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首页> 外文期刊>European spine journal >Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area
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Additive-manufactured patient-specific titanium templates for thoracic pedicle screw placement: novel design with reduced contact area

机译：用于胸椎椎弓根螺钉放置的增材制造的患者专用钛模板：减少接触面积的新颖设计

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PurposeImage-based navigational patient-specific templates (PSTs) for pedicle screw (PS) placement have been described. With recent advances in three-dimensional computer-aided designs and additive manufacturing technology, various PST designs have been reported, although the template designs were not optimized. We have developed a novel PST design that reduces the contact area without sacrificing stability. It avoids susceptibility to intervening soft tissue, template geometric inaccuracy, and difficulty during template fitting.MethodsFourteen candidate locations on the posterior aspect of the vertebra were evaluated. Among them, locations that had high reproducibility on computed tomography (CT) images and facilitated accurate PS placement were selected for the final PST design. An additive manufacturing machine (EOSINT M270) fabricated the PSTs using commercially pure titanium powder. For the clinical study, 36 scoliosis patients and 4 patients with ossification of the posterior longitudinal ligament (OPLL) were treated with thoracic PSs using our newly developed PSTs. We intraoperatively and postoperatively evaluated the accuracy of the PS hole created by the PST.ResultsBased on the segmentation reproducibility and stability analyses, we selected seven small, round contact points for our PST: bilateral superior and inferior points on the transverse process base, bilateral inferior points on the laminar, and a superior point on the spinous process. Clinically, the success rates of PS placement using this PST design were 98.6?% (414/420) for scoliosis patients and 100?% (46/46) for OPLL patients.ConclusionThis study provides a useful design concept for the development and introduction of patient-specific navigational templates for placing PSs...
机译：目的已经描述了用于椎弓根螺钉（PS）放置的基于图像的导航患者专用模板（PST）。随着三维计算机辅助设计和增材制造技术的最新发展，尽管未对模板设计进行优化，但已报道了各种PST设计。我们开发了一种新颖的PST设计，该设计可在不牺牲稳定性的情况下减小接触面积。它避免了对软组织的干扰，模板的几何误差以及模板拟合过程中的困难。方法对椎骨后方的14个候选位置进行了评估。其中，在最终的PST设计中选择了在计算机断层扫描（CT）图像上具有高可重复性并有助于准确放置PS的位置。增材制造机器（EOSINT M270）使用商业纯钛粉制造了PST。在临床研究中，使用我们最新开发的PST对36例脊柱侧弯患者和4例后纵韧带骨化症（OPLL）患者进行了胸腔PS治疗。结果在基于分割重现性和稳定性分析的基础上，我们为PST选择了七个小的圆形接触点：横向过程基础上的双侧上，下侧点，双侧下侧。在层状点上突出，在棘突上突出。临床上，使用这种PST设计的PS放置对脊柱侧弯患者的成功率为98.6％（414/420），对于OPLL患者为10​​0％（46/46）。结论本研究为开发和引入PST设计提供了有用的设计概念。用于放置PS的特定于患者的导航模板...

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