Department of Orthopedics, The 920th Hospital of Joint Logistic Support Force of PLA, Kunming, 650032, China.
Department of Neurosurgery, The 452 Hospital of Western Air Force, Chengdu, 610021, China.
Eur Spine J. 2021 Feb;30(2):498-506. doi: 10.1007/s00586-020-06644-9. Epub 2020 Oct 23.
The objective of the study was to compare the safety, efficacy, and accuracy of the pedicle screws with the three-dimensional (3D) printed navigation template to the free-hand screws for type II odontoid fractures.
A total of 60 patients with type II odontoid fractures, treated with either template guiding pedicle screws or free-hand screws, were retrospectively assessed. The guiding group was treated with pedicle screws with the assistance of a virtual reality (VR) software-designed, 3D printed navigation template with two guide tubes. The safety rate and treatment efficacy of the screw placement, as well as the trajectory accuracy, were evaluated by respective measures and compared between two surgical groups.
There were reduced surgical time (P < 0.05), blood loss (P < 0.01), and C-arm shots (P < 0.01) with 3D printed template guiding screws. The rates of safe pedicle screws in both C1 and C2 were significantly higher in 3D guiding group (P < 0.01) compared to the free-hand group, and the scores of visual analogue scale (VAS) and impairment scale (ASIA) were improved in guiding group at 1 week post-surgery (P < 0.01 and P < 0.05, respectively). Postoperative CT and image reconstruction showed the 3D guiding group had better horizontal screw accuracy on both sides of C1 (L: P < 0.001, R: P < 0.01) and C2 (L: P < 0.001, R: P < 0.01) than free-hand group.
The herein screw technique using 3D printed navigation template leads to greater improvement in the screw safety, efficacy, and accuracy, which may be a promising alternative to free-hand surgery for the treatment of odontoid fractures.
本研究旨在比较使用三维（3D）打印导航模板辅助下的经皮椎弓根螺钉与徒手螺钉治疗Ⅱ型齿状突骨折的安全性、疗效和准确性。
回顾性评估了 60 例接受模板引导椎弓根螺钉或徒手螺钉治疗的Ⅱ型齿状突骨折患者。在引导组中，使用虚拟现实（VR）软件设计的、带有两个导向管的 3D 打印导航模板辅助经皮椎弓根螺钉置入。通过各自的措施评估螺钉放置的安全性和治疗效果，并比较两组手术的轨迹准确性。
3D 打印模板引导螺钉组的手术时间（P < 0.05）、术中出血量（P < 0.01）和 C 臂机透视次数（P < 0.01）均减少。3D 引导组 C1 和 C2 安全椎弓根螺钉的比例明显高于徒手组（P < 0.01），引导组术后 1 周视觉模拟量表（VAS）和损伤量表（ASIA）评分均有所改善（P < 0.01 和 P < 0.05）。术后 CT 和图像重建显示，3D 引导组在 C1（L：P < 0.001，R：P < 0.01）和 C2（L：P < 0.001，R：P < 0.01）两侧的水平螺钉准确性均优于徒手组。
使用 3D 打印导航模板的螺钉技术可显著提高螺钉的安全性、疗效和准确性，可能成为治疗齿状突骨折的一种有前途的徒手手术替代方法。
