Clinical Application of Computer-aided Design-Rapid Prototyping in C1–C2 Operation Techniques for Complex Atlantoaxial Instability
Clinical Application of Computer-aided Design-Rapid Prototyping in C1–C2 Operation Techniques for Complex Atlantoaxial Instability
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DOI：
10.1097/01.bsd.0000450173.95940.ed
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发表时间：
2014-06
影响因子：
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通讯作者：
Jincheng Yang;Xiang-yang Ma;H. Xia;Zenghui Wu;Fuzhi Ai;Kai Zhang;Qing‐shui Yin
中科院分区：
文献类型：
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作者：
Jincheng Yang;Xiang-yang Ma;H. Xia;Zenghui Wu;Fuzhi Ai;Kai Zhang;Qing‐shui Yin
研究设计：这是一项回顾性临床研究。目的：评价计算机辅助设计-快速成型（CAD-RP）技术在寰枢椎不稳（AAI）手术治疗中的临床疗效。背景数据汇总：上颈椎解剖结构的复杂性使得治疗AAI的手术对外科医生来说特别具有挑战性。本研究代表了一系列CAD-RP辅助下的AAI C1-C2手术。方法：49例AAI患者，男21例，女28例。根据CAD-RP技术的使用情况，将患者分为RP组和非RP组。术前对每例患者进行上颈椎CT扫描。对于RP组，根据三维CT数据制作上颈椎的物理RP模型，并用于术中指导。2组均采用个性化手术方式。比较两组的螺钉错位率、术中透视使用频率、手术时间、失血量和神经功能改善情况。平均随访时间为32个月（范围，24-50个月）。结果：48例手术成功，无RP组1例手术失败。共置入204枚螺钉。在后路和前路中，RP组的术中透视频率和手术时间均显著低于无RP组，而两组的螺钉错位率在两种入路中均无差异。术后48例颈髓减压、寰枢椎复位满意。在随访期间，47例患者在2年内出现脊神经功能改善。结论：CAD-RP技术对于外科医生提供个性化AAI治疗具有显著的益处，特别是复杂畸形的病例。
Study Design: This is a retrospective clinical study. Objective: To evaluate the clinical efficacy of computer-aided design-rapid prototyping (CAD-RP) techniques in surgical treatments for atlantoaxial instability (AAI). Summary of Background Data: The complexity of the upper cervical anatomic structures makes the procedures for the treatment of AAI particularly challenging for surgeons. The present study represents a series of C1–C2 surgery for AAI aided by CAD-RP. Methods: A total of 49 patients (21 men and 28 women) with AAI were treated in our department. According to the use of the CAD-RP technique, the patients were divided into RP group and No RP group. Preoperative CT scans of the upper cervical spine were performed for each patient. For the RP group, physical RP models of the upper cervical spine were manufactured from the 3-dimensional CT data and were used for intraoperative guidance. Personalized surgeries were performed for each case of the 2 groups. The screw malposition rate, frequency of using intraoperative fluoroscopy, operation time, blood loss, and improvement of neurological function were compared between the 2 groups. The mean follow-up duration was 32 months (range, 24–50 mo). Results: The operations were successfully performed in 48 cases expect for 1 case in the No RP group. A total of 204 screws were placed. The intraoperative fluoroscopy frequency and operation time were significantly lower in the RP group than that in the No RP group in both posterior and anterior approaches, whereas the screw malposition rate showed no difference between the 2 groups for both approaches. After the operation, 48 cases achieved satisfactory decompression of the cervical cord and repositioning of the atlantoaxial spine. During follow-up, 47 cases presented improvements in the spinal nerve function within 2 years. Conclusions: CAD-RP techniques have significant benefits for surgeons providing personalized treatments for AAI, especially cases with complicated deformities.