| 3D printing,also known as additive manufacturing(AM),is now a rapid prototyping manufacturing(RP)emerging from industrial manufacturing.Originally developed in the mid-1980 s,The United States,after more than 20 years of continuous development and improvement is now maturing.With the rapid development of the industry as a whole,3D printing technology has been applied to industrial manufacturing,aerospace,medical and many other high-tech fields.At present,the country is also actively and in-depth research,in medicine,clinical and scientific research more concentrated in the dentistry,plastic surgery and orthopedic surgery,spinal surgery because of its anatomical structure and complex and fine characteristics,has become a 3D printing technology in orthopedics Field focus on the direction of research and development.Now more and more rapid social construction and development,medical orthopedic trauma,especially spinal injury in patients with more and more,to adapt to the choice of surgical treatment programs are also more and more cases.According to the "three-column" theory of the spine,pedicle screw fixation has become one of the commonly used spinal fixation methods for surgical treatment of clinical spine-related diseases.It has good clinical efficacy and application promotion.For the development of spinal surgery Progress played a very important role.From the lumbar pedicle screw fixation system invented the use of so far,is a long exploration process,in 1948,King invented a new type of screw,the new screw through the spine of the articular process arrived at the pedicle,Of the interphalangeal joint between the fixed to promote the integration of the spine,but failed.In 1959,Boucher in the lumbar fusion internal fixation surgery using long screws through the vertebral pedicle through the screw into the vertebral body,take a good clinical effect.After Roy-Camille and other continuous improvement of pedicle screw and clinical trials,and finally in 1986 confirmed that this new technology application of pedicle fixation treatment of spinal fractures can provide a more secure,strong and solid short-segment spinal fixation,Andhas a very good clinical treatment effect.In 1977,the US FDA formally approved this method as a viable posterior lumbar fixation method,after which the pedicle screw fixation technology has been rapid development.At present,the more commonly used spinal pedicle screw implantation methods include the following: anatomical landmark method,X-ray fluoroscopy method,computer-aided navigation method,robot method and individual lumbar pedicle screw navigation template method The However,the accuracy of pedicle screw placement is not ideal due to the importance of the adjacent tissue around the vertebral body and the complexity of the pedicle structure and the stringent technical requirements of the surgeon.,But also to be improved,different spinal pedicle screw implantation methods,also have their own different advantages and disadvantages.In recent years,with the science and technology advances,3D printing technology in the field of medicine has been rapid and extensive development.In today’s medical research,3D printing technology can print out the human body or tissue of the three-dimensional solid model,the organ or tissue can be the details of the local structure of the real highlights,so that medical organizations become more intuitive,so that doctors in more detail Understand the patient’s condition,such as: complex fractures,severe deformities and so on.3D printing technology provides more specific information than the current medical image data,from the virtual to the reality,from two to three,from the plane to the three-dimensional change,the doctor can print out the three-dimensional solid model on the surgical design and Ahead of the simulation exercise,both open up the diagnosis and treatment ideas,skilled operation,but also increased the success rate of surgery.In general,the current 3D printing technology for clinicians to diagnose and treat diseases to provide new ideas and methods in the country to develop precision medical environment,contribute to the development of personalized medical and progress,but in order to promote the Technology clinical application and development,still need to do further research and discussion.Part I Design and Production and Precision Analysis of Personalized Lumbar Pedicle Screw Navigation Template[Objective]The three-dimensional CT imaging data of the normal lumbar specimens were collected and reconstructed by 3D printing technology.The lumbar vertebral body modelwas reconstructed and designed to produce practical and targeted individual pedicle screws.Template to assess the accuracy of its auxiliary nail.[Methods]The three-dimensional reconstructed data were reconstructed by 3D reconstruction software,and the reconstruction data was obtained and then imported into the three-dimensional design software to locate and design the screw positioning guide hole And extract the best pedicle axis of the vertebral pedicle screw,and generate the hollow cylindrical tube based on the axis;cut the hollow cylindrical tube inside the vertebral body with the posterior lamina surface as the reference,Of the pipeline is the pedicle screw positioning guide hole,bilateral a total of two,the length of the actual situation according to the design of the middle part of the connection,after the extraction of the lamina and spinous process of the anatomical surface and its cutting,to get the ideal surface,Then the surface of the patch to the outside of the thickening treatment,and by the face of the entity,this entity is the posterior lamina and spinous process root dorsal anatomical shape complementary reverse template,can achieve seamless surface bonding.And then see the connection to grasp the stability of the situation by holding the handle.The two of the two positioning guide hole pipe model and the previous thickening of the entity generated by the Boolean operation,the resulting unified as a whole three-dimensional model,the three-dimensional printer can identify the format file derived.Based on the rapid prototyping technique and the medical photosensitive resin as the printing material,the personalized pedicle screw guide plate with the vertebral body was made according to the diameter of the positioning guide hole and the diameter of the pedicle screw and the Kirschner wire.[Results]Through the above methods,the use of 3D printing technology to design and produce with the physical specimen matching individualized pedicle screw into the guide template,check it can be very good with the posterior lamina and spinous process surface close and complete the screw precision In.