To Evaluate The Application Effect Of Personalized 3D Printing Technology In Posterior Pedicle Screw Placement For Basilar Invagination

Objective(s): To observe the application effect of personalized 3D printing technology in posterior pedicle screw placement in basilar invagination.Methods: By referring to patient medical records such as course records,surgical records,anesthesia records,nursing records and imaging data in the united medical record system and imaging system,a retrospective analysis was conducted between January 2010 and October 2022.Patients who underwent surgical treatment for basilar invagination in the Department of Orthopedics and Neurosurgery in the First People’s Hospital of Yunnan Province(pedicle screws were placed by the same group of orthopedics physicians in both groups)were divided into 2 groups according to whether personalized 3D printing technology was used to assist pedicle screw placement: 1.A total of 29 patients,including 12 males and 17 females,aged(49.17±5.32)years,were assisted by personalized 3D printing technology.2.A total of 40 patients were enrolled in the group without personalized 3D printing technology,including 16 males and 24 females,aged(48.41±3.94)years.t test of independent samples and Chi-square test were used to analyze the cervical JOA scores of patients in 1 and 2 groups before surgery and 1,3 and 6 months after surgery.The anterior and posterior space of the atlas,the spinal horn of the brainstem and the convex teeth were compared between the two groups before and after surgery.2.Operation time and intraoperative blood loss of the two groups;3.Intraoperative and postoperative complications(nerve and vascular injury)were recorded;4.The accuracy of pedicle screw placement in the two groups was evaluated using the Gertzbein-Robbins classification criteria for pedicle screw placement.Statistical analysis was performed.Results: 1.Preoperative cervical spine JOA score of the 3D printing group was10.39 ± 2.39(points),and that of the non-3D printing group was 10.28 ± 2.73(points).1,3 and 6 months after surgery,JOA scores of cervical vertebrae in the two groups were as follows: 3D printing group: 12.19 ±2.76(points),14.73 ±1.92(points),15.52 ±2.85(points);Non-3d printing group: 11.28 ±2.53(min),13.89 ±2.01(min),14.57 ±2.62(min);There was no statistically significant difference between the two groups in cervical spine JOA assessment,but there was statistically significant difference between the two groups before and after surgery.ADI(mm),PDI(mm),CAM(°)and CL(mm)of the two groups before and after surgery were 6.26±2.33,10.58±2.19,128.47±8.31,12.11±2.93 in the 3D printing group,respectively.In the3 D printing group,1.94±0.62,15.73±2.41,137.06±6.74,6.93±1.72;Non-3d printing group: 6.74±2.42,10.43±2.41,127.52±8.27,12.15±2.87 before operation;Postoperative results in the non-3D printing group: 2.01±0.58,15.27±2.39,136.73±7.24,7.01±1.68,there was no statistical significance between the two groups,and there was statistical significance in preoperative and postoperative comparison between the two groups.2.The operative time(230.34 ±108.25min)and intraoperative blood loss(177.59 ±109.86ml)in the 3D printing group were compared with that in the non-3D printing group(304.13 ±94.47min)and intraoperative blood loss(249.83 ±170.97ml).The difference between the two groups was statistically significant.3.In the 3D printing group(29 cases),there were no vertebral artery and nerve injuries;In the non-3D printing group(40 cases),5 cases(12.5%)had vertebral artery and injury after surgery.Postoperative incision infection occurred in both groups,including 2 cases(6.9%)in the 3D printing group and 4 cases(10%)in the non-3D printing group.All the patients recovered after debridement with antibiotics.4.78 pedicle screws were implanted with the assistance of various 3D printing techniques: Class A: 73 screws(93.59%),Class B: 5 screws(6.41%);A total of 110 pedicle screws were implanted in the non-3D printing group,including 89(80.92%)of class A.Category B: 15(13.63%);Class C: 6(5.45%);The comparison of the two groups of data was statistically significant.Conclusion(s):Personalized 3D printing assisted technology can more intuitively understand the patient’s anatomy,more accurate postoperative nail placement,reduce postoperative complications,surgical time and intraoperative blood loss.