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Patient-specific processes for occipitocervical fixation using biomodelling and additive manufacturing.

使用生物调节和增材制造的枕颈固定的患者特异性过程。

  • 影响因子:1.63
  • DOI:10.1016/j.jocn.2019.10.005
  • 作者列表:"Thayaparan GK","Owbridge MG","Thompson RG","D'Urso PS
  • 发表时间:2020-01-01
Abstract

:This report describes a novel method for occipitocervical fixation using a patient-specific, 3D-printed implant and tools. A 79-year-old female presented with progressive neck pain due to a pathologic fracture of C1. DICOM data was used to 3D-print 1:1 scale biomodels of the occipitocervical spine for pre-operative planning, patient education, and intraoperative reference. The surgeon collaborated with engineers to design and 3D-print a titanium patient-specific implant (PSI) and a stereotactic drill guide for occipitocervical screw fixation. The surgical plan specified the occipitocervical "neutral" position, screw sizes, entry points, and trajectories. The PSI was pre-contoured to match the posterior occipitocervical bony spine and reproduce the planned occipitocervical "neutral" position. Stereotactic portholes for screw fixation were integrated into the PSI. The planned "neutral" position was achieved by intraoperatively matching the occipitocervical alignment to the PSI. Screw placement under fluoroscopy was simplified using the stereotactic drill guide. There were no intraoperative or postoperative complications. At 6-month follow up, our patient reported resolution of symptoms and demonstrated satisfactory occipitocervical alignment without evidence of implant dysfunction. Our experience demonstrates that preoperative planning can be combined with biomodelling and 3D-printing to develop patient-specific tools and implants that are viable for occipitocervical fixation surgery.

摘要

: 本报告描述了一种使用患者特异性3d打印植入物和工具进行枕颈固定的新方法。一名79岁的女性因c1病理性骨折出现进行性颈部疼痛。DICOM数据用于3d打印1:1尺度的枕颈脊柱生物模型,用于术前规划、患者教育和术中参考。外科医生与工程师合作,设计并3d打印了钛患者特异性植入物 (PSI) 和立体定向钻孔导向器,用于枕颈螺钉固定。手术计划规定了枕颈 “中立” 位置、螺钉尺寸、进入点和轨迹。将PSI预先轮廓以匹配后枕颈骨性脊柱,并再现计划的枕颈 “中性” 位置。将用于螺钉固定的立体定向舷窗整合到PSI中。通过术中将枕颈对准与PSI匹配来实现计划的 “中性” 位置。使用立体定向钻导向器简化了透视下的螺钉放置。术中及术后均无并发症发生。在6个月的随访中,我们的患者报告了症状的缓解,并表现出满意的枕颈对齐,没有植入物功能障碍的证据。我们的经验表明,术前计划可以与生物调节和3d打印相结合,以开发患者特定的工具和植入物,这些工具和植入物对于枕颈固定手术是可行的。

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影响因子:2.98
发表时间:2020-01-01
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作者列表:["Guo W","Liu H","Tan Z","Zhang X","Gao J","Zhang L","Guo H","Bai H","Cui W","Liu X","Wu X","Luo J","Qu Y"]

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