Digital Orthopaedic Techniques
Development and clinical application of individualized 3D printed drilling guide for implantation of atlantoaxial pedicle screws
Wu Xinghuo, Liu Rong, Tang Chao, Feng Liping, Xu Song, Lu Lin, Yang Cao, Liu Guohui, Ye Zhewei
Published 2017-04-15
Cite as Chin J Orthop Trauma, 2017,19(04): 304-310. DOI: 10.3760/cma.j.issn.1671-7600.2017.04.006
Abstract
ObjectiveTo evaluate the individualized 3D printed drilling guide we developed and used for placement of C1/2 pedicle screws in the clinical treatment of fracture and dislocation of the at-lantoaxial joint.
MethodsFrom January 2014 to June 2016, we treated a total of 17 patients with fracture and dislocation of the atlantoaxial joint. All the cervical CT data of the patients were imported into the digital orthopaedic workstation for 3D reconstruction, data modeling and 3D printing to design and manufacture individualized atlantoaxial vertebral guide templates. Intraoperatively, C1 and C2 pedicle screws were placed under the guide of individualized 3D printed drilling template. Cervical short-segment fixation and fusion were conducted for the patients. Postoperatively, regular clinical and radiographic follow-ups were carried out.
ResultsNo serious complications like injury to spinal cord and vertebral artery happened due to failed placement of C1/2 pedicle screws. The operation time ranged from 136 to 222 min (average, 168.0 min); the intraoperative blood loss ranged from 260 to 556 mL (average, 356.0 mL). The 17 patients were followed up for 6 to 36 months (average, 13.5 months) . The patients obtained bony union after 4 to 6 months (average, 4.8 months). At the final follow-up, according to ASIA92 scoring system, the average sensory score was improved significantly from preoperative 7.4+3.2 to postoperative 13.1+5.9, and the average motor score was improved significantly from preoperative 5.3+3.1 to postoperative 11.7+5.1 (P< 0.05). No such complications as infection or implant failure occurred after operation.
ConclusionIndividualized 3D printed drilling guide for implantation of atlantoaxial pedicle screws can make the complicate and risky placement become accurate, safe and simple.
Key words:
Cervical vertebrae; Surgery, computer-assisted; Bone nails; 3D printing
Contributor Information
Wu Xinghuo
Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Liu Rong
Department of Orthopaedic Surgery, Puren Hospital of Wuhan, Wuhan University of Science and Technology, Wuhan 430081, China
Tang Chao
Department of Orthopaedic Surgery, Traditional Chinese Medicine Hospital of Honghu, Honghu 433200, Hubei, China
Feng Liping
Department of Orthopaedic Surgery, Xinxiang Central Hospital, Xinxiang 453000, Henan, China
Xu Song
Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Lu Lin
Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Yang Cao
Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Liu Guohui
Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Ye Zhewei
Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China