3D打印技术用于腰椎椎弓根螺钉植入术的可行性分析

摘要

Objective To explore the feasibility of 3D printing technique for lumbar vertebral pedicle screw implantation.Method We selected the thin CT scan data of 40 healthy human lumbar vertebrae (L1-5),and designed the navigation in the pedicle center to obtain the navigation module.Through 3D printing technology,we printed out the navigation module and lumbar model,and implanted the lumbar vertebral pedicle screw with the assistant of navigation module.Meanwhile,we observed the entry point,screw direction and screw position clearly to determine whether the pedicle cortex was damaged or not.With the assistance of the navigation module,we performed lumbar pedicle screw implantation on adult lumbar (body) specimens and evaluated the placement effect.Results We applied the navigation module to perform 98 times of placement experiments (98 pedicle screws) in both the 3D printed lumbar models and adult lumbar specimens,including 18 times on L1,L2 22,L3 21,L4 19,and L5 18;no statistically significant difference was found between the virtual screw length and the actual screw length (all P ＞ 0.05).The entry point of all the screws,the direction of the screws and the position of the screw in the pedicle conformed to the predicted nail path,and all the other structures beside the pedicle were not damaged.Conclusion The 3D printing lumbar navigation module can guide the lumbar screw implantation,and the implanted screws have no deviation in the entry point,the direction of the nail entry and the fixed position.%目的 探讨3D打印技术指导腰椎椎弓根螺钉植入术的可行性.方法 提取40例健康人腰椎(L1～5)薄层CT扫描数据,在椎弓根中心设计导航,获得导航模块.通过3D打印技术打印出导航模块和腰椎模型,在导航模块辅助下植入腰椎椎弓根螺钉,观察植入螺钉的进钉点、进钉方向及螺钉在椎弓根内的位置,明确椎弓根皮质是否破坏.在导航模块辅助下,于成人腰椎(尸体)标本上实施腰椎椎弓根螺钉植入,评价置钉效果.结果 3D打印腰椎模型及成人腰椎标本应用导航模块均进行98次(置钉98枚)置钉实验,其中L1均为18枚、L2均为22枚、L3均为21枚、L4均为19枚、L5均为18枚,虚拟钉道长度与实际钉道长度比较差异均无统计学意义(P均＞0.05).全部螺钉的进钉点、进钉方向及螺钉于椎弓根内的位置均与方案中预见的钉道相符合,均未损伤椎弓根旁其余结构.结论 3D打印腰椎导航模块可指导腰椎螺钉植入,植入的螺钉在进钉点、进钉方向及固定位置等方面均无偏差.