3D Printing Individualized Navigation Module And The Computer Navigation System On The Effect Of The Lumbar Pedicle Screw Placement

Objective: to study the application of 3D printing individualized navigation module auxiliary lumbar pedicle screw placement accuracy,nailing time,blood loss and curative effect,and compared with computer navigation system for analysis,so as to not basic-level hospitals navigation equipment to provide a reliable method for nailing.Methods: from May 2016 to February 2017 at the records of 40 underwent lumbar spine surgery between posterior disc excision decompression intervertebral bone graft fusion with pedicle screw fixation of lumbar degeneration patients(operative segment includes lumbar 4/5),In order to prevent the impact ofdifferent surgical segments on this study,this study only compared the effect of 4 different ways of lumbar pedicle screw placement with the help of two different methods.Randomly divided into experimental group and control group,20 patients,respectively.Experimental men in 12 cases,8 patients were female,aged 41 to 71 years old,the average age of 55.9 years,13 cases of lumbar intervertebral disc protrusion and lumbar spinal stenosis disease 5 cases,dish outstanding merger between stenosis(2 cases);Single section 15 cases,double section 5cases;There were 15 cases of 4/5 in the lesions of the lumbar spine,4/5 in the lumbar spine and lumbosacral 5/ in the lumbar spine,with a total of 5 cases.Adopt 3 d printing individualized navigation module auxiliary pedicle screw placement.There were13 males and females in the control group(n = 7),age 49-76,the average 57.9 years old.14 cases of lumbar intervertebral disc protrusion and lumbar spinal stenosis disease in 6 cases,Single segment in 14 cases,6 cases of double segment.Among them,there were 14 cases with and 4/5 in lumbosacral 4/5 combined with lumbosacral 5/ in lumbar spine and lumbar spine in 4/5,with lumbar spinal fusion in 3/4 in 1 cases.intraoperative navigation system adopts computer assisted pedicle screw placement.Compare two groups in time,nailing nailing effect,intraoperative radiation and postoperative effect if there is a statistically significant differences.Postoperative line X-ray and CT scan to observe the presence of worn out pedicle cortex and in the location of the vertebral body,through the perspective evaluation by radiation,at the same time and nailing nailing process evaluation.Application of Mobbs-Raley simple classification standard evaluation of pedicle screw placement of pedicle screw position,will be divided into 4grades: grade 0: located in the cortex of pedicle screw;pedicle screw: 1 breakthrough bone wall but less than or equal to 2mm;2: >2mm pedicle screw break through the wall,but no nerve compression symptoms;3 grade: screw related complications(pedicle fracture,vertebral.Clinical curative effect of lumbar pain JOA score system for grading.Its computation formula for the period = [(postoperatie JOA score-preoperative JOA score)/(17-preoperative JOA score)] x 100%.Good clinical therapeutic effect: optimal: 75% ~ 75%,50% ~ 75% : 25% ~ 50%poor: < 25%.Results: In the experimental group,only 15 cases of patients completed the 3D printing personalized navigation module assisted pedicle screw placement,5 cases because the navigation module can not be completely attached to the posterior spine orforcibly attached caused damage and failure of.6 navigation module were 12 screws,screw the effect is good,no case of perforation of pedicle the average time for the pedicle cortex.(6.24 + 0.221)min;the control group a total of 30 screws were inserted,all screws were in good position,no case of perforation of pedicle cortex,average screw time(11.22 + 0.387)min,nailing effect is no significant difference between the two.The average placement Time of the experimental group was significantly shorter than the control group,the difference was statistically significant(P<0.05).The average screws fluoroscopy time in experimental group(58.2 + 4.3)S,the control group(37.2 + 3.4)S,the experimental group compared with the control group,the fluoroscopy time prolonged,the difference was statistically significant(P<0.05).The effect of 1 months after the operation(using the JOA scoring system)in experimental group,the excellent rate of 100%,93% in the control group,the operation effect is good.Conclusion: in a certain range,shorten the time of screw placement assisted by computer navigation system is the use of3 D printing personalized navigation module,no obvious difference nailing effect than the computer navigation system,radiation time by operation in a computer navigation system isextended.But this number of samples is less,and the experimental group were more than the failure,so conclusion for reference only.