Design and Application of a Novel Patient-Specific Three-Dimensional Printed Drill Navigational Guiding in Atlantoaxial Pedicle Screw Placement.

Abstract

To explore accuracy and clinical efficacy of a novel patient-specific three-dimensional (3D) printed drill navigational guiding template in atlantoaxial pedicle screw placement. A retrospective analysis of 49 patients with atlantoaxial vertebral fractures and dislocations was performed. Patients were divided into a 3D printed navigational guiding template group (n= 25) and traditional group (n= 14). Safety of screw position was assessed, and accuracy of 2 screw placement methods was compared. Accuracy of screw placement was assessed by comparing differences between preoperative designed channel transverse angle and postoperative actual screw placement angle. Two groups were compared to find differences between operative time, intraoperative blood loss, screw placement time, number of fluoroscopy examinations, visual analog scale score, and Japanese Orthopaedic Association score. There were statistically significant differences between the guiding template group and traditional group in operative time, intraoperative blood loss, screw placement time, and number of fluoroscopy examinations. No statistically significant differences were found between groups in transverse and sagittal angles with ideal values. There were statistically significant differences between preoperative and 1-week, 1-month, 3-month, 6-month, and 1-year postoperative visual analog scale and Japanese Orthopaedic Association scores in the same group, whereas there were no statistically significant differences between the groups. Use of the novel patient-specific 3D printed drill navigational guiding template in surgical treatment of atlantoaxial fracture and dislocation can improve accuracy of pedicle screw placement and safety of the surgery, can reduce surgical risks, and can obtain satisfactory clinical curative effects.