[Conclusions]3D printing technology can be based on the actual situation of each segment of the lumbar spine,designed to meet the corresponding vertebral precise pinning requirements of the individual navigation template,in theory,through the 3D printing technologydesigned by the three-dimensional vertebral model and its personalized The root nail navigation template is close to the exact match,but also has its actual error and insufficient.However,with the progress of the development of materials,these shortcomings should be a good improvement,3D printing pedicle screw guide plate auxiliary nail technology is an effective precision guidance technology,in clinical spinal surgery has a broad application and promotion prospect.Part II Experimental Study on the Precision Implantation Technique of 3D Pedicle Pedicle Plate[Objective]Three-dimensional CT scans of lumbar anatomical specimens were transformed with3 D printing technique.The three-dimensional configuration of the lumbar pedicle screw navigation template was designed and matched with the experimental specimen.The template template was made and the navigation template The experimental results were carried out to evaluate the feasibility and accuracy of the navigation template.The results were as follows:(1)The screw fixation test was carried out on the lumbar specimen,and the actual nail was replaced with the ideal nail pattern designed by the anatomical logo method and the computer.Advantage.[Methods]The experimental group was divided into three groups: the three segments of the lumbar spine were inserted into the pedicle screw by the traditional anatomical landmark.The lumbar spine of group B was designed with 3D printing technique to produce individual lumbar pedicle screw navigation template,And the pedicle screw was inserted into the pedicle screw.The C group was a simulated three-step simulated lumbar vertebrae,that is,the simulated ideal nail group designed in group B in 3D printing technique.And then the actual set of nails after the group B were set up with the A group with anatomical landmarks and the C group of computers designed in the ideal cruise line to do the comparative analysis to verify the feasibility and accuracy of navigation template advantages,evaluation of the use of Experimental effect of personalized lumbar pedicle screw fixation template.[Results]Using the 3D printing technique,15 miniature pedicle screws of the lumbar pediclescrew were made,and 30 sets of pedicle screws were inserted into the template to check the staples of the auxiliary screw.All in the pedicle position is good,no one screw piercing the pedicle cortex.The results show that the accuracy of the actual cruciform pattern is higher than that of the ideal crucified,but there is no statistically significant difference between the results.[Conclusions]3D printing technology is with the modern computer,imaging,industrial manufacturing and materials science and other interdisciplinary areas of the combination of achievements in the crystallization of scientific and technological progress,has now become a popular concern and research.With the 3D printing technology of digital pedicle screw navigation template is also developed in depth,it overcomes the traditional set of nail navigation methods of some deficiencies,pedicle screw individual placement principle,can better improve the nail Accuracy,we use 3D printing technology,reverse engineering principles and rapid prototyping technology can be complex structure of the vertebral body for high-precision individualized nail,the technology design principles of science,production methods easy to operate simple,the operator’s experience And technical requirements are relatively low.Part III Clinical application of 3D laser pedicled lumbar pedicle screw fixation template assisted screw fixation technique[Objective]According to the three-dimensional CT scan data of the preoperative lumbar spine,the matched lumbar pedicle screw navigation template was designed and manufactured using3 D printing technique and used in the lumbar pedicle screw fixation operation.The individual lumbar vertebrae Feasibility and Accuracy of Pedicle Screw Fixation Template in Pediatric Pedicle Screw.[Methods]Patients with clinical need for posterior lumbar pedicle screw fixation were randomly divided into group A,using a personalized lumbar pedicle screw fixation template;group B,using the current clinical use of anatomical signs combined with C Type arm under the fixed positioning nail method for operation;C group,is the A group of surgical lumbar vertebral body through the 3D printing technology designed to simulatethe ideal screw channel group.After analysis,the differences between the two groups were analyzed,and the effect of the two groups was evaluated by grade grading method.The pedicle screw and the ideal nail were designed in the postoperative group A Road to compare the relevant parameters.[Results]A group of three-dimensional use of 3D printing technology to produce lumbar spine with individualized lumbar pedicle screw navigation template,auxiliary implantation of 52 screws are located in the lumbar pedicle,the location is good,no one screw piercing lumbar pedicle cortex,There was no significant difference between the accuracy of the fixation and the accuracy of the nail in the group C,However,in the operation of the average time of each screw,the average intraoperative blood loss,intraoperative use of the average number of fluoroscopic fluoroscopy than the B group has obvious advantages.[Conclusions]With the advances in medical technology and technology,the lumbar peduncle has been developed continuously,although the nail accuracy has improved,but each method has its shortcomings,or technical requirements are high,or Is a large amount of radiation during surgery,expensive learning curve is long,difficult to carry out.3D printing pedicle screw navigation template auxiliary nail technology to overcome the previous set nail method of some shortcomings,significantly improve the accuracy of patients in the operation of the nail,improve the efficiency of surgery.This method of operation is simple and easy to use,with the development of 3D industry,but also easy to promote to the primary hospital,can help the lack of pedicle screw implant surgery experience and technology of young doctors to effectively complete the lumbar pedicle screw implant surgery. |
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