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目的 :探讨个性化导航模板辅助儿童颈椎椎弓根螺钉置入的可行性及准确性,并与徒手置钉进行对比。方法:选取儿童尸体4具,男女各2具,年龄6~9岁。随机分为2组,均行颈椎椎弓根螺钉置入术。徒手置钉组(A组)行徒手置钉;个性化导航模板辅助下置钉组(B组)依据颈椎CT扫描资料,利用计算机辅助及快速成型技术设计并制作出相应颈椎椎弓根螺钉置入个性化导航模板,行该模板辅助下置钉。置钉后行颈椎CT扫描评价两种置钉方法的置钉成功率及优级率并行统计分析。结果:A组共置入28枚螺钉,寰椎置入4枚螺钉,其中良级3枚、差级1枚;枢椎置入4枚螺钉,其中优级2枚、良级2枚;下颈椎(C3~C7)置入20枚螺钉,其中优级9枚、良级5枚、差级6枚。B组共置入28枚螺钉,寰椎置入4枚螺钉,其中良级2枚、差级2枚;枢椎置入4枚螺钉,其中优级3枚、良级1枚;下颈椎置入20枚螺钉,其中优级16枚、良级3枚、差级1枚。两组上颈椎的置钉成功率及优级率因样本数太少未进行统计学比较;两组下颈椎置钉的成功率及优级率均有统计学差异(P<0.05)。结论 :个性化导航模板辅助儿童下颈椎椎弓根螺钉置入术具有较好的置钉成功率,该方法操作简单、易于掌握,充分体现了儿童置钉个性化原则。
Objective: To explore the feasibility and accuracy of personalized navigation template for pedicle screw placement in pediatric cervical pedicle and to compare with pedicle screw fixation. Methods: 4 children were selected, 2 male and 2 female, aged 6 to 9 years old. Randomly divided into two groups, all underwent cervical pedicle screw placement. (Group A) underwent hand nailing; personalized navigation templates assisted nail placement group (Group B) based on cervical CT scan data, the use of computer-assisted and rapid prototyping technology to design and produce the corresponding cervical pedicle screw set Into the personalized navigation template, the template to help set the nail. After nailing, cervical spine CT scan was used to evaluate the success rate and superior grade rate of nail placement by two kinds of nailing methods. Results: There were 28 screws in group A and 4 screws in atlas, of which 3 were of good grade and 1 of poor grade; 4 screws were inserted into the axis of vertebra, of which 2 were good and 2 were good; Cervical vertebrae (C3 ~ C7) placed 20 screws, including 9 excellent, good 5, poor 6. Group B, a total of 28 screws into the atlas into the 4 screws, of which two good grades, the difference of 2; 4 vertebral screws placed, of which 3 excellent, good grade 1; Into 20 screws, of which 16 excellent grade, good grade 3, poor grade 1. The success rate and excellent grade of the upper cervical vertebrae in the two groups were not statistically compared because of too few samples. The success rates and excellent grades of the lower cervical vertebrae in both groups were significantly different (P <0.05). Conclusion: Personalized navigation template assisted pedicle screw placement in pediatric lower cervical spine has a good success rate of nail placement. The method is simple and easy to master, which fully reflects the principle of personalized pedicle screw placement.