目的:比较徒手和3D打印导航模板辅助螺钉置入Ⅱ型陈旧性齿状突骨折的安全性和临床疗效。
方法:2018年11月至2022年12月收治陈旧性齿状突Ⅱ型骨折患者38例,均表现为慢性颈痛。根据椎弓根螺钉插入方法的不同,将患者分为导航模板组和徒手组.在导航模板组中,其中男9例,女8例,平均年龄(51.30±13.20)岁,病程为(22.18±7.59)个月。在写意组中,其中男7例,女14例,平均年龄(49.46±11.92)岁,病程为(19.52±9.17)个月。术中失血,操作时间,记录并比较两组的术后引流量。通过CT扫描评估螺钉放置的准确性。手术前和手术后1年,通过视觉模拟评分(VAS)评估颈椎疼痛,通过日本骨科协会(JOA)评分评估神经系统变化,采用美国脊髓损伤协会(ASIA)损伤量表评定脊髓损伤程度。
结果:所有患者均获随访(25.31±1.21)个月。模板组手术时间(112.00±20.48)min明显短于徒手组(124.29±15.24)min(P<0.05),而两组在术中出血量方面无显著差异,术后引流,住院时间(P>0.05)。手术后1年,在模板组和徒手组中,VAS[(2.88±0.86),(2.90±0.83)]和JOA[(14.94±1.82),(14.62±2.19)]术前改善[VAS(4.71±0.92),(4.86±0.79)和JOA(12.18±2.30),(11.95±2.31)](P<0.05),两组间差异无统计学意义(P>0.05)。两组患者术后1年ASIA分级均无明显改善(P>0.05)。两组间差异无统计学意义(P>0.05)。模板组椎弓根螺钉置入精度明显优于徒手组(P<0.05),两组椎弓根置钉的准确性差异无统计学意义(P>0.05)。
结论:后路椎弓根螺钉内固定治疗Ⅱ型陈旧性齿状突骨折,3D打印导航模板螺丝放置可以显著缩短操作时间,达到与徒手螺钉置入相似的临床疗效,并显著提高了螺钉在椎弓根中轴的放置精度。
OBJECTIVE: To compare the safety and clinical efficacy of freehand and 3D printing navigation template assisted screw placement in patients with old odontoid fractures of typeⅡ.
METHODS: Total of 38 patients with old odontoid fractures of typeⅡwere treated from November 2018 to December 2022, all of which presented as chronic neck pain. According to the different methods of screw insertion into the pedicle, the patients were divided into a navigation template group and a freehand group. In the navigation template group, there were 17 patients including 9 males and 8 females with an average age of (51.30±13.20) years old, disease duration was (22.18±7.59) months. In the freehand group, there 21 patients including 7 males and 14 females with an average age of (49.46±11.92) years old, disease duration was (19.52±9.17) months. The intraoperative blood loss, operation time, and postoperative drainage output were recorded and compared between two groups. The accuracy of screw placement was evaluated by CT scan. Before operation and 1 year after operation, cervical pain was assessed by visual analogue scale(VAS), neurological changes were evaluated by the Japanese Orthopaedic Association (JOA) score, and the degree of spinal cord injury was assessed by the American Spinal Injury Association (ASIA) injury scale.
RESULTS: All patients were followed up for (25.31±1.21) months. The operation time of template group (112.00±20.48) min had significantly shorter than that of the freehand group(124.29±15.24) min(P<0.05), while there were no significant differences between two groups in terms of intraoperative blood loss, postoperative drainage, and hospital stay(P>0.05). At 1 year after operation, in template group and freehand group, the VAS [(2.88±0.86), (2.90±0.83)] and JOA [(14.94±1.82), (14.62±2.19)] improved with preoperative [VAS(4.71±0.92), (4.86±0.79) and JOA (12.18±2.30), (11.95±2.31)](P<0.05), with no significant difference between two groups (P>0.05). No significant improvement was observed in ASIA grading in either group at 1 year after operation(P>0.05), and there was no significant difference between two groups(P>0.05). The template group had significantly better accuracy of screw placement in the pedicle of the axis than the freehand group (P<0.05), while no significant difference was observed between two groups in the accuracy of screw placement in the pedicle of the atlas (P>0.05).
CONCLUSIONS: In the treatment of typeⅡold odontoid fractures with posterior pedicle screw fixation, 3D printing navigation template screw placement can significantly shorten the operation time, achieve similar clinical efficacy as free-hand screw placement, and significantly improve the accuracy of screw placement in the pedicle of the axis.