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      Experimental accuracy of lumbar pedicle screw placement based on digital design and 3D printing navigation module

      Lin Haibin;Zhang Guodong;Chen Xuanhuang;Wu Changfu;Zheng Xiaohui;Chen Xu;Yu Zhengxi;Lin Yijun;Huang Wenhua;Department of Orthopedics,Affiliated Hospital of Putian University,Teaching Hospital of Fujian Medical University;Affiliated Putian Hospital of Southern Medical University;Affiliated Hospital of Putian University;Department of Human Anatomy,School of Basic Medical Sciences,Southern Medical University;Department of Orthopaedics,Hospital of Fujian Provincial Corps,Chinese People's Armed Police Force;Department of Medical Imaging,Affiliated Hospital of Putian University,Teaching Hospital of Fujian Medical University;Affiliated Putian Hospital of Southern Medical University;Affiliated Hospital of Putian University;  
      Objective:To explore the evaluation method of experimental precision and accuracy for the implementation of lumbar pedicle screw based on digital design and 3D printing technology,and to investigate the key techniques that affect the accuracy.Methods:14 adult cadaveric lumbar spine specimens were used in this experiment.All specimens were treated with thin slice CT scanning to separate vertebraes by 3D editing in Mimics 14.0 to design the screw channels according to the symmetry principle,and to design the navigation module that had a locating surface and a stabilizing surface according to the dissectable area on the bone surface.The navigation modules were 3D printed with high precision.Lumbar pedicle screws were inserted into the specimens by using the assisted navigation modules.3D registration was performed between the postoperative and the preoperative designed lumbars to obtain the data of the threedimensional coordinate values of postoperative and the preoperative designed screw channels.Taking the absolute value of the difference as the experimental precision index,the qualified screw points under various levels precision in design group and operation group were treated with chi square test.Results:Of 128 lumbar pedicle screws,no one was found penetrating out of the bone substance.The precision of entrance points of X,Y,Z axis were 0.60 mm±0.44 mm,0.66 mm±0.64 mm,0.48 mm±0.36 mm respectively,while the piercing points were1.13 mm±0.82 mm,0.51 mm±0.44 mm,0.67 mm±0.62 mm respectively.Conclusion:The precision of the digitized placement of lumbar pedicle screw can be judged by the absolute value of the difference of three-dimensional coordinate values of postoperative and the preoperative entrance points and piercing points,and the accuracy of the implementation can be judged by various levels precision.The unique intraoperative clamping position can be realized by using the clamping module that has a locating surface and a stabilizing surface,which is designed according to the dissectable area on the bone surface.The symmetry principle of the screw channel must be followed not only in design but also in operative implementation.
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