| Objective: To compare the short-term effect of individualized 3D printing model assisted posterior screw fixation with the manual screw placement in the treatment of upper cervical spine injury.Methods: From September 2015 to October 2017,30 cases of upper cervical fracture or dislocation were selected as the research object in our hospital.All cases were randomly divided into the observation group(3D printing auxiliary group)and the control group(manual nailing group).All patients underwent preoperative thin-section CT and CTA scanning.The original CT data of the observation group was imported into the Mimics 3D image processing software for 3D reconstruction,and the three-dimensional model of the cervical vertebra after injury was obtained.Then printed out the individualized 3D printing model with the entity 1:1,and performed the simulated internal fixation operation,collected the individual data of the nailing angle which used screw technique to fix.The data was used to further assist intraoperative real surgery,in which one-stage posterior reduction and internal fixation was performed.In the control group,the traditional localization method introduced by domestic scholars combined with preoperative CT data was used to treat the patients with manual nail placement and posterior reduction.Comparing two groups with the time of operation,postoperative drainage volume,intraoperative bleeding volume,fusion rate.In addition,the Visual Analogue Scale(VAS),the Japanese Orthopaedic Association(JOA)were also compared between the two groups before and after surgery.Results: All the operations in the two treatment groups were carried out successfully.A total of 120 internal fixations were performed,in which 112 screws and 8 Apofix were included.2 cases of vertebral artery injury occurred in the control group,and no further bleeding occurred after screwing.There were no complications such as spinal cord and nerve root injury,infection,cerebrospinal fluid leakage in both groups.The mean operation time was(155.80±9.21)min in the observation group and(185.07±16.18)min in the control group,and there was a significant difference between the two groups(P<0.05).The average intraoperative bleeding volume was(138.40±23.04)ml and(188.43±38.33)ml in the observation group and the control group,respectively,and the difference was statistically significant(P<0.05).The average drainage volume of the two groups was(127.07±27.77)ml and(193.53±52.09)ml,respectively,and the difference was statistically significant(P<0.05).In the Visual Analogue Scale(VAS),the VAS of the observation group at 3 months and 6 months after operation were all significantly lower than those of the control group(P<0.05).At 3 months after surgery,the fusion rate in the observation group was better than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in fusion rate and JOA score between the two groups at 6 months postoperatively(P>0.05).According to the current method of evaluating the accuracy of posterior screw,the relationship between the position of posterior screw and bony passage was classified on CT plain scan images,50 cases of type I in observation group and 41 cases of type I in control group were classified.There was statistical significance of difference between the two by statistical analysis.(P < 0.05).Conclusion: The posterior screw fixation of the upper cervical spine assisted by individualized 3D printing model can select safe and effective internal fixation.Compared with the method of manual nail insertion,it has a higher success rate,which can effectively protect the vertebral artery,reduce iatrogenic complications,and shorten the learning curve of doctors. |
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