CAJ | 학술논문

目的探讨3D打印技术在颅底凹陷合并寰枢椎脱位手术中的临床应用价值.方法 2013年1至9月解放军总医院神经外科对10例行后路固定手术的颅底凹陷合并寰枢椎脱位患者进行3D模型打印,打印范围为颅底到C4椎体,对骨质结构和椎动脉进行颜色区分制作1∶1大小的模型.在模型上进行术前模拟置钉,探讨固定方式和最佳进钉点以避开椎动脉,获得个性化置钉数据后进行手术操作,对3D打印模型的置钉数据和实际临床结果进行对比分析.结果 3D打印模型模拟手术发现,10例均有C1后弓发育不良或与枕骨融合,无法行C1后弓螺钉,进钉点选择在C1侧块;C2螺钉根据模型个体化设计:3例椎动脉异常或C2椎弓根宽度＜3.5 mm无法行椎弓根螺钉固定,其中1例行C2椎板螺钉,1例行C2～3经关节螺钉,1例因合并C2～3椎体融合行C3椎弓根螺钉;2例椎弓根宽度在3.5～4.0 mm,经评估后设计钉道仍行椎弓根螺钉固定;1例单侧C1侧块垂直脱位于C2前方,采用寰枢椎经关节螺钉固定;其余均行椎弓根螺钉.10例手术方案均与3D打印模拟方案一致,术后随访12～18个月,随访时患者临床症状均有改善,植骨融合率100％.结论 3D打印模型可全面评估骨性结构异常和椎动脉走向,有助于制定手术策略、设计置钉点和置钉角度,避免椎动脉和脊髓损伤,值得推广.
목적 탐토3D타인기술재로저요함합병환추추탈위수술중적림상응용개치.방법 2013년1지9월해방군총의원신경외과대10례행후로고정수술적로저요함합병환추추탈위환자진행3D모형타인,타인범위위로저도C4추체,대골질결구화추동맥진행안색구분제작1∶1대소적모형.재모형상진행술전모의치정,탐토고정방식화최가진정점이피개추동맥,획득개성화치정수거후진행수술조작,대3D타인모형적치정수거화실제림상결과진행대비분석.결과 3D타인모형모의수술발현,10례균유C1후궁발육불량혹여침골융합,무법행C1후궁라정,진정점선택재C1측괴;C2라정근거모형개체화설계:3례추동맥이상혹C2추궁근관도＜3.5 mm무법행추궁근라정고정,기중1례행C2추판라정,1례행C2～3경관절라정,1례인합병C2～3추체융합행C3추궁근라정;2례추궁근관도재3.5～4.0 mm,경평고후설계정도잉행추궁근라정고정;1례단측C1측괴수직탈위우C2전방,채용환추추경관절라정고정;기여균행추궁근라정.10례수술방안균여3D타인모의방안일치,술후수방12～18개월,수방시환자림상증상균유개선,식골융합솔100％.결론 3D타인모형가전면평고골성결구이상화추동맥주향,유조우제정수술책략、설계치정점화치정각도,피면추동맥화척수손상,치득추엄.
Objective To investigate the clinical application value of the 3D printing technique in the treatment of basilar invagination and atlantoaxial dislocation.Methods From January 2013 to September 2013,10 patients with basilar invagination and atlantoaxial dislocation needing posterior fixation undertook 3D printing modes at the Department of Neurosurgery in PLA General Hospital.The 1 ∶ 1 size models were established from skull base to C4 level with different colors between bone structures and vertebral arteries.The simulation of screw insertion was made to investigate the fixation plan and ideal entry point to avoid vertebral artery injury.After obtaining the individual screw insertion data in 3D printing modes,the according surgical operations were performed.The actual clinical results and virtual screw data in 3D printing mode were compared with each other.Results The 3D printing modes revealed that all the 10 patients had the dysplasia or occipitalized C1 posterior arch indicating C1 posterior arch screw implantation was not suitable.C1 lateral masses were chosen as the screws entry points.C2 screws were designed individually based on the 3D printing modes as follows:3 patients with aberrant vertebral artery or narrow C2 pedicle less than 3.5 mm were not suitable for pedicle screw implantation.Among the 3 patients,1 was fixed with C2 laminar screw,and 1 with C2-3 transarticular screw and 1 with C3 pedicle screw (also combined with congenital C2-3 vertebral fusion).Two patients with narrow C2 pedicle between 3.5 and 4mm were designed to choose pedicle screw fixation after 3D printing mode evaluation.One patient with C1 lateral mass vertically dislocated axis was planned with C1-2 transarticular screw fixation.All the other patients were planned with C2 pedicle screws.All the 10 patients had operation designed as the 3D printing modes schemes.The follow-up ranged from 12 to 18 months and all the patients recovered from the clinical symptoms and the bony fusion attained to 100％.Conclusions 3D printing mode could provide thorough information of the bony structure abnormalities and route of vertebral artery.It is helpful for setting operation strategy and designing screw entry point and trajectory and avoiding vertebral artery and spinal cord injury and thus deserves generalization.