Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China; Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Liaoning Province, China.
Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, China.
J Clin Neurosci. 2020 Mar;73:294-298. doi: 10.1016/j.jocn.2020.01.083. Epub 2020 Feb 5.
The conventional surgical method of percutaneous pedicle screw fixation (PPSF) mainly uses X-ray fluoroscopy guidance to target the vertebral pedicle for screw placement. This study aimed to explore the feasibility of establishing a personalized drill guide template for PPSF based on a three-dimensional (3D) printing technique and to evaluate the accuracy and safety of the method for assisting screw insertion in cadaveric specimens. The T3-L3 trunk cadaveric specimens from six adults were subject to a computed tomography (CT) scan in the prone position. A three-dimensional model containing the back skin contour was reconstructed. A bilateral ideal pedicle screw in the T6-L1 segment was designed. Then, the reverse templates were designed. The two templates were fused and printed into an individualized guide template. PPSF was performed under the assistance of the guide template, and the CT scan was taken postoperatively to access the screw position. Ninety-six pedicle screws were successfully placed on the bilateral vertebral body of the T6-L1 segment with the assistance of a guide template. The guide plate was not loosened or displaced when operated by a single hand, and the operation time was 24.6 ± 7.9 s. The axial CT images after puncture indicated that in 96 puncture needles, 90 needles were grade I and 6 were grade II, with a puncture accuracy rate of 98.6%. In conclusion, an individualized PPSF navigation template was developed using Mimics software and 3D printing prototyping, which improved the accuracy of PPSF in cadaveric specimens.
经皮椎弓根螺钉固定（PPSF）的传统手术方法主要采用 X 射线透视引导，以瞄准椎弓根进行螺钉放置。本研究旨在探讨基于三维（3D）打印技术为 PPSF 建立个性化钻头导向模板的可行性，并评估该方法在尸体标本中辅助螺钉插入的准确性和安全性。对 6 具成年人的 T3-L3 躯干尸体标本进行俯卧位 CT 扫描。重建包含背部皮肤轮廓的三维模型。设计 T6-L1 节段双侧理想椎弓根螺钉。然后，设计反向模板。将两个模板融合并打印成个体化的导向模板。在导向模板的辅助下进行 PPSF，术后进行 CT 扫描以评估螺钉位置。在导向模板的辅助下，成功地在 T6-L1 节段的双侧椎体上放置了 96 枚椎弓根螺钉。单手操作时，导向板不会松动或移位，手术时间为 24.6±7.9 秒。穿刺后的轴向 CT 图像显示，在 96 根穿刺针中，90 根为 1 级，6 根为 2 级，穿刺准确率为 98.6%。总之，使用 Mimics 软件和 3D 打印原型制作了个性化的 PPSF 导航模板，提高了尸体标本中 PPSF 的准确性。
