Hu Yong, Yuan Zhen-Shan, Spiker William Ryan, Dong Wei-Xin, Sun Xiao-Yang, Yuan Jian-Bing, Zhang Jiao, Zhu Bingke
Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo, 315040, Zhejiang Province, China.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Eur Spine J. 2016 Jun;25(6):1706-15. doi: 10.1007/s00586-016-4540-2. Epub 2016 Mar 28.
The aim of this study was to assess the accuracy of rapid prototyping drill template technique for placing pedicle screws in the mid-upper thoracic vertebrae in clinics.
151 consecutive patients underwent thoracic instrumentation and fusion for a total of 582 pedicle screws placed in the mid-upper thoracic vertebrae. Using computer software, the authors constructed drill templates that fit onto the posterior elements of the mid-upper thoracic vertebrae with drill guides designed to instrument the pedicles. The start point and three dimensional location of the planned and inserted screws were measured and compared.
Grading of the CT scans revealed 559 (96.1 %) out of 582 screws completely within the desired pedicle. The direction of pedicle violation included 5 medial, 2 airball, and 16 lateral. The paired t test suggested that these results were statistically significant in more than half of the locations (T1-left-TA(P = 0.024), T2-left-SA(P = 0.031), T3-left-SA(P = 0.014), T4-left-TA(P = 0.004), T5-left-TA(P = 0.034), T7-left-TA(P = 0.000). T1-right-TA(P = 0.049), T2-right-TA(P = 0.044), T3-right-TA(P = 0.014), T5-right-TA(P = 0.013)). The paired t-test suggested that these results were statistically significant at several locations (T4-left-Δy(P = 0.041), T5-left-Δx(P = 0.016), T3-right-Δy(P = 0.015)).
Use of a rapid prototyping drill template to assist in the placement of mid and upper thoracic pedicle screws may lead to increased accuracy. This patient specific technology must be combined with an understanding of the patients' anatomy and carefully secured to the posterior elements intraoperatively to avoid nerve or vascular complications.
本研究旨在评估临床中快速成型钻孔模板技术在上胸椎置入椎弓根螺钉的准确性。
151例连续患者接受胸椎内固定融合术，共在上胸椎置入582枚椎弓根螺钉。作者使用计算机软件构建了适合上胸椎后部结构的钻孔模板，并设计了用于椎弓根器械操作的钻孔导向器。测量并比较计划置入和实际置入螺钉的起始点及三维位置。
CT扫描分级显示，582枚螺钉中有559枚（96.1%）完全位于理想的椎弓根内。椎弓根侵犯方向包括5枚向内侧、2枚呈气圈样、16枚向外侧。配对t检验表明，在超过一半的位置这些结果具有统计学意义（T1左侧 - TA（P = 0.024），T2左侧 - SA（P = 0.031），T3左侧 - SA（P = 0.014），T4左侧 - TA（P = 0.004），T5左侧 - TA（P = 0.034），T7左侧 - TA（P = 0.000）。T1右侧 - TA（P = 0.049），T2右侧 - TA（P = 0.044），T3右侧 - TA（P = 0.014），T5右侧 - TA（P = 0.013））。配对t检验表明，在几个位置这些结果具有统计学意义（T4左侧 - Δy（P = 0.041），T5左侧 - Δx（P = 0.016），T3右侧 - Δy（P = 0.015））。
使用快速成型钻孔模板辅助上胸椎椎弓根螺钉置入可能会提高准确性。这种针对患者的技术必须结合对患者解剖结构的了解，并在术中小心固定于后部结构，以避免神经或血管并发症。
