Zhang J H, Gu Y J, Yu L, Zhao L J, Xiao W, Xu J F, Xu R M
Department of Spinal Surgery, Ningbo NO.6 Hospital, Ningbo 315040, China.
Ningbo University School of Medicine, Ningbo 315211, China.
Zhonghua Yi Xue Za Zhi. 2021 Mar 9;101(9):636-640. doi: 10.3760/cma.j.cn112137-20200612-01829.
To explore The feasibility of digital guidance drill templates assisted expansive open-door laminoplasty. Ten specimens of normal adult cervical spine (C) were selected, including six males and four females. The specimens aged 42-67 years, with an average age of (43.6±4.2) years. After CT scanning, the date was imported into Mimics software in DICOM format. 3D models were reconstructed and the position and depth of troughs on the open side and hinge side were selected for expansive open-door laminoplasty. Drill templates were designed and exported in STL, manufactured by 3D printing finally. Then drill templates were attached to the posterior part of cervical lamina and spinous process. Under guidance of templates, troughs of both sides were conducted by using a high-speed drill. Then the lamina is elevated and instrumentations were implanted. Postoperative CT scanning was conducted to record the fracture of trough on the hinge side. 3D reconstruction was performed again to compare the position and depth between theory and actual trough on both sides by paired test. A total of 50 drill templates were designed and manufactured. There was no occurrence of hinge fracture after operation. In C, the distance range between the theory position of troughs on the open side and the midline was 11.8-14.4 mm, while in actual it was 11.4-14.0 mm. The distance range between the theory position of troughs on the hinge side and the midline was 11.6-14.3 mm; in actual, it was 10.9-14.0 mm. The theory depth range of trough on the hinge side was 3.0-3.8 mm, while the actual depth was 3.1-3.8 mm. According to the statistical analysis, the difference in the position of trough on the open side, the position of trough on the hinge side and the depth of trough on the hinge side between theory and actual were not statistically significant (all >0.05). Digital guided template assisted open-door laminoplasty is a feasible technique, which can improve the accuracy and safety of the position and depth of the trough, and has clinical application value.
探讨数字引导钻孔模板辅助扩大开门式椎板成形术的可行性。选取10例正常成人颈椎标本，其中男性6例，女性4例。标本年龄42 - 67岁，平均年龄（43.6±4.2）岁。CT扫描后，将数据以DICOM格式导入Mimics软件。重建3D模型，选择开门侧和铰链侧槽的位置及深度用于扩大开门式椎板成形术。设计钻孔模板并导出为STL格式，最终通过3D打印制造。然后将钻孔模板附着于颈椎椎板和棘突后部。在模板引导下，使用高速钻头进行双侧开槽。然后抬起椎板并植入器械。术后进行CT扫描记录铰链侧槽的骨折情况。再次进行3D重建，通过配对检验比较双侧理论与实际槽的位置及深度。共设计并制造了50个钻孔模板。术后未发生铰链骨折。在颈椎中，开门侧槽的理论位置与中线的距离范围为11.8 - 14.4 mm，实际为11.4 - 14.0 mm。铰链侧槽的理论位置与中线的距离范围为11.6 - 14.3 mm；实际为10.9 - 14.0 mm。铰链侧槽的理论深度范围为3.0 - 3.8 mm，实际深度为3.1 - 3.8 mm。经统计分析，开门侧槽的位置、铰链侧槽的位置及铰链侧槽的深度在理论与实际之间的差异无统计学意义（均>0.05）。数字引导模板辅助开门式椎板成形术是一种可行的技术，可提高槽位置和深度的准确性及安全性，具有临床应用价值。
