Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Curr Med Sci. 2018 Dec;38(6):1090-1095. doi: 10.1007/s11596-018-1988-9. Epub 2018 Dec 7.
This study is aimed to explore the clinical application of the guiding template designed by three-dimensional printing data for the insertion of sacroiliac screws. A retrospective study of 7 cases (from July 2016 to December 2016), in which the guiding template printed by the threedimensional printing technique was used for the insertion of sacroiliac screws of patients with posterior ring injuries of pelvis, was performed. Totally, 4 males and 3 females were included in template group, aged from 38 to 65 years old (mean 50.86±8.90). Of them, 5 had sacral fractures (3 with Denis type I and 2 with type II) and 2 the separation of sacroiliac joint. Guiding templates were firstly made by the three-dimensional printing technique based on the pre-operative CT data. Surgical operations for the stabilization of pelvic ring by applying the guiding templates were carried out. A group of 8 patients with sacroiliac injuries treated by percutaneous sacroiliac screws were analyzed as a control group retrospectively. The time of each screw insertion, volume of intra-operative blood loss, and the exposure to X ray were analyzed and the Matta's radiological criteria were used to evaluate the reduction quality. The Majeed score was used to evaluate postoperative living quality. The visual analogue scale (VAS) was applied at different time points to judge pain relief of coccydynia. All the 7 patients in the template group were closely followed up radiographically and clinically for 14 to 20 months, mean (16.57±2.44) months. Totally 9 sacroiliac screws for the S1 and S2 vertebra were inserted in the 7 patients. The time length for each screw insertion ranged from 450 to 870 s, mean (690.56±135.68) s, and the number of times of exposure to X ray were 4 to 8, mean (5.78±1.20). The intra-operative blood loss ranged from 45 to 120 mL, mean (75±23.32) mL. According to Matta's radiology criteria, the fracture and dislocation reduction were excellent in 6 cases and good in 1. The pre-operative VAS score ranged from 5.2 to 8.1, mean (7.13±1.00). The average one-week/six-month post-operative VAS was (5.33±0.78) and (1.33±0.66), respectively (P<0.05 when compared with pre-operative VAS). The 12-month postoperative Majeed score ranged from 86 to 92, mean (90.29±2.21). The three-dimensional printed guiding template for sacroiliac screw insertion, which could significantly shorten the operation time, provide a satisfied outcome of the stabilization of the pelvic ring, and protect doctors and patients from X-ray exposure, might be a practical and valuable new clinical technique.
本研究旨在探索三维打印数据引导模板在骶髂螺钉置入中的临床应用。回顾性分析 2016 年 7 月至 2016 年 12 月采用三维打印技术引导模板置入骨盆后环损伤患者骶髂螺钉的 7 例（男 4 例，女 3 例）患者资料。模板组年龄 3865 岁，平均 50.86±8.90 岁。其中骶骨骨折 5 例（Denis Ⅰ型 3 例，Ⅱ型 2 例），骶髂关节分离 2 例。基于术前 CT 数据，采用三维打印技术制作引导模板。应用引导模板行骨盆环稳定术。回顾性分析同期采用经皮骶髂螺钉治疗的 8 例骶髂关节损伤患者作为对照组。分析两组患者的置钉时间、术中出血量、X 线透视次数，采用 Matta 影像学标准评价复位质量，采用 Majeed 评分评价术后生活质量，采用视觉模拟评分（VAS）评估不同时间尾骨痛缓解情况。模板组 7 例患者均获得随访，随访时间 1420 个月，平均（16.57±2.44）个月。7 例患者共置入 S1、S2 骶髂螺钉 9 枚，置钉时间 450870 s，平均（690.56±135.68）s，X 线透视次数 48 次，平均（5.78±1.20）次；术中出血量 45120 mL，平均（75±23.32）mL。根据 Matta 影像学标准，6 例复位优良，1 例复位良好。术前 VAS 评分 5.28.1 分，平均（7.13±1.00）分；术后 1 周、6 个月 VAS 评分分别为（5.33±0.78）、（1.33±0.66）分，与术前比较差异有统计学意义（P<0.05）。术后 12 个月 Majeed 评分 86~92 分，平均（90.29±2.21）分。三维打印引导模板辅助骶髂螺钉置入术可明显缩短手术时间，获得满意的骨盆环固定效果，减少医患 X 线暴露，是一种实用、有价值的新技术。
