occurred in 2 cases.Conclusion Posterior screw fixation operation assisted by individualized 3D printing model can improve the success rate and safety of screw insertion,and effectively protect the vertebral artery avoiding damage,which suggests this technique is very useful for the new comer and worth popularizing; there is a good short-term efficacy for direct posterior distraction reduction treatment of atlantoaxial dislocation.