3D打印技术在腰椎滑脱椎体椎弓根螺钉置入技术中的应用(1)
【摘要】 目的：探讨3D打印技术在滑脱腰椎椎体中椎弓根钉置入过程中的应用价值。方法：选取本院2014年7月-2015年6月间因腰椎滑脱施行手术的40例患者分为两组，每组各20例。手术方案均采用传统腰椎后路椎板切除椎管减压椎间植骨融合椎弓根钉内固定术(PLIF)手术，传统徒手穿刺组采用传统徒手穿刺完成椎弓根钉置入，3D打印组术前进行3D实体腰椎模型的打印，记录两组在滑脱椎体椎弓根钉置入过程中的工作时间、穿刺次数，均在术后复查CT以判断椎弓根钉置入的准确性。结果：应用3D打印组在滑脱椎体中置入单个椎弓根的平均时间为(5.60±1.85)min，明显短于传统徒手穿刺组的(8.10±1.63)min；穿刺次数平均为(1.20±0.20)次，少于传统徒手穿刺组的(1.80±0.50)次；术后CT平扫提示3D打印组的38枚(95.00%)椎弓根螺钉完全位于椎弓根内，准确率明显高于传统徒手组的80.00%，两组比较差异均有统计学意义(P<0.05)。结论：应用3D打印技术有助于椎弓根螺钉置入术前计划的制定，在滑脱腰椎椎体椎弓根钉的置入过程中可有效减少置钉时间并且明显提高置钉的准确性。
, 百拇医药
【关键词】 3D打印； 腰椎滑脱； 椎弓根螺钉技术
【Abstract】 Objective：To discuss the value of the 3D Printing Technology in lumbar spondylolisthesis pedicle screws.Method：40 patients with lumbar spondylolisthesis were selected in our hospital from July 2014 to June 2015，they were divided into two groups，20 cases in each group.All patients were instrumented with posterior lumber interbody fusion(PLIF)，the conventional hand puncture group was treated by traditional method of pedicle screws，the 3D printing group was treated by the help of 3D printing technology. The finish time of single pedicle screw and the number of replacement times were recorded， all the position of perdicle screw of spondylolisthesis were observed by CT scan to evaluate the screw placement accuracy.Result：The finish time of single screw in 3D printing group was (5.60±1.85)min，which was shorter than(8.10±1.63)min of conventional hand puncture group；the number of replacement times in 3D printing group was (1.20±0.20)times，which was less than(1.80±0.50)times of conventional hand puncture group；according to the CT results， the excellent rate of pedicle screw position in 3D printing group was 95.00%，which was higher than 80.00% of the conventional hand puncture group，the differences were statistically significant(P<0.05).Conclusion：Application of 3D printing technology is helpful to the development of the pedicle screw placement plan，can effectively reduce the time of the pedicle screw placement in the course of the pedicle screw placement and improve the accuracy of the screw placement.
, 百拇医药
【Key words】 3D Printing Technology； Lumbar spondylolisthesis； Pedicle screws
First-author’s address：The People’s Hospital of Ganzhou，Ganzhou 341000，China
doi：10.3969/j.issn.1674-4985.2015.35.019
目前腰椎滑脱症的手术治疗主要以后路PLIF手术为主，虽然在滑脱椎体的复位与否上目前存在一定争议，然而目前达成共识的观点都认为腰椎滑脱手术的目的在于解决滑脱椎体的失稳定，手术治疗的最终目的为实现腰椎滑脱节段的融合[1-2]。在传统脊柱融合技术当中，椎弓根钉棒系统是目前应用最多且最为重要的技术，其中椎弓根螺钉的置入准确性与否直接影响最终的手术治疗效果，由于滑脱椎体与正常椎体解剖标志差异较大，以往经验的定位方法常导致椎弓根钉置入的困难以及螺钉的穿出，并导致严重的神经损伤[3-4]。本科自2014年开始引进美国Makerbot公司的3D打印机及配套MakerBot Desktop 3.6软件，并在腰椎滑脱患者术前进行应用，结合腰椎滑脱节段打印出的实体模型制定相应的椎弓根钉置钉计划，取得了较好的置钉效果，现报道如下。, http://www.100md.com(陈勤 陈荣春 游辉)
, 百拇医药
【关键词】 3D打印； 腰椎滑脱； 椎弓根螺钉技术
【Abstract】 Objective：To discuss the value of the 3D Printing Technology in lumbar spondylolisthesis pedicle screws.Method：40 patients with lumbar spondylolisthesis were selected in our hospital from July 2014 to June 2015，they were divided into two groups，20 cases in each group.All patients were instrumented with posterior lumber interbody fusion(PLIF)，the conventional hand puncture group was treated by traditional method of pedicle screws，the 3D printing group was treated by the help of 3D printing technology. The finish time of single pedicle screw and the number of replacement times were recorded， all the position of perdicle screw of spondylolisthesis were observed by CT scan to evaluate the screw placement accuracy.Result：The finish time of single screw in 3D printing group was (5.60±1.85)min，which was shorter than(8.10±1.63)min of conventional hand puncture group；the number of replacement times in 3D printing group was (1.20±0.20)times，which was less than(1.80±0.50)times of conventional hand puncture group；according to the CT results， the excellent rate of pedicle screw position in 3D printing group was 95.00%，which was higher than 80.00% of the conventional hand puncture group，the differences were statistically significant(P<0.05).Conclusion：Application of 3D printing technology is helpful to the development of the pedicle screw placement plan，can effectively reduce the time of the pedicle screw placement in the course of the pedicle screw placement and improve the accuracy of the screw placement.
, 百拇医药
【Key words】 3D Printing Technology； Lumbar spondylolisthesis； Pedicle screws
First-author’s address：The People’s Hospital of Ganzhou，Ganzhou 341000，China
doi：10.3969/j.issn.1674-4985.2015.35.019
目前腰椎滑脱症的手术治疗主要以后路PLIF手术为主，虽然在滑脱椎体的复位与否上目前存在一定争议，然而目前达成共识的观点都认为腰椎滑脱手术的目的在于解决滑脱椎体的失稳定，手术治疗的最终目的为实现腰椎滑脱节段的融合[1-2]。在传统脊柱融合技术当中，椎弓根钉棒系统是目前应用最多且最为重要的技术，其中椎弓根螺钉的置入准确性与否直接影响最终的手术治疗效果，由于滑脱椎体与正常椎体解剖标志差异较大，以往经验的定位方法常导致椎弓根钉置入的困难以及螺钉的穿出，并导致严重的神经损伤[3-4]。本科自2014年开始引进美国Makerbot公司的3D打印机及配套MakerBot Desktop 3.6软件，并在腰椎滑脱患者术前进行应用，结合腰椎滑脱节段打印出的实体模型制定相应的椎弓根钉置钉计划，取得了较好的置钉效果，现报道如下。, http://www.100md.com(陈勤 陈荣春 游辉)