应用数字计算机辅助设计快速成型技术指导翻修儿童寰枢椎术后复发脱位

摘要

目的 探讨应用计算机辅助设计快速成型(computer aided design and rapid prototype,CAD-RP) 技术指导儿童术后复发寰枢椎脱位行后路椎弓根螺钉固定的可行性及临床疗效.方法 对12例5～13岁术后复发寰枢椎脱位的儿童,根据CT数据应用CAD-RP技术制作寰枢椎实物模型,在气管插管全麻下依据模型进行寰枢椎后路椎弓根钉棒固定翻修,术后评价复位情况及螺钉位置情况.结果 全组12例患者均获寰枢椎椎弓根螺钉固定,术后随访3～19个月,平均9个月,临床症状得到不同程度的改善;X线、CT复查显示复位满意,螺钉位置良好,无松动、断钉,植骨3～6个月均达到满意融合.结论 儿童具有进行寰枢椎椎弓根螺钉固定的临床可行性,CAD-RP技术可提升寰枢椎螺钉固定和上颈椎翻修手术的准确性和安全性.%Objective To evaluate the feasibility and the clinical effectiveness of digital computer-aided design and rapid prototype (CAD-RP) techniques in guiding the C1 and C2 pedicle screw placement for repairing the C1/C2 re-dislocation in children patients following atlantoaxial operation. Methods The real size C1/C2 models of 12 post-operation atlantoaxial re-dislocation children (from 5 to 13 years old) were constructed based on CT data using CAD-RP techniques. Under general anesthesia, pedicle screw-rod repair was employed via atlantoaxial posterior approach according to the constructed model of 12 children, and then the reduction degree and the screw position were evaluated. Results All the 12 cases achieved C1,2 screw-rods fixation and were followed up for 3-19 months, with an average of 9 months. The clinical symptoms of patients were all improved to some extent. Satisfactory C1/C2 reduction and screw position were verified by the postoperative reontgenographs and CT scans. There were no loosening or breaking of the screw. All patients had a solid bone fusion on radiographs at 3-6 months after surgery. Conclusion C1 and C2 pedicle screws can be placed in children patient safely, and CAD-RP technique can enhance the accuracy of the C1/C2 pedicle screw placement and the safety of the atlantoaxial re-operation.