数字骨科技术在颅颈交界疾患外科治疗中的临床应用

摘要

目的 评价数字骨科技术在治疗颅颈交界疾患中的临床意义.方法 2010年1月～2010年12月,43例颅脊交界疾患病例应用临床数字骨科技术进行治疗.所有病例均通过计算机辅助设计快速成型(computer aided design and rapid prototype,CAD-RP)技术制作颅脊交界区的1:1三维模型实物;部分复杂病例通过术前在模型实物上模拟手术进钉,获得准确进钉角度、方向,为在体手术提供参考;部分复杂后路手术在软件中设计并制作椎弓根螺钉导向钻套模板,术中采用该模板指导实时进钉.采用的手术方法为经口寰枢椎复位内固定钢板(transoral atlantoaxial reduction plate,TARP)手术30例,后路寰枢椎弓根螺钉固定7例及枕颈固定6例.结果 43例患者颈部疼痛和肢体麻木无力症状均不同程度改善.术后5例美国脊髓损伤协会(American spinal injury association,ASIA)分级为E级(运动评分100分)的患者无变化,但颈痛缓解;33例D级患者中9例改善至E级,其余24例分级无变化,但术后运动评分改善至86～100分(96.2±4.1);5例C级患者均改善至D级.38例术前为C级和D级的患者术后评分增加5～35分(15.2±9.1).术后随访3～12个月,平均7.3个月,无感染、神经血管损伤和钉板松脱等手术并发症发生,小部分病例术后有短暂头晕,术后2周～1个月自愈.结论通过数字骨科技术制作的实物模型进行预手术操作以及通过制作的螺钉导向模板指导在体手术,可以使复杂的颅脊交界疾患手术简单化,而且安全有效.%Objective To evaluate the clinical application of digital orthopedics technique in surgical treatment of craniocervical diseases.Methods Totally 43 patients with cranio-cervical disease were surgically treated with the assistance of digital orthopedics technique during January 2010 to December 2010.Three-dimensional cranio-cervical models of real size (1:1 ) were constructed by computer aided design and rapid prototype (CAD-RP) for all cases.Preoperational screw-insertion simulation of the model was performed for some cases to obtain the accurate angle and direction for the screw insertion.The drilling-gnided template of posterior C1/C2 transpedicualr screw was designed for some complicated posterior operations.The surgical treatments included 30 receiving transoral atlantoaxial reduction plate (TARP) internal fixation, 7 receiving afiantoaxial transpedicular screw internal fixation, and 6 receiving occipito-cervical internal fixation.Results Postoperatively thesymptoms of neck pain and extremity anesthesia or asthenia were improved to different degrees in all the 43 cases.Five patients of E degree (motor score was 100) preoperatively remained unchanged after the operation, but their neck pain was completely resolved.Nine of the 33 patients of D degree were improved to E degree after operation; the other 24 patients had no degree changes, but their motor scores increased to 86-100, with a mean of 96.2 ±4.1.Five patients of C degree improved to D degree.The motor score of the 38 patients of D and E degrees was increased by 5-35 ( 15.2 ±9.1 ) after operation.No neurological, vascular complications or screw-loosening was observed during a follow up of 3-12 months ( a mean of 7.3 months).Some patients receiving TARP internal fixation developed slight dizziness, which disappeared 2-4 weeks postoperatively.Conclusion The digital orthopedics techniques, including preoperative screw insertion simulation on the craniocervical model and the application of drilling-guided template for the C1/C2 transpedicular screw insertion, make the complicated cranio-cervical operation simple, safe and effective.