Orthopedics Center of Zigong Fourth People's Hospital, Zigong, China.
Digital Medical Center of Zigong Fourth People's Hospital, Zigong, China.
Orthop Surg. 2020 Feb;12(1):241-247. doi: 10.1111/os.12620.
To evaluate the accuracy and safety of a combined 3D printed guide template (combined template) to assist iliosacral (IS) screw placement for sacral fracture and dislocation.
A total of 37 patients, 24 men and 13 women, age from 22 to 68 years old, diagnosed with a sacral fracture and dislocation were involved in this study for retrospective analysis from January 2016 to February 2018. There were 19 patients in the template group (42 screws) and 18 patients in the conventional group (31 screws). In the combined template group, IS screw placement was assisted by a combined 3D printed template; in the conventional group, the IS screws were placed freehand under fluoroscopy. The accuracy of the IS screw placement was evaluated by comparing the screw angle and the location of the screw entry point between the actual and the simulated screw in the combined template group. The safety of the IS screw placement was evaluated by comparing the quality of the reduction, the grading of the screws, the operation time, and radiation exposure times between groups.
A total of 73 pedicle screws were placed in 37 patients: 42 screws (30 S1, 12 S2) in the combined template group and 31 screws (23 S1, 8 S2) in the conventional group. In the conventional group, 1 patient developed symptoms of L5 nerve stimulation. In the combined template group, the average operative time of each screw was 25.01 ± 2.90 min, with average radiation exposure times of 12.05 ± 4.00. In the conventional group, the average operative time of each screw was 46.24 ± 9.59 min, with an average radiation exposure time of 56.10 ± 6.75. There were significant differences in operation and radiation exposure times between groups. The rate of screw perforation was lower in the combined template group (2 of 42 screws, 0 at grade III and 2 at grade II) than in the conventional group (5 of 38 screws, 2 at grade III and 3 at grade III). In the combined template group, the mean distance between the entry points of the actual and simulated screws was 1.4 ± 0.9 mm, with a mean angle of deviation of 2.1° ± 1.6°. All patients were followed up once every 3 months and were followed for 3 to 12 months.
Using the combined template to assist with the insertion of IS screws delivered good accuracy, less fluoroscopy and shorter operation time, and avoided neurovascular injury as a result of screw malposition.
评估联合 3D 打印导板（联合导板）辅助骶骨骨折和脱位骶髂（IS）螺钉置入的准确性和安全性。
回顾性分析 2016 年 1 月至 2018 年 2 月收治的 37 例诊断为骶骨骨折脱位的患者，男 24 例，女 13 例，年龄 22~68 岁。其中模板组 19 例（42 枚螺钉），常规组 18 例（31 枚螺钉）。在联合模板组中，使用联合 3D 打印模板辅助 IS 螺钉置入；在常规组中，透视下徒手置入 IS 螺钉。通过比较联合模板组实际和模拟螺钉的螺钉角度和螺钉进钉点，评估 IS 螺钉置入的准确性。通过比较两组间复位质量、螺钉分级、手术时间和射线暴露次数，评估 IS 螺钉置入的安全性。
37 例患者共置入 73 枚椎弓根螺钉：联合模板组 42 枚（30 枚 S1，12 枚 S2），常规组 31 枚（23 枚 S1，8 枚 S2）。常规组中，1 例患者出现 L5 神经刺激症状。联合模板组中，每枚螺钉的平均手术时间为 25.01±2.90 min，平均射线暴露时间为 12.05±4.00。常规组中，每枚螺钉的平均手术时间为 46.24±9.59 min，平均射线暴露时间为 56.10±6.75。两组手术时间和射线暴露时间差异均有统计学意义。联合模板组螺钉穿孔率较低（2 枚螺钉，0 级 2 枚，2 级 2 枚），常规组较高（5 枚螺钉，3 级 3 枚，3 级 2 枚）。联合模板组实际与模拟螺钉进钉点之间的平均距离为 1.4±0.9mm，平均偏差角度为 2.1°±1.6°。所有患者均每隔 3 个月随访一次，随访 3~12 个月。
使用联合模板辅助 IS 螺钉置入可获得良好的准确性，减少透视次数和缩短手术时间，并避免因螺钉位置不当导致的神经血管损伤。
