3D打印技术在骶神经调控术中精准穿刺的应用评估研究

顾寅珺; 吕婷婷; 方伟林; 傅琦博; 冷静; 薛蔚; 吕坚伟

doi:10.13201/j.issn.1001-1420.2016.12.002

3D打印技术在骶神经调控术中精准穿刺的应用评估研究

- 1 上海交通大学医学院附属仁济医院南院泌尿外科(上海, 201112);
- 2 上海交通大学医学院附属仁济医院泌尿外科

详细信息

通讯作者: 吕坚伟,E-mail:ljwass@126.com

中图分类号: R699.1

收稿日期: 2016-10-08

Evaluation of 3D printing in the application of the sacral nerve regulation technique

- 1 Department of Urology, South Campus of Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201112, China;
- 2 Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine

More Information

Corresponding author: LV Jianwei, E-mail: ljwass@126.com

Received Date: 08 October 2016

摘要

摘要: 目的:探讨基于CT三维重建、计算机辅助设计技术的3D打印技术在骶神经调控术中的应用及疗效评估。方法:2016年4月~2016年9月,12例行骶神经调控术的患者被纳入本研究,随机分为对照组5例、试验组7例。对照组采用传统X线透视下十字定位法,试验组采用3D打印技术制造个性化穿刺导航模板进行定位。两组患者性别、年龄、骶尾椎骨折、骶尾椎畸形、骶神经孔大小等一般资料差异无统计学意义(P＞0.05),具有可比性。统计两组患者穿刺进针次数、穿刺成功所需时间、术中调控测试时间及术后感染、出血等术后并发症作为评判指标进行临床疗效评估。结果:穿刺进针次数对照组(3.20±0.84)次vs. 试验组(1.50±0.79)次(P＜0.01);穿刺成功所需时间对照组(25.80±8.41)min、试验组(9.42±3.31)min;术中调控测试时间对照组(40.20±7.76)min、试验组(30.86±3.63)min,两组间差异有统计学意义(P＜0.05);两组术后均无切口感染,术后3天切口渗血各有1例,差异均无统计学意义(P＞0.05)。结论:骶神经调控术在3D打印出个性化的穿刺导航模板的辅助下,明显减少了穿刺的次数、缩短了穿刺时间、提高了术中调控测试的效率。同时与传统方法相比较,术后感染、出血等并发症发生率并无显著增加。该方法尤其适用于有骶骨骨折、畸形,骶神经孔狭小以及骶骨手术史的患者。同时我们还将进一步调整及完善3D打印设计方案,期待更好、更快、更方便的精准穿刺方法。
- 导航模板 /
- 3D打印 /
- 计算机辅助 /
- 神经调控
Abstract: Objective: To discuss the application of CT 3D reconstruction, computer aided design technology of 3D printing technology in the sacral nerve regulation technique and evaluate the effect.Method: Between April 2016 and September 2016, 12 patients undergoing sacral nerve regulation were included in the study.They were randomly divided into control group (five cases) and experimental group (seven cases). Traditional cross positioning method under X-ray fluoroscopy was used in control group, while 3D printing manufacture personalization puncture positioning navigation template was used in the experimental group. There was no statistical significancein gender, age, sacral coccygeal vertebra fracture, sacral coccygeal vertebra deformity, sacral pore size, and other general data between two groups (P＞0.05). We recorded times of needle puncture, time needed for puncture success, intraoperative control test time and postoperative infection and postoperative complications in order to evaluate the clinical efficacy.Result: Times of needle puncture between the control group and the experimental group showed significant difference (3.20±0.84 vs. 1.50±0.79, P＜0.01). Also, significant difference could be found in puncture success time needed (25.80±8.41 min vs. 9.42±3.31 min) and intraoperative control test time (40.20±7.76 min vs. 30.86±3.63 min) between the control group and the experimental group (P＜0.05). However, no significant difference was found in postoperative complication (P＞0.05).Conclusion: Sacral nerve regulation technique in 3D print out personalized puncture navigation template has sharply reduced the number of puncture, shorten the puncture time, improve the efficiency of the intraoperative control test. At the same time compared to traditional methods, the incidence of postoperative complications such as infection and hemorrhage doesn't increase. This method is especially suitable for the sacrum fracture, deformity, small sacral hole and sacrum surgery patients. We will further adjust and perfect the design of 3D printing, looking forward to a better, faster, more convenient accurate puncture method.
- individualized navigation templates /
- 3Dprinting /
- computer-assisted surgery /
- neuromodulation

HTML全文

参考文献(14)

[1]	Coppen C,Weijs W,Berge S J,et al.Oromandibular reconstruction using 3D planned triple template method[J].J Oral Maxillofac Surg,2013,71(8):e243-e247.
[2]	白石柱,刘宝林,陈小文,等.种植导板的制作及CADCAM技术的应用[J].实用口腔医学杂志,2011,27(1):138-142.
[3]	孙明,律娜,后军,等.计算机辅助的模型外科在治疗面部骨折中的临床应用[J].安徽医科大学学报,2014,49(3):395-397.
[4]	Amend B,Khalil M,Kessler T M,et al.How does sacral modulation work best?Placement and programming techniques to maximize efficacy[J].Curr Urol Rep,2011,12(5):327-335.
[5]	Carmel M E,Vasavada S P,Goldman H B.Troubleshooting sacral neuromodulation issues[J].Curr Urol Rep,2012,13(5):363-369.
[6]	陈国庆,宋勇,丁留成,等.骶神经调节术临床应用专家共识[J].中华泌尿外科杂志,2014,35(1):1-5.
[7]	Gormley E A,Lightner D J,Burgio K L,et al.Diagnosis and treatment of overactive bladder(non-neurogenic)in adults:AUA/SUFU guideline[J].J Urol,2012,188(6 Suppl):2455-2463.
[8]	Wang Y,Hassouna M M.Neuromodulation reduces cfos gene expression in spinalized rats:a double-blind randomized study[J].J Urol,2000,163(6):1966-1970.
[9]	Thomas G P,Dudding T C,Rahbour G,et al.Sacral nerve stimulation for constipation[J].Br J Surg,2013,100(2):174-181.
[10]	Fariello J Y,Whitmore K.Sacral neuromodulation stimulation for IC/PBS,chronic pelvic pain,and sexual dysfunction[J].Int Urogynecol J,2010,21(12):1553
[11]	孙坚.计算机辅助外科技术在口腔颌面外科中的应用[J].中国实用口腔科杂志,2014,6(6):329-334.
[12]	谭新颖,胡敏,刘昌奎,等.计算机辅助外科在获得性颌面骨不对称畸形矫治中的应用[J].北京口腔医学,2014,23(12):974-978.
[13]	Giovinco N A,Dunn S P,Dowling L,et al.A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction[J].J Foot Ankle Surg,2012,51(3):387-393.
[14]	Rengier F,Mehndiratta A,von Tengg-Kobligk H,et al.3D printing based on imaging data:review of medical applictaions[J].Int J Comput Assist Radiol Surg,2010,5(4):335-341.