方法:前瞻性研究。
目的:评估使用三维(3D)打印模型管理颅骨(CV)连接异常的实用性和局限性。
背景:与其他骨和血管异常相比,CV连接异常难以治疗。对于不可约寰枢椎脱位(AAD)的病例,后路复位和稳定已取代前路减压作为标准治疗方案.使用3D模型,如本文所述,可以为外科医生提供有关椎动脉途径和与CV连接异常相关的骨异常的深入知识。
方法:分析了2017年3月至2019年2月在SawaiManSingh医学院治疗的18例CV连接异常患者的临床和影像学特征。斋浦尔,印度。获得并研究了CV交界处的动态计算机断层扫描(CT)和颈部相对于C1-C2关节处椎动脉的CT血管造影。然后根据CT数据制作CV接头的定制3D模型,在进行实际手术的前一天,使用3D模型进行了外科手术的预演。
结果:17例患者患有先天性AAD,而一名患者患有创伤后AAD。在随访中,所有患者的颈部疼痛和脊髓病都得到了改善,使用视觉模拟量表和日本骨科协会量表评分进行分析,分别。没有螺钉错位或任何直接椎动脉损伤的病例,虽然一个病人,当优势椎动脉在骨弓和螺钉头之间被压缩时,远端血流被切断。
结论:与计算机生成的图像相比,3D打印模型是处理复杂CV连接异常的更实用的方法。它们为外科医生提供了对复杂的骨异常以及椎动脉路径变化的深刻见解,从而改善手术效果。
METHODS: Prospective study.
OBJECTIVE: To evaluate the utility and limitations of using three-dimensional (3D)-printed models for the management of
craniovertebral (CV) junction abnormalities.
BACKGROUND: In comparison to other bony and vascular anomalies, CV junction abnormalities are difficult to treat. For cases of irreducible atlantoaxial dislocation (AAD), posterior reduction and stabilization have replaced anterior decompression as the standard management protocol. The use of 3D models, such as those described herein, can provide surgeons with in-depth knowledge of the vertebral artery course and bony anomalies associated with CV junction abnormalities.
METHODS: Clinical and radiological features of 18 patients with CV junction abnormalities were analyzed between March 2017 and February 2019 at Sawai Man Singh Medical College, Jaipur, India. Dynamic computed tomography (CT) of the CV junction and CT angiographies of the neck with respect to the vertebral artery course at the C1-C2 joints were obtained and studied. Customized 3D models of the CV junction were then made based on the CT data, and rehearsal of the surgical procedure was performed using the 3D model one day prior to performing the actual procedure.
RESULTS: Seventeen patients had congenital-type AAD, whereas one patient had posttraumatic AAD. Improvements in neck pain and myelopathy were seen in all patients at the follow-up, as analyzed using the Visual Analog Scale and the Japanese Orthopedic Association Scale score, respectively. There were no cases of malpositioning of screws or any direct vertebral artery injury, although in one patient, the distal flow in the dominant vertebral artery was cut off as it got compressed between the bony arch and the screw head.
CONCLUSIONS: Compared to computer-generated images, 3D-printed models are a more practical approach for dealing with complex CV junction abnormalities. They provide surgeons with deep insights into the complex bony anomalies as well as variations in the vertebral artery courses, thereby improving surgical outcomes.