Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland).
Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland).
Med Sci Monit. 2019 Dec 26;25:9981-9990. doi: 10.12659/MSM.918440.
BACKGROUND Since C2 is adjacent to important nerves and blood vessels, the implantation risk of C2 internal fixation in this area is high and requires high accuracy. This study mainly discussed the application value of 3-dimensional (3D)-printed navigation template in C2 screw placement. MATERIAL AND METHODS A retrospective study compared 3D-printed navigation template-assisted screw placement (group A, n=32) and the C-arm based navigation-assisted screw placement group (group B, n=32). Group A was divided into 2 subgroups: A1 (C2 pedicle screw placement) and A2 (C2 pars screw placement); group B was divided into B1 (C2 pedicle screw placement) and B2 (C2 pars screw placement). The accuracy and safety of screw placement and clinical outcomes were evaluated. RESULTS There were 64 C2 screws placed in group A, and 95.31% achieved a grade A accuracy rating, including 52 screws in group A1 (96.15% grade A) and 12 screws in group A2 (91.67% grade A). A total of 64 C2 screws were placed in group B, and 84.38% achieved a grade A accuracy rating, including 50 screws in group B1 (84.00% grade A) and 14 screws in group B2 (85.71% grade A). The accuracy of screw placement differed significantly between groups A and B (=0.041) and between groups A1 and B1 (=0.039) but not between groups A2 and B2 (=0.636). The postoperative efficacy of the 2 groups was satisfactory. And there were no complications of blood vessels or nerves related to screw placement in either group. CONCLUSIONS Although 3D-printed navigation template-assisted and C-arm based navigation-assisted C2 pedicle and pars screw placement provided similar safety and clinical efficacy, 3D-printed navigation template technology achieved more accurate C2 pedicle screw placement.
背景：由于 C2 紧邻重要的神经和血管，因此在此区域进行 C2 内固定的植入风险较高，需要高精度。本研究主要探讨了 3 维（3D）打印导航模板在 C2 螺钉放置中的应用价值。
材料与方法：回顾性研究比较了 3D 打印导航模板辅助螺钉放置组（A 组，n=32）和 C 臂导航辅助螺钉放置组（B 组，n=32）。A 组分为 2 个亚组：A1（C2 椎弓根螺钉放置）和 A2（C2 椎板螺钉放置）；B 组分为 B1（C2 椎弓根螺钉放置）和 B2（C2 椎板螺钉放置）。评估螺钉放置的准确性和安全性以及临床结果。
结果：A 组共放置 64 枚 C2 螺钉，其中 95.31%达到 A 级准确性评分，包括 A1 组 52 枚螺钉（96.15%A 级）和 A2 组 12 枚螺钉（91.67%A 级）。B 组共放置 64 枚 C2 螺钉，其中 84.38%达到 A 级准确性评分，包括 B1 组 50 枚螺钉（84.00%A 级）和 B2 组 14 枚螺钉（85.71%A 级）。A 组与 B 组（=0.041）、A1 组与 B1 组（=0.039）之间的螺钉放置准确性差异有统计学意义，但 A2 组与 B2 组（=0.636）之间无统计学意义。两组的术后疗效均满意，且两组均未发生与螺钉放置相关的血管或神经并发症。
结论：虽然 3D 打印导航模板辅助和 C 臂导航辅助 C2 椎弓根和椎板螺钉放置具有相似的安全性和临床疗效，但 3D 打印导航模板技术可实现更精确的 C2 椎弓根螺钉放置。
