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目的探讨应用计算机辅助设计快速成型(computer aided design and rapid prototype,CAD-RP)技术指导儿童术后复发寰枢椎脱位行后路椎弓根螺钉固定的可行性及临床疗效。方法对12例5～13岁术后复发寰枢椎脱位的儿童,根据CT数据应用CAD-RP技术制作寰枢椎实物模型,在气管插管全麻下依据模型进行寰枢椎后路椎弓根钉棒固定翻修,术后评价复位情况及螺钉位置情况。结果全组12例患者均获寰枢椎椎弓根螺钉固定,术后随访3～19个月,平均9个月,临床症状得到不同程度的改善;X线、CT复查显示复位满意,螺钉位置良好,无松动、断钉,植骨3～6个月均达到满意融合。结论儿童具有进行寰枢椎椎弓根螺钉固定的临床可行性,CAD-RP技术可提升寰枢椎螺钉固定和上颈椎翻修手术的准确性和安全性。
Objective To investigate the feasibility and clinical efficacy of posterior pedicle screw fixation guided by computer aided design and rapid prototype (CAD-RP) in children with recurrent atlantoaxial dislocation. Methods 12 children aged 5 to 13 years with recurrent atlantoaxial dislocation were enrolled in this study. According to the CT data, a CAD model of atlantoaxial spine was established. According to the model, atlantoaxial posterior pedicle screw Root bar fixed rod revision, postoperative evaluation of reset conditions and screw position. Results The whole group of 12 patients were atlantoaxial pedicle screw fixation, followed up for 3 to 19 months, an average of 9 months, the clinical symptoms were improved to varying degrees; X-ray, CT showed satisfactory reset, the screw position Good, no loose, broken nail, bone grafting 3 to 6 months to achieve satisfactory fusion. Conclusions Children have clinical feasibility of atlantoaxial pedicle screw fixation. CAD-RP can improve the accuracy and safety of atlantoaxial screw fixation and upper cervical revision surgery.