论文部分内容阅读
目的:评价骶椎CT、MRI影像融合建模3D打印引导骶神经穿刺的安全性和有效性。方法:前瞻性收集2016年7月至2017年8月间上海交通大学医学院附属仁济医院拟行骶神经调控术(SNM)的42例患者,采用随机数字表法将患者随机分为对照组(n n=22)与试验组(n n=20)。对照组采用传统的X线透视下十字定位法进行骶神经穿刺,试验组采用骶椎CT、MRI影像融合建模3D打印辅助骶神经穿刺。记录两组穿刺次数、穿刺成功所用时间、刺激器调试时间、刺激器最小起效电压、累计X线辐射剂量和术后疗效(二期转化)、并发症。通过两独立样本n t检验或χ2检验比较两组间的差异。n 结果:试验组的穿刺次数、穿刺成功所需时间、术中刺激器调试时间、辐射剂量、最小起效电压均低于对照组(n P<0.05)。对照组和试验组各有15例和16例患者完成二期转化,差异无统计学意义(χ2=0.757,n P=0.384)。对照组术后3例出现并发症,其中感染2例,出血1例,试验组未出现并发症。n 结论:骶椎CT、MRI影像融合建模3D打印方法能安全引导SNM骶神经穿刺,相较于传统X线下透视穿刺定位法,能有效提高穿刺效率,减少术中辐射剂量。“,”Objective:To evaluate the safety and effectiveness of the accurate puncture during sacral neuromodulation (SNM) guided with 3D printing navigation template based on reconstruction techniques using fusing sacral CT and MRI images.Methods:Totally 42 patients operated with SNM were selected in Renji Hospital, School of Medicine, Shanghai Jiaotong University from July 2016 to August 2017. The patients were randomly divided into control group (n n=22) and experimental group (n n=20) using random number table. The conventional cross-positioning technique under X-ray was used for puncture during SNM in the control group. While in the experimental group, the sacral CT and MRI images were fused for reconstruction and design of the navigation template, printed by 3D technique for the puncture in SNM. The times of punctures, the average time for puncture operation, the time of intraoperative testing of the stimulator device, the minimum onset voltage of the stimulator, the X-ray radiation dose, postoperative curative effect (rate of secondary transformation) and the incidence rate of complications were compared between the two methods using independent-simple n t test or χn 2 test.n Results:Compared to control group, fewer times of punctures, shorter time needed for puncture operation, shorter time of intraoperative testing of the stimulator, smaller radiation dose and minimum effective voltage were found in the experimental group (n P<0.05). There were 15 and 16 patients who completed the secondary transformation in the control group and experimental group, and there was no significant difference between the two groups (χ2=0.757,n P=0.384). There were 3 cases of complications in the control group, including 2 cases of infection and 1 case of bleeding, while no complications in the experimental group.n Conclusions:CT and MRI images fusion reconstruction-guided 3D printing navigation template can help perform accurate and safe punctures in SNM. Compared to conventional puncture positioned under X-ray, it can effectively improve the puncture efficiency, and reduce the radiation dose in the operation